(NEW YORK) — Rachel Simner, the mom of a 13-year-old child in Illinois, said she took her child to a local emergency room last September at the urging of her child’s school officials, who had done a suicide risk assessment.
Simner, a mom of two, told Good Morning America that when her child was discharged from the emergency room several hours later, her only guidance was a list of pediatric mental health providers that were said to specialize in autism, a condition with which her child has been diagnosed.
“It turns out a lot of them weren’t pediatric or they didn’t deal with autism or they had waitlists, so it took a while to find anybody and this is a kid who was suicidal, so it was urgent,” Simner said. “Four or five days later I went to the mental health hospital itself instead of the ER to try to get them admitted directly, and we were turned away again.”
Simner said her child, who also uses they/them pronouns, has for the past several months relied on a patchwork of providers and an at-home tutor provided by the school district while she and her husband continue to search for a more permanent treatment plan.
“We get bad information. The providers aren’t adequately trained. There’s such a shortage of space and beds for inpatient treatment,” Simner said. “In the meantime, my child is falling through the cracks and not getting the help that they need.”
Several states away, in the Washington, D.C., area, Ann, a mom of two, estimates that she and her husband have spent hundreds of thousands of dollars to get mental health care for their oldest child, a high school student.
“We’ve been paying basically out-of-pocket since she was in third grade for weekly therapy,” Ann, who asked that her last name not be used, told GMA, noting that is even with her family being lucky enough to have health insurance.
Around eighth grade, Ann said her child, who uses they/them pronouns, began to self-harm and experience suicidal thoughts, which led to years of searching for and bouncing between inpatient and outpatient treatment programs.
“At one point I switched to half-time in my job to take care of my child because we were too scared to leave them alone physically,” Ann said, adding of the financial toll, “We’ve spent anything that they had for college, and possibly everything that their sibling had for college and possibly our retirement, just so that they could do all of this so that they could survive enough to decide what they wanted to do after high school.”
In addition to the financial burden, Ann said the logistical burden of finding treatment for their child has fallen squarely on her and her husband.
After one 10-hour stay at a local emergency room following their child’s suicide threat, Ann said they left with little more than a list of mental health care providers to try to call for an appointment.
“Everyone is just trained to say, ‘Call 911,’ and then you get discharged from the hospital and you’re like, what do I do now?” Ann said. “It’s like a state of crisis for a parent to be constantly like, how do I manage that someone will be home 24/7 with my child and still work and still be able to pay our bills and still have another child who is supposed to be able to function like a normal person?”
A mental health crisis of care for kids
Mental health experts say what Simner and Ann described experiencing is part of a larger crisis across the country, where a record number of kids in need of mental health care are crashing up against a lack of access to care.
“I think out of the 100,000 psychologists [in the U.S.], there are around 4,000 adolescent clinicians, and most of those are in urban areas,” Robin Gurwitch, Ph.D. , professor of psychiatry and behavioral sciences at Duke University School of Medicine, told GMA. “You tell a family, ‘Here’s what you need to do,’ but then what? If you’ve got a six-month waiting list, that isn’t helpful for a family in crisis, particularly for a child in crisis.”
The American Academy of Child and Adolescent Psychiatry estimates that when it comes to child and adolescent psychiatrists — medical doctors who are able to prescribe medicine — there are just over 10,000 currently practicing in the U.S., at a ratio of 14 per 100,000 children.
Two years ago, the AACAP joined with the American Academy of Pediatrics and the Children’s Hospital Association — which collectively represent more than 77,000 physicians and over 200 children’s hospitals — in declaring children’s mental health a “national emergency.”
Last year, a report from U.S. Surgeon General Dr. Vivek H. Murthy warned of a growing mental health crisis among young people. The report, issued during the coronavirus pandemic, cited statistics including a 50%-plus-increase in emergency room visits for suspected suicide attempts among girls and a doubling of anxiety and depression symptoms reported across genders.
On Thursday, a new report from the U.S. Centers for Disease Control and Prevention painted an even starker picture: According to the agency, the number of high school female students seriously considering suicide jumped from 24% in 2019 to 30% in 2021.
The percentage of those who made a suicide plan increased from 19.9% to 23.6% in that same time frame. There was also an increase in suicide attempts, from 11% to 13.3%, according to the CDC.
