Children’s mental health is a pandemic crisis that needs immediate solutions, CHOP’s psychiatry chief says

Health-care providers nationwide continue to see fallout from the mental and emotional toll the pandemic has taken on children and teens, Children’s Hospital of Philadelphia’s top psychiatrist said in a virtual Q&A Wednesday.

The pandemic exacerbated preexisting increases in mental health conditions among children, said Tami Benton, CHOP’s chief psychiatrist. Nationwide, hospitals saw in a seven-month span in 2020 a 24% increase over the same period in the year before in emergency visits due to mental health conditions among 5-to-11-year-olds, and a 31% increase among patients ages 12 to 17.

“We’ve actually never seen the rapid rate of rise of mental health conditions for populations that we’ve seen with the pandemic,” Benton said. “That typically doesn’t happen unless there’s some event that caused that to happen.”

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She described the state of children’s mental health as a “crisis,” and said about a third of all children will experience a mental health condition during their lifetimes, but less than 20% will receive specialty treatment. At present, children in need of treatment face long waits at pediatric emergency departments and hospitals, and gaps that stretch nearly two months before they can receive specialized care.

It’s not just more children needing mental health interventions, Benton said. Those who are coming to hospitals for treatment are presenting with more serious conditions at a younger age. Between ages 5 and 17, hospitals are seeing more frequent cases of self-injury and suicidal ideation.

The crisis comes as health-care professionals in a range of disciplines are struggling with insurance reimbursement rates that have not kept pace with the cost of care. Both private insurance and Medicaid have long had different payment rates for mental and behavioral health care than for physical medical care, but Medicaid typically pays even less than private insurance.

The result, Benton said, are fewer providers willing to accept payments from private insurance or Medicaid, and insufficient staff and resources at those that do.

“Even among those that are willing to provide services, there are frequently community agencies that are really struggling to try to stay afloat from a financial perspective,” Benton said. “Maybe they really need five child psychiatrists to support their population, but they actually can only afford one.”

The limited resources available have had a domino effect on the health-care system, with some children in need of serious psychiatric treatment waiting in hospitals and taking up beds that are needed for more acutely sick patients.

The pandemic surge in behavioral health concerns among children is believed to stem from several catalysts, Benton said. Children and teens feared catching COVID-19 and infecting family members, she said, and also had to cope with the emotional and financial instability that came with lockdown restrictions. Meanwhile, virtual learning at schools robbed children of crucial social interactions.

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“They lost school, they lost their social circumstances, they lost their friends,” Benton said. “They lost their certainty that everything was going to be OK.”

The lack of mental health resources has hit nonwhite populations particularly hard. Black and Hispanic workers were more likely to have lost jobs and income during the pandemic in Philadelphia. People of all races feared seeking care in person, but communities of color often had less access to telehealth and were hit harder by COVID-19.

“There was more parental illness, more parental job loss, more complicated grief in that some children saw their parents or relatives go off to the hospital and then never saw them again,” Benton said.

The pandemic deepened disturbing trends that had started to develop before March 2020. One indicator of mental health trauma, suicides among Black children under age 13, happened at twice the rate of white peers from 2001 to 2015.

Benton said symptoms that raise concerns about suicide have increased among girls during the pandemic.

CHOP is participating in a nationwide collaborative effort among pediatric providers called Sound the Alarm, designed to raise awareness of the mental health crisis among children. Benton also encouraged a greater focus on prevention among younger children.

The hospital is expanding its outpatient services and boosting services for people with eating disorders and will make available more intensive day treatment for children. It is planning to open an inpatient pediatric mental health crisis center, with 46 psychiatric beds and a 10-bed crisis stabilization unit, in December 2022.

“Mental health interventions work,” she said, adding that the conditions children face are “not terrible things without solutions.”