The true toll of this pandemic on the mental health of children and adolescents may take decades to fully understand. Young people can be resilient but the academic and social milestones missed may have repercussions across their lifespans that are not yet visible.
With more acute issues of mental health, the effects are being felt in the here and now. Across the United States, mental health-related visits to emergency rooms rose 24 percent for children ages 5-11 and 31 percent for adolescents 12-17 in 2020, as compared with 2019, according to the Centers for Disease Control.
In New Hampshire, where U.S. Senator Jean Shaheen recently held a virtual meeting with experts across the state to discuss the barriers to mental health faced by children, emergency room visits have seen a sharp rise over the past year.
“Even before the pandemic, New Hampshire statistics around mental health and particularly adolescent mental health, had been worse than the national average,” Shaheen said during the meeting, “and the pandemic has made things worse.”
Since 2012, the state has had an on-going issue of emergency room boarding, where someone experiencing a mental health crisis is held in the ER due to a shortage of available treatment beds in the state.
The numbers of adults and children and the length of time they wait has steadily increased with a sharp rise over the past year.
“The highest quarter for emergency room boarding for children and young adults prior to the pandemic had an average of seven per day in 2017,” said Ken Norton, LICSW, executive director of the New Hampshire chapter of the National Alliance on Mental Illness (NAMI-NH).
“During the second quarter of 2020, April, May and June, we hit seven again. In the third quarter, we were at 10 and in the fourth quarter, we were at an average of 15 kids per day. This year, we hit a single day high of 51 kids being boarded in emergency rooms on Valentine’s Day.”
“As of yesterday, [May 24, 2021],” he added, “there were five adults and 20 children waiting in emergency rooms.”
During the meeting with Sen. Shaheen, experts from across the state gave feedback on the situation and what issues need to be addressed. From the ER boarding crisis to a severe shortage in the workforce because, in part, of low reimbursement rates from commercial insurances, the concerns raised illuminate a situation where children and adolescents are not receiving the care they desperately need during a very difficult year.
At a time when everyone is under stress, the increase of children in need is notable.
“Over the course of the COVID-19 pandemic, an unprecedented number of children in crisis sought treatment in hospital emergency departments,” said Kathy Remillard, public information officer for the NH Department of Health and Human Services (DHHS.)
The shortage of alternatives to ER boarding was highlighted throughout the meeting. Even with a temporary 10-bed unit for adolescents added by the DHHS at New Hampshire Hospital, there is still a demand for more options throughout the system, including programs to work with children beyond the inpatient setting.
“Youth should have access to mobile crisis care and intensive outpatient programs rather than relying on emergency departments,” said Julie Wolter, Psy.D., chair of the behavioral healthcare advocacy committee for the New Hampshire Psychological Association, who was in attendance at the meeting.
Another issue raised by many of the attendees is the on-going workforce shortage. While money has been earmarked for the state from the federal government, providing financial support may not be enough when there are not enough mental health professionals.
Filling vacant job openings is made more difficult when applicants can take higher paying positions elsewhere.
“Access to mental health and substance use care for youth is particularly difficult in NH’s workforce shortage,” said Wolter. “Comprehensive care for the whole family that involves collaborating with schools, pediatricians, DCYF and others is essential for treatment, yet, based on unreimbursed collaborative care and low reimbursement for family therapy, this is not understood.”
Saving money by providing lower reimbursements may, in fact, be counterintuitive, she added.
“Early intervention and a thorough, annual assessment of youth’s social and psychological health are key to less costly…care,” Wolter said.
According to Remillard, the DHHS is working toward increasing beds and other services.
“The department is taking steps to expand inpatient capacity for children and increase the pool of mental health providers and services so that children and families can access treatment early and effectively to prevent a mental health crisis,” she said.
The state operating budget for 2020-21 included resources for implementing certain recommendations of the 2019 Ten Year Mental Health Plan, she explained.
After the NH Supreme Court ruled against the state over the way it handled emergency room boarding, Governor Chris Sununu issued an executive order to create improvements.
The executive order “allows the Department to make some immediate changes to increase community-based services and inpatient treatment for adults and children experiencing a mental health crisis. As a result, the Department is actively speaking with out-of-state providers to provide children’s inpatient services,” Remillard said.
The silver lining, Norton added, may be that children and adolescents are seeking help during this crisis and the state increased access to telemedicine during the past year.
“People are asking for help,” he said, “and, in terms of takeaways, telehealth has been significant in terms of improving access to mental health care. Providers are hoping that the changes to rules and laws will be made permanent.”
The chance to meet with Sen. Shaheen to discuss the state’s needs is a key factor in moving the state forward on the issue of access to mental health care, he added.
“I think I speak for other providers in saying that we appreciate how frequently our congressional delegation has these meetings with key groups, from law enforcement and first responders to mental health care,” Norton said. “It helps to have that communication so we all understand what is happening in Washington and they can understand what is happening on ground in New Hampshire.”