As a pediatrician in training, I am often the first to enter a patient’s room when they come to the emergency department. With alarming frequency, I open the chart of a newly arrived patient and see “Suicidal,” “Self-Harm,” or “Mental Health Issue.” Some have intentionally hurt themselves or overdosed. Often, their parents know something is gravely wrong and have no other place to go. Emergency department pediatricians are overwhelmed with the influx of children suffering from the psychological distress of the past two years, and families are struggling to access long-term treatment.
Along with COVID-19, we are concurrently experiencing a behavioral health epidemic with the capacity to devastate a generation. Behavioral health, often used interchangeably with mental health, encompasses a broad range of conditions including anxiety, depression and ADHD, as well as psychiatric illnesses like bipolar disorder and schizophrenia, and substance use disorders. The American Academy of Pediatrics has declared a national state of emergency in child and adolescent mental health. Centers for Disease Control and Prevention evidence shows the proportion of emergency department visits for mental health increased significantly for children in 2020 compared to 2019.
We know how to help kids before they end up in the emergency department. When behavioral health treatment is integrated into primary care clinics, data shows that children have better outcomes. Families raise behavioral health concerns at approximately half of their visits with a pediatrician in clinic. Pediatricians alone lack the capacity to optimally address these problems, but when they collaborate with behavioral health clinicians — like psychiatrists, psychologists and social workers — patients receive comprehensive care. Behavioral health integration allows patients to attend appointments in the same familiar clinic and develop a longstanding relationship with their treatment team.
I recently cared for a teenager in clinic who described changes in her mood as she transitioned to in-person school this year. Although excited for many of her classes, she found herself lacking the energy to even start her homework. She shared that some nights she hoped she wouldn’t wake up the next morning. I prescribed her an antidepressant, but there is clear evidence that depression is best treated with medication and talk therapy together. Fortunately, my clinic has a therapist who began meeting with my patient biweekly. We are now providing integrated care to this patient by sharing updates and coordinating treatment goals. With her therapist, the patient has developed tools to address stressors in her life exacerbated by the pandemic. And with me, she reports improvement in her depressive symptoms and renewed interest in school.
The state Legislature’s Children and Youth Behavioral Health Work Group published its recommendations for the legislative session that began this month. Its first priority is funding for behavioral health integration at primary care clinics. As a pediatrician, I see the emotional damage the COVID-19 pandemic has wrought on children and its potential to impair their futures. Policymakers must allocate resources to deliver desperately needed treatment. The thousands of children pouring into our hospitals each day have problems that can only be solved by improving access to long-term behavioral health care.