Study Delivers More Evidence of a Mental Health Crisis Among Teens, Particularly Girls

Depression, suicidal thoughts and other mental health problems sent record numbers of American kids, especially girls, to emergency rooms during the COVID-19 pandemic.

Once there, many waited days or even weeks to be admitted to the hospital, a new study reports.

“The system was already stretched to begin with and then the pandemic hit and more people were seeking care,” said senior researcher Haiden Huskamp, a professor of health care policy at Harvard Medical School in Boston. “There are just not enough providers, clinicians, facilities or inpatient beds.”

For the study, Huskamp and her colleagues looked at data on more than 4 million health insurance claims for U.S. children ages 5 to 17.

They discovered nearly 89,000 ER visits for mental health problems in this age group.

Compared with 2020, the first year of the pandemic, ER visits rose 6.7% between March 2021 and February 2022, the researchers found. Visits by teen girls jumped 22%.

During that period, hospital admissions for mental health issues rose 8.4% and the length of hospital stays increased by nearly 3.8%. Moreover, the wait for a hospital bed was 76% longer than during the year before COVID, researchers found.

To ease the problem, Huskamp said several steps are needed.

No. 1: The shortage of mental health providers and burnout among them must be addressed.

“We need to help support primary care clinicians to provide mental health care, given that we don’t have enough mental health specialty providers, and we need to develop interventions that could take the load off emergency departments, maybe even telemedicine,” Huskamp said.

Since the pandemic, she added, there’s more awareness that the mental health of children and adolescents must be taken seriously.

“We need to do a better job,” Huskamp said.

Dr. Victor Fornari, director of child, and adolescent psychiatry at Northwell Health’s Zucker Hillside Hospital in Great Neck, N.Y., said the findings highlight an ongoing problem.

“Our youth are in crisis,” said Fornari, who was not involved with the study. “The negative impacts of the pandemic continue as a force in that crisis. Certainly, prior to the pandemic, youth mental health has been a serious issue with suicidal ideation and behavior, and since the pandemic, those rates have increased.”

He said social isolation and social media are two of the key reasons. Family financial pressures and the illness and death of loved ones from COVID, as well as parental stress have all contributed to the mental health crisis among kids and teens, he added.

It’s not surprising that more children are turning up in emergency rooms, Fornari said.

“The ER usually is a place where people go in a crisis,” he said.

Fornari’s own emergency room is evidence of the growing demand.

“In 1982, we had about 250 emergency room visits a year for adolescent mental health problems,” he said. “By 2000 we had 2,000, by 2010 we had 4,000, and 6,000 by 2020. Last year, we had 8,000.”

To ease the strain on emergency rooms, Northwell Health has developed urgent care centers for pediatric behavioral health.

But Fornari said there are too few child and adolescent psychiatrists to handle the increased need.

“We graduate about 350 new child psychiatrists every year, and about that number retire every year,” he said. “So we’re at a steady state of about 8,000 in the country, and estimated need is about 30,000.”

The shortage of trained mental health professionals means that many children wait months for an appointment, increasing the odds of a crisis that forces them to go to the emergency room.

“I think that every generation struggles with what the social challenges are,” Fornari said. “Whether it’s concerns about gun safety, climate change, family challenges, parental substance abuse or child abuse, kids are facing many challenges. I often say it’s not easy for a kid to grow up today.”

The research was published online July 12 in JAMA Psychiatry.

More information

The U.S. Centers for Disease Control and Prevention has more about children’s mental health.

SOURCES: Haiden Huskamp, PhD, professor, health care policy, Harvard Medical School, Boston; Victor Fornari, MD, director, child and adolescent psychiatry, Northwell Health, Zucker Hillside Hospital, Great Neck, N.Y.; JAMA Psychiatry, online, July 12, 2023