“So many people that I’ve worked with have had to make the choice where they know that their child is imminently suicidal, and they just can’t afford to bring them somewhere to get treatment,” said Mitch Prinstein, Ph.D. , chief science officer for the American Psychological Association, noting that many parents struggle to find treatment at all. “So they come home every day from work, hoping and praying that their child is still alive.”
Prinstein described kids as moving targets who develop so quickly that a delay of any time in mental health treatment can set them on a different life course.
“If a kid has to wait six months until they get an evaluation or they get better, that means they’re missing, potentially, a significant portion of their school year,” Prinstein said. “When they are able to start functioning again, they’re now on a whole new trajectory and where they end up might be miles away from where they would have been had they been able to get minimal disruption where they did not lose a school year and they did not have major conflicts with teachers, parents and peers.”
Prinstein and other experts point to data showing the mental health crises among kids has been a long time coming, and was both exacerbated and highlighted by the pandemic, a time when kids faced everything from loss and isolation to economic uncertainty at home.
A new report by the National Academies of Sciences, Engineering, and Medicine, a policy-focused nonprofit organization, determined that in the absence of a “focused strategy” for help post-pandemic, “a generation of young people will enter adulthood with worse mental health,” particularly those in low-income communities.
“Just because [COVID] is not like it was three years ago, doesn’t mean that it has completely disappeared from the lives of our children,” said Gurwitch. “Those concerns that arose during COVID — those that were often coupled with grief and loss issues, with changes in their family due to housing or food or job insecurity — we couldn’t just turn those off and put them back into the learning environment.”
Gurwitch said a silver lining of the increased focus on mental health care post-pandemic is the expansion of the government-backed 988 Suicide & Crisis Lifeline, which people can call or text 24/7 for help. A federal funding bill passed in January included $506.1 million to support and expand services provided by the lifeline.
Both Gurwitch and Prinstein said the lasting impacts of COVID are piled on top of what is an already stressful time to be a child in America. Kids today, they said, feel the weight of school shootings, natural disasters like hurricanes and tornadoes, economic uncertainty, social justice, climate change and war, on top of social media and academic pressures.
At the same time, according to Prinstein, they are not prepared emotionally to cope, despite a renewed public discourse on mental health that came out of the pandemic.
“We have basically an almost complete lack of any prevention right now,” Prinstein said. “When it comes to physical health, there’s all kinds of prevention that we teach kids about — how to eat well and exercise and avoid unhealthy practices — but there’s just remarkably little prevention that’s built into the way that we raise kids or that we talk about at the family and community level.”
‘We need a mental health moonshot’
Prinstein said if the U.S. wants to make any significant progress towards ending the mental health crisis among kids, there needs to be substantial change.
“We made a big investment in building a whole mental health infrastructure in our country after World War II, for the veterans, but we’ve made no meaningful changes to the mental health infrastructure in this country since that time 70 years ago, and that system already was built for adults, not for kids,” he said. “So we’re just sitting on a whole bunch of solutions that could work if we developed a system that reflected the science.”
He added, “All of that is just going to waste because everyone is making these tiny, incremental, ultimately meaningless changes that don’t address the heart of the issue.”
Just as President Joe Biden last year outlined a new “American Moonshot ” aimed at eradicating cancer, Prinstein said the U.S. needs a “mental health moonshot.”
“We should be thinking about mental health in the exact same way we do physical health. People should be aware of their options, they should know about the scientific approaches to treatment that are likely to work and they should be able to access that treatment,” he said. “We should be building mental health resilience and competencies into every kid, K-12, in every community.”
Prinstein applauded the Biden administration’s $1 billion in funding to increase the number of school-based health professionals, but described that effort and others as “tiny band-aids” being placed on the problem, instead of a necessary “systemic fix.”
“Right now, the government pays billions of dollars every year to make sure as a national priority that we have a sufficient number of physicians with the right specialties in the right parts of the country so that everyone has access. There is no such effort being made for mental health care providers,” he said. “It really is that substantial and that big of a concern that we’re talking about the need for a major, systemic federal commitment, and we haven’t been doing that for decades.”
Last year, when the Biden administration’s funding increase was announced, Education Department Assistant Secretary for Planning, Evaluation, and Policy Development, Roberto Rodríguez, told ABC News there’s never been an effort of this magnitude by the federal government to distribute mental health professionals to schools. The recent spending, according to Rodríguez, also helps President Biden inch closer