September, which is National Suicide Awareness Month, is coming to an end, but it has been a time to highlight a national emergency with local ramifications: the growing suicide rate in children.
Nationwide, the numbers are staggering, and according to the Centers for Disease Control and Prevention:
- Suicide is the second leading cause of death for children ages 10-14.
- Suicide is the third leading cause of death for young people ages 15-24.
The CDC has reported that 20% of U.S. high school students — 1 in 5 children — contemplated suicide during the COVID-19 pandemic. Over the past two and a half years, children’s hospitals in Texas have seen an increased number of children and adolescents with more serious mental health conditions in the emergency departments because these children and their families have nowhere else to go. The greater demand for care has left children’s hospitals struggling to meet the needs of their patients due to a lack of mental health services and workforce to provide those services.
While some increase in mental health conditions is because of the impact of COVID-19, the truth is that children’s hospitals have been seeing more kids with mental health issues for years before the pandemic. Between 2016 and 2020, children ages 3-17 had a 29% increase in anxiety and a 27% increase in depression. In the U.S., from 2007 to 2018, there was a 60% increase in the number of children dying by suicide.
At the Children’s Hospital Association of Texas member hospitals, the numbers could not be more alarming:
- In Dallas, Children’s Health reported a 270% increase over the past five years in the number of children who arrived at the emergency department to receive mental health evaluations.
- Cook Children’s Medical Center in Fort Worth has seen an increase in mental health consultations of almost 350% while simultaneously seeing suicide attempts among children and adolescents rise by over 200% from 2015 to 2021.
- Over the past three months, Texas Children’s Hospital in Houston has treated around 1,100 children in mental health crisis in its three emergency centers. TCH has seen a 322% increase in the number of children whose conditions require inpatient admission between 2019 and 2022 and has received more than 32,000 referrals to outpatient mental health care from October 2021 to August 2022 — more than any other outpatient service.
Children’s Hospital Association of Texas continues to work with leaders to identify smart solutions to address this crisis. These solutions start with the immediate need for more pediatric psychiatric inpatient beds. According to data from a 2020 hospital survey, there are about 1,200 beds in Texas for more than 7.5 million children. There are not enough pediatric beds to meet the needs of young Texans. Delay in receiving the right care due to the lack of critical infrastructure puts these children at risk.
Texas must invest in partial hospitalization programs and intensive outpatient programs that help kids stay out of crisis and reduce the overall need for pediatric psychiatric inpatient beds. Children could be discharged from a hospital bed to a more structured program like partial hospitalization, which offers counseling and school five days a week. Similarly, we could potentially avoid some inpatient hospital stays by having services that treat children who need more than just a counseling visit every couple of weeks but do not need to be admitted to a hospital.
It is vital that these programs be reimbursed appropriately to ensure that they remain available to every child, regardless of income. Reimbursement for mental health services must be at least on par with reimbursement for physical health services.
Finally, we must bolster the workforce pipeline for mental health professionals. Training individuals to fill these positions has become even more important, as over the last decade, Texas has gone from 69% of counties designated as total or partial Mental Health Professional Shortage Areas to over 99% today. Increasing funding to the Texas Loan Repayment Program for Mental Health Professionals would be a crucial step in addressing this issue.
While the Texas Legislature has created and funded the Texas Child Mental Health Care Consortium over the last several years, and that entity has done wonderful work, the Consortium focuses on less severe conditions. The children in Children’s Hospital Association of Texas members’ emergency departments need a higher level of care, which these recommendations would help address.
Our kids need action. The upcoming 88th Texas legislative session gives our elected leaders the opportunity to increase mental health services for the children of Texas. The lives of so many young Texans depend on us getting this right, not tomorrow, but right now.
Stacy E. Wilson is the president of the Children’s Hospital Association of Texas, which includes Dell Children’s Medical Center of Central Texas (Austin), Driscoll Children’s Hospital (Corpus Christi), Children’s Health (Dallas), El Paso Children’s Hospital, Cook Children’s Health Care System (Fort Worth), Texas Children’s Hospital (Houston), and Covenant Children’s Hospital (Lubbock).
We welcome your thoughts in a letter to the editor. See the guidelines and submit your letter here.