‘The lid just blew off’: The U.S.’ youth mental health crisis isn’t getting much better

The country’s youth are in a mental health crisis that has been exacerbated by the pandemic. A recent study on pediatric suicidal behavior reveals what may have led to this breaking point because it doesn’t include the years since COVID-19′s spread.

This large study of admissions to acute care hospitals shows the portion of American hospital beds occupied by children with suicidal or self-harming behavior has soared from 2009 to 2019.

But its exclusion of psychiatric hospitals and the years since the pandemic began suggests a considerable undercount.

“Because of the trauma of the pandemic, the rates of mental health disorders among children and adults have gone through the roof,” said Dr. Adiaha Spinks-Franklin, a developmental-behavioral pediatrician and Clinical Associate Professor of Pediatrics at Baylor College of Medicine. “So, the problem that was already a problem, got exacerbated by the pandemic.”

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Over 4.5 million pediatric hospitalizations were analyzed by Dartmouth researchers in the study. They found a 25.8 percent increase in pre-pandemic mental health hospitalizations and a 64.2 percent rise of suicidal or self-harming behavior as a cause.

Recent data suggest that the pandemic has significantly worsened children’s mental health. A survey conducted by KFF/CNN last October found that 47 percent of parents believed the pandemic negatively impacted their children’s mental health.

A sharp increase in pediatric emergency department visits for mental health concerns was also recorded by the CDC, beginning in March 2020.

Dr. Spinks-Franklin believes this isn’t just a healthcare issue. “This is a social justice issue. This is a health equity issue. Because who’s going to suffer the most? Our economically poor, Black, Indigenous, and brown children will suffer the most,” she said.

Long-standing inequities and structural barriers have been shown to contribute to racial and ethnic disparities in mental health care for children and young adults.

“You look at economically impoverished, Black, Indigenous, and brown children who have developmental disabilities and behavior disorders… they’re more likely to be misdiagnosed,” said Spinks-Franklin. “And they’re late to getting the kind of medical interventions and care that they need.”

Black, Indigenous, brown, and low-income communities are more likely to have poor, minimal or disrupted insurance coverage, and are not given the same mental health information they need as their more affluent, white counterparts. “So parents, community, family and religious members don’t necessarily know the warning signs of mental illness in their child, because they’re not provided the same information,” said Spinks-Franklin.

The lack of trained, licensed, mental health providers available to serve the community doesn’t help. “You’re seeing these professions, where there are shortages that have always been, but you were able to keep a lid on it, until the pandemic hit,” added Spinks-Franklin. “And now everything is just coming out. The lid just blew off.”

A legislative bill introduced in May 2022 attempted to address this issue.

H.R. 7666, also known as Restoring Hope for Mental Health and Well-Being Act, would, among many, re-authorize the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances program, along with addressing school-based mental health services and coverage of mental and behavioral health care through Medicaid and the Children’s Health Insurance Program (CHIP), including for juveniles in public institutions.

The bill was never passed by the senate.

The Department of Health and Human Services announced nearly $35 million in funding opportunities to strengthen mental health support for children and young adults. The Bipartisan Safer Communities Act provided an additional $80 million to continue the Pediatric Mental Health Care Access program for over four years. But both of these initiatives only began in 2022.

In contrast, the backlog of underfunded mental health resources has lasted for more than three decades.

“We need to actually hyper fund it, because it’s been underfunded for so long,” said Spinks-Franklin. “We’re so far behind on mental health interventions, care and resources that parity isn’t enough.”

Correction: This story has been updated to reflect Dr. Spinks-Franklin’s correct title and position as a developmental-behavioral pediatrician and Clinical Associate Professor of Pediatrics of Baylor College of Medicine. It originally said Dr. Spinks-Franklin is a developmental-behavioral pediatrician at Texas Children’s Hospital.