How can integrated systems of care help us provide the appropriate level of high-quality care to each individual child?
Even before we were forced into isolation and schools across the country shut down due to COVID-19, our society was experiencing a pediatric mental health crisis. One in 5 children were already living with a mental health disorder prior to spring 2020.1 As children and families dealt with the repercussions of the pandemic, the mental health struggles young people faced were exacerbated. In December 2021, US Surgeon General Vivek H. Murthy, MD, issued a special advisory alerting the country to this national crisis.1
This impact is only starting to be calculated, but early research shows that emergency department visits for suspected suicide attempts were nearly 51% higher for adolescent girls in spring 2021 compared to the same time in 2019, before the pandemic. As many as 25% of youth around the world are experiencing clinically elevated depression symptoms—double the estimated prepandemic level; and as many as 20% of youth are experiencing clinically elevated anxiety symptoms—again, double the prepandemic level.2
Unfortunately, hospitals across the country are facing staffing shortages in many specialties and disciplines. There has long been a shortage of psychiatrists and other behavioral health professionals,3 and it is abundantly clear that there are not enough child psychiatrists to meet demand, either now or in the future.
To address this crisis in the context of limited resources and improve access to mental health care for children and adolescents, hospital systems should work with partners to develop an integrated system of care across their region. These systems should offer multiple levels of care, from crisis and inpatient psychiatric services through treatment in primary care and schools—even school-based prevention interventions can be useful in reducing the need for mental health services.
This is not just a pipedream or an idealistic notion, as Nationwide Children’s Hospital and its many partners in and around Columbus, Ohio, have been developing this kind of integrated system of care. The hospital’s Big Lots Behavioral Health Pavilion was launched at the start of the pandemic in 2020. It is now the largest pediatric mental health care and research facility of its kind in the United States. It serves as a hub of treatment for young people in crisis, but also has partial hospitalization and intensive outpatient and outpatient services that can coordinate with our crisis services.4 However, our system reaches far beyond the Pavilion, with community-based services, school-based mental health programs and evidence-based prevention programs.
We also train primary care and other providers to deliver mental and behavioral health care at the community level, and this training is a crucial part of our system. To ensure success, there is ongoing education, support, and consultation to these community providers.
The hospital achieves this in part through Project ECHO, a learning collaborative5 that helps community providers become more comfortable managing behavioral and mental health conditions, as well through support programs6 that allow pediatricians and other primary care professionals to have virtual 15-minute consultations with experts for guidance on diagnosis, medications, and other issues. Project ECHO is designed to help move knowledge, not patients. This allows psychiatric experts to share their robust expertise with community practitioners and increases access to high quality psychiatric care to kids across the region.
It should be a goal of hospitals and other facilities nationwide to utilize strong partnerships so that every level of care is accounted for in our system, leveraging the resources that already exist in their areas to improve the well-being of children. This coordinated approach allows for the community-wide delivery of the appropriate level of high-quality care to each individual child, while potentially decreasing the burden on families who may otherwise need to travel out of town for treatment.
Although it is important to recognize the gravity of the pediatric mental health crisis, I am hopeful that if more providers work collaboratively with a variety of partners, we will be able to tackle this issue and improve the futures of children not only within communities but across the country.
Dr Axelson is chief of the department of psychiatry and medical director of behavioral health at Nationwide Children’s Hospital.
1. U.S. Surgeon General issues advisory on youth mental health crisis further exposed by COVID-19 pandemic. US Department of Health & Human Services. News Release. December 7, 2021. Accessed April 25, 2022. https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html
2. The U.S. Surgeon General’s Advisory. Protecting youth mental health. Department of Health and Human Services Office of the Surgeon General. 2021. Accessed April 25, 2022. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
3. Axelson D. Beyond a bigger workforce: addressing the shortage of child and adolescent psychiatrists. Pediatrics Nationwide. April 10, 2020. Accessed April 25, 2022. https://pediatricsnationwide.org/2020/04/10/beyond-a-bigger-workforce-addressing-the-shortage-of-child-and-adolescent-psychiatrists/
4. Big Lots Behavioral Health Pavilion: transforming children’s mental health through an unprecedented community commitment. Nationwide Children’s Hospital. Accessed April 25, 2022. https://www.nationwidechildrens.org/specialties/behavioral-health/behavioral-health-pavilion
5. Project ECHO. Nationwide Children’s Hospital. Accessed April 25, 2022. https://www.nationwidechildrens.org/for-medical-professionals/education-and-training/echo
6. Behavioral health treatment insights and provider support (BH-TIPS). Nationwide Children’s Hospital. Accessed April 25, 2022. https://www.nationwidechildrens.org/specialties/behavioral-health/for-providers/treatment-insights-and-provider-support