Children’s Hospitals Grapple With Wave of Mental Illness

By Carmen Heredia Rodriguez, Kaiser Health News

Krissy Williams, 15, had attempted suicide before, but never with pills.

The teenager was diagnosed with schizophrenia at the age of 9. People with this chronic mental illness perceive reality differently and often experience hallucinations and delusions. She has learned to manage these symptoms through a variety of services available at home and at school.

But the pandemic has overturned these lifelines. She lost much of the support offered at school. She also lost regular contact with her peers. Her mother lost access to respite care, which allowed her to take a break.

One Thursday in October, the isolation and sadness came to a head. As Krissy’s mother Patricia Williams called a mental crisis helpline, she said Krissy stood on the deck of their Maryland home with a bottle of pain reliever in one hand and l water in the other.

Before Patricia could react, Krissy placed the pills in her mouth and swallowed.

Efforts to contain the spread of the novel coronavirus in the United States have led to sweeping changes in the way children and teens learn, play and socialize. Tens of millions of students attend school through some form of distance learning. Many extracurricular activities have been canceled. Playgrounds, zoos and other recreational areas have closed. Children like Krissy have struggled to cope and the toll is becoming evident.

Government figures show that the proportion of children arriving in emergency rooms with mental health problems increased by 24% from mid-March to mid-October, compared to the same period in 2019. Among pre-teens and children adolescents, it increased by 31%. Anecdotally, some hospitals have said they are seeing more cases of severe depression and suicidal thoughts in children, especially attempted overdoses.

The increased demand for intensive mental health care that accompanied the pandemic has compounded the problems that have long plagued the system. In some hospitals, the number of children unable to immediately get a bed in the psychiatric unit has increased. Others have reduced the number of beds or closed psychiatric units to reduce the spread of covid-19.

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“It’s only a matter of time before a tsunami hits the shore of our service system, and it’s going to be overwhelmed by the mental health needs of children,” said Jason Williams, psychologist and director. of Pediatric Mental Health operations. Colorado Children’s Hospital Institute.

“I think we’re just starting to see the tip of the iceberg, to be honest with you.

Before covid, more than 8 million children between the ages of 3 and 17 were diagnosed with a mental or behavioral health problem, according to the most recent National Child Health Survey. A separate survey by the Centers for Disease Control and Prevention found that one in three high school students in 2019 reported feeling consistently sad and hopeless – a 40% increase from 2009.

The coronavirus pandemic seems to add to these difficulties. A review of 80 studies found that forced isolation and loneliness in children was correlated with an increased risk of depression.

“We are all social beings, but they [teenagers] at the point of their development when their peers are their reality, ”said Terrie Andrews, psychologist and behavioral health administrator at Wolfson Children’s Hospital in Florida. “Their peers are their basic mechanism.”

Children’s hospitals in New York, Colorado, and Missouri have all reported an increase in the number of patients who have thought or attempted suicide. Clinicians have also reported spikes in children with severe depression and those with autism who take action.

The number of overdose attempts in children caught the attention of clinicians at two facilities. Andrews of Wolfson Children’s said the facility distributes gun and medicine safes to the public – including to parents who come after children attempt to kill themselves using medicine.

The National Children’s Hospital in Washington, DC, has also seen a rise, said Dr. Colby Tyson, associate director of hospital psychiatry. She has seen children’s mental health deteriorate due to a likely increase in family conflict – often a consequence of the chaos caused by the pandemic. Without school, peer relationships, or jobs, families lack the opportunity to spend time away from each other and come together, which can add stress to an already tense situation.

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“This break is over,” she said.

The increased demand for child mental health services caused by the pandemic has made it more difficult to find a bed in an inpatient unit.

Now, some hospitals report operating at full capacity and having more children “interned” or sleeping in emergency departments before being admitted to the psychiatric unit. Among them is the Institute of Pediatric Mental Health at Colorado Children’s Hospital. Williams said the inpatient unit has been full since March. Some children are now waiting almost two days for a bed, up from the usual eight to ten hours before the pandemic.

The Cincinnati Children’s Hospital Medical Center in Ohio is also operating at full capacity, clinicians said, and had several days in which the unit was over capacity and placed the children in the emergency department while waiting to be admitted. In Florida, Andrews said, up to 25 children have been held on the surgical floors of Wolfson Children’s pending a place in the inpatient psychiatric unit. Their wait could last up to five days, she said.

Several hospitals have said the usual summer recession in child psychiatry admissions was absent last year. “We never saw this during the pandemic,” Andrews said. “We stayed completely busy the entire time.”

Some facilities have decided to reduce the number of beds available to maintain physical distance, further restricting the offer. The Children’s National of DC has cut five beds from its unit to maintain single occupancy in each room, said Dr Adelaide Robb, division chief of psychiatry and behavioral sciences.

Steps taken to curb the spread of covid have also affected the way hospitalized children receive mental health services. In addition to vendors wearing protective gear, some hospitals like the Cincinnati Children have rearranged furniture and placed clues on the floor as a reminder to stay 6 feet apart. UPMC Western Psychiatric Hospital in Pittsburgh and other facilities encourage children to keep their masks on by offering rewards such as extra computer time. Children’s National patients now eat in their rooms, a change from when they ate together.

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Despite the need for distance, social interaction is still an important part of mental health care for children, clinicians said. Institutions have developed a variety of ways to do this safely, including creating smaller modules for group therapy. Children at Cincinnati Children’s can play with toys, but only those that can be wiped off afterwards. No cards or board games, said Dr Suzanne Sampang, clinical medical director of child and adolescent psychiatry at the hospital.

“I think what’s different about psychiatric treatment is that, in reality, the interaction is the treatment,” she said, “just as much as a drug.”

Additional infection control precautions pose challenges in establishing therapeutic connections. Masks can make it difficult to read a person’s face. Online meetings make it difficult to build trust between a patient and a therapist.

“There’s something about the real in-person relationship that the best technology can’t do for you,” Robb said.

For now, Krissy relies on virtual platforms to receive some of her mental health services. Although she was hospitalized and suffered brain damage from the overdose, she is now home and in a good mood. She enjoys geometry, dancing on TikTok, and trying to beat her mom in Super Mario Bros. on Wii. But being away from her friends, she says, has been a tough adjustment.

“When you’re used to something,” she says, “it’s not easy to change everything.”

If you have considered suicide, or someone you know has mentioned it, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use
Lifeline Online Crisis Chat
, both available 24 hours a day, 7 days a week.

Kaiser Health News (KHN) is a national information service on health policy. This is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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