The hospital where I practice recently admitted a 14-year-old girl with post-traumatic stress disorder, or PTSD, to our outpatient program. He was referred to us six months earlier, in October 2022, but we were at capacity at that time. Even though we tried to refer him to several other hospitals, they were also full. During that six month wait, he attempted suicide.
Unfortunately, this is an all too common story for young people with mental health problems. A 2021 survey of 88 children’s hospitals reported that they received, on average, four teenagers per day for inpatient programs. In many of these hospitals, more children are waiting for help, but there are not enough psychiatric services or beds for them.
So these kids languish, sometimes for days or even weeks, in the emergency department of a hospital. This is not a good place for young people who are dealing with severe mental health issues and may be considering suicide. Waiting at home is also not a good option – families are often unable or unwilling to deal with a child who is desperate or abusive.
I am a professor of psychiatry and pediatrics at the University of Colorado, where I founded and directs the Stress, Trauma, Adversity Research and Treatment Center. For 30 years, my practice has focused on adolescent stress and trauma.
Over the years, I noticed that this young patient was becoming more aggressive and suicidal. They are sicker when compared to previous years. And the data backs up my observation: From 2007 to 2021, the suicide rate among young people ages 10 to 24 increased by 62%. From 2014 to 2021, the homicide rate rose 60%. The situation was so grim that in October 2021, health care professionals declared a national emergency in child mental health.
Since then, the crisis has not subsided; it only gets worse. But there aren’t enough mental health professionals to meet those needs.
The numbers behind the suffering
The American Academy of Child and Adolescent Psychiatry reported in May 2023 that there is a drastic shortage of child and adolescent psychiatrists across the US
For every 100,000 children in the US — with 1 in 5 having a mental, emotional, or behavioral disorder in a given year — there are only 14 child and adolescent psychiatrists available to treat them, according to the American Academy of Child and Adolescent Psychiatry. It takes at least three times as much.
There is also a significant shortage of child therapists – social workers, psychologists, licensed professional counselors – too. This is especially the case in rural areas across the country.
Studies show that young people in the US are increasingly stressed and traumatized. The constant barrage of information via social media and requests to participate in it are complex, and interactions can harm a child’s mental health.
Young people deal with cyberbullying and exposure to endless body image-focused social media content.
But what kids and teens see online isn’t the only problem. Most of life still happens offline, and much of it is not good. Millions of young people daily deal with alcoholics, drug abusers or neglectful parents; peers who drink, vape, and do drugs; violence in their schools or on their streets; and overwhelmed caregivers – whether parents or others – preoccupied with financial or other personal problems.
For a teenager who is already struggling to make sense of the world, any of these issues can be overwhelming.
Not enough time or money
The US health care system does little to help these children or their families. This pattern begins at birth, and is ingrained in the system.
Ideally, prospective parents or those who are pregnant get parenting classes that continue until the child’s development phase. That’s generally not the case. Then, many new parents do not go on nursing visits and maternal care or paid maternity leave. And for families who are struggling financially, there is no adequate safety net.
Some families also cannot afford mental health care to support their children’s needs. Many mental health providers do not take out insurance and instead choose to pay patients out of pocket. This is due to the low reimbursement rate of most insurance companies, which makes it very difficult to maintain a practice. Depending on the service, fees can range from US$100 to $600 per session.
To see which provider takes insurance, there is usually a co-pay – usually between $20 and $50 a week. But it is often a challenge for the insured to find a suitable provider in the network to meet the child’s needs.
The payments add up, especially when mental health treatment takes months, and sometimes years, to take effect. There’s a reason it took so long. Unlike medical doctors, mental health professionals don’t just make a diagnosis and provide medication or surgery. Instead, for treatment to be successful and change outcomes for young people who are struggling, it requires an ongoing – and long – relationship between therapist and patient.
Caring for a child is significantly more difficult than caring for an adult. That’s partly because children are constantly developing and changing. But perhaps the most pressing challenge is the many entities a child therapist may have to work with: caregivers, school systems, courts, and child welfare agencies. What’s more, getting a diagnosis, treatment, or both often involves working with multiple providers, such as primary care doctors, individual therapists, family-focused therapists, and psychiatrists.
At the institute where I work, the psychiatric department loses nearly every patient we treat. If it weren’t for fundraising and building donor relationships, the department could only care for a select few.
Possible solution
Children and adolescents who are struggling in the US need early intervention. While schools are ideal places to teach social skills, they still do not offer sufficient activities to help young people develop resilience to adversity.
Sometimes, young patients see primary care physicians who do not have sufficient training in this area. Telephone hotline programs, which offer these doctors free consultations from mental health professionals to help assess problems in young patients, should be available throughout the US. But currently, only 19 states have such programs. One bright spot: 988 Suicide and Crisis Lifeline, which launched in July 2022, is available 24/7.
When a young person needs care, parents should make it a priority to find a mental health provider right away. Asking for referrals from the primary pediatrician and school counselor is a good start. If the child is already on the waiting list, the parent or guardian should call the provider weekly to check in and make sure the child isn’t forgotten.
The process can be discouraging and frightening, but in our current environment, which provides limited support, it just is. And without a heavy burden from parents, children are still at great risk.
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