>>The ‘shadow pandemic’ of behavioral health is putting US pediatric hospitals at risk

There is a “shadow pandemic” evolving among our children — a mental and behavioral health emergency. This month, the U.S. surgeon general, citing the additional cumulative stress from the pandemic, issued a public health advisory about this escalating mental health crisis in our youth. We must respond. The time to engage in positive action to save our children’s lives is now.

Across the country, more children without medical needs are being admitted to pediatric hospitals and are staying longer due to the lack of mental or behavioral health services in our communities. This results in more hospital staff days spent on 1:1 observations to keep these children safe from harm, which increases pressure on bed availability and staffing levels. Due to lack of resources, these children are being deprived of the mental health services they desperately need and, as a result, their mental health needs intensify, and they become more disruptive and more verbally and physically aggressive to our staffs.

At Children’s Mercy Kansas City, a “Code Strong” is called whenever a patient becomes disruptive and cannot be deescalated. It indicates the patient requires intervention in order to prevent them from doing harm to themselves or others. The team who responds includes social work, hospitalists, pharmacy and security, as well as the shift supervisor and charge nurse. Before the pandemic, Children’s Mercy experienced 23 Code Strongs annually. This year, the hospital will have more than 300.

During this pandemic, kids’ social isolation and increased family stress has only intensified these troubling pre-pandemic trends. From April to October 2020, the proportion of mental health emergency department visits increased significantly among kids ages 5 to 11 (24%) and ages 12 to 17 (31%) versus the same period in 2019.

We request support for the following efforts:

▪ The demand for pediatric mental health services, both inpatient and outpatient, far exceeds supply. There simply aren’t enough specialty trained health care providers to care for this population of kids. The Children’s Hospital Association estimates our nation needs 47 child psychiatrists per 100,000 kids and teens. Currently, there are 10 per 100,000. Additionally, hospitals lack adequate inpatient mental and behavioral health beds, and our communities lack adequate placement facilities that can provide appropriate and safe care to patients whose mental health needs are the most acute.

▪ Children’s hospitals are not equipped to care for patients with mental health needs at scale. Due to the shortage of specialty providers for these kids, children’s hospitals are bearing the brunt of the volumes because, in some cases, our emergency departments are a child or family’s only refuge. Holding kids with mental health needs in our emergency rooms — often for 24 hours or more — while waiting for an inpatient bed or community placement is not therapeutic. Stimulation from a busy and sometimes chaotic environment can increase their levels of anxiety and agitation. It frequently results in a worsening of symptoms, higher risk of harm for both patients and staff, and greater likelihood of patients leaving the hospital when doing so may present an imminent threat to their safety.

▪ We must keep our kids — and our staff — safe. Children’s hospitals — and more specifically, the people who work at them — exist to take care of our communities’ most vulnerable kids at their times of greatest need. But even those who thought they knew what they signed up for — the triumph, the heartbreak, the risk — couldn’t have imagined this. Our most highly acute patients can be a threat to themselves, but also to our staff. Patients who are in crisis do not always know how to express themselves. At times they lash out, and several have inflicted extensive harm on our front-line team members.

The severity of the “shadow pandemic” requires us to sound the alarm on behalf of our families. We continue to engage with stakeholders to develop immediate next steps. Undeniably, we will need all levels of government and our communities’ grassroots support to rise to meet this challenge. We have always done so in our past, and we know we can do so again.

Paul Kempinski is president and CEO of Children’s Mercy Kansas City.