Dr. Deborah Levine has been a pediatric emergency medicine physician in the New York City area for over two decades. In recent years, she has observed an increase in the number of mental health emergencies in adolescents -- which only got worse during the pandemic.
"The problem has always been there. The pandemic, we felt it even more so," said Levine, who practices at NewYork-Presbyterian Komansky Children’s Hospital and is an associate professor of clinical pediatrics and emergency medicine at Weill Cornell Medicine.
Last week's surgeon general's advisory on the youth mental health crisis during the pandemic didn't come as a surprise to hospitalists like Levine, who continues to see the impact as demand still outpaces access 21 months later.
"We're seeing it on the ground," Levine said. "We're looking for ways to help ameliorate the crisis and in the meantime, we're actively treating these children who need help."
Hospitals are often a "safety net" for people experiencing mental health emergencies, she said, and that's only become more pronounced as outpatient clinics and offices continue to be overwhelmed.
"I think this crisis is so significant that we just can't meet the demand," she said.
Some hospitals are trying to meet the immediate demand by increasing bed capacity. Though greater access to psychiatric care is needed to help prevent mental health issues from escalating to emergencies in the first place, experts said. At the same time, an existing shortage of behavioral health professionals is compounding the problem, they said. Telemedicine, which proliferated during the pandemic, can also continue to increase access, particularly vulnerable youth in more rural areas, where specialists are in shorter supply.
The surgeon general's advisory came on the heels of a coalition of pediatric groups declaring children's mental health challenges amid the COVID-19 pandemic a "national emergency" earlier this fall. The medical associations pointed to research from the Centers for Disease Control and Prevention (CDC) that found an uptick in mental health-related emergency department visits for children early in the pandemic when compared to 2019, as well as a 50.6% increase in suspected suicide attempt emergency department visits among girls ages 12 to 17.
Depression and suicide attempts in adolescents were already on the rise before the pandemic, the surgeon general's advisory noted.
"I am worried about our children," Dr. Vivek Murthy, the surgeon general, said during a recent White House briefing. "[Our] kids have been struggling for a long time, even for this pandemic."
Continued increase in demand
When the pandemic disrupted access to schools, health care and social services, Texas Children's Hospital saw adolescents who had received prior treatment for issues such as anxiety and depression come back, along with "tremendous increases of new-onset problems," Chief of Psychology Karin Price told ABC News.
Even as schools and services have gone back online, the volume "hasn't let up at all," she said.
"Our numbers of referrals on the outpatient side continue to increase -- general referrals for common mental health conditions in children and adolescents," she said. "Unfortunately, we've also seen increases in the demand for crisis services -- children and adolescents having to come to the emergency center for crisis evaluations and crisis intervention."
During the previous fiscal year, behavioral health had the third-highest number of referrals throughout the Texas Children's Hospital system -- behind ENT surgery and orthopedic surgery -- much higher than it typically is, Price said.
"That has been very striking within our system and really demonstrating the need," she said.
The Children's Hospital of Philadelphia has seen more than a 30% increase in emergency department volume for mental health emergencies compared to the year before, according to Psychiatrist-in-Chief Dr. Tami Benton.
"We're starting to see more kids who were previously well, so they were youngsters who were not having any specific mental health conditions prior to the pandemic, who are now presenting with more depression, anxiety," she said. "So things have definitely not been heading in the right direction."
The hospital has also been seeing adolescents with autism who lost services during the pandemic seeking treatment for behavioral problems, as well as an increase in girls with suicidal ideation, she said.
As the need has gone up, the number of services hasn't necessarily followed, she said.
"It's the same services that were challenged before, there are just more young people in need of services," she said.
Adapting to the need
Amid the demand for psychiatric beds, CHOP converted its extended care unit to treat children in the emergency department while they wait for hospitalization, Benton said. The hospital also shifted clinicians to provide emergency outpatient services.
"We've had to make a lot of changes in our care practices to try to accommodate the volume to try to see more young people," Benton said.
CHOP was already planning pre-pandemic to expand its ambulatory practices, though the increased demand has only accelerated the project, Benton said. The hospital is also building a 46-bed in-patient child and adolescent psychiatry unit. Both are slated to open later next year, "but as you can imagine, that's really not soon enough," Benton said.
Some hospitals have been looking at ways to prevent children from needing crisis services in the first place. Texas Children's Hospital has developed a behavioral health task force that, for one, is focused on supporting screening for mental health concerns at pediatric practices, Price said. Levine is part of a team researching the pandemic's effect on pediatric mental health emergencies with one goal being to prevent repeat visits to the emergency department.
"We're trying to see if we can target certain areas that are at high-risk," Levine said.
As far as increasing access, telehealth services have been invaluable during the pandemic, especially for reaching more rural populations. Though access may still be limited due to a family's means, Levine said. Demand also continues to be high amid a workforce shortage, Price said.
"Behavioral health professionals have a lot of different opportunities now," she said. "Any kind of behavioral health clinicians that didn't already have full caseloads before certainly have them now."
According to the American Academy of Child and Adolescent Psychiatry, every state has a high to severe shortage of child and adolescent psychiatrists.
With those challenges in mind, engaging community partners will be key to addressing the mental health crisis, Benton said.
"The most important thing for us to do right now really is focused on expanding access, and I think the quickest way for us to do that is for us to partner with other communities where kids are every day," she said. "Greater partnerships with schools and the primary care practices is a way to do that … and get the biggest bang for our buck."
ABC News' Cheyenne Haslett contributed to this report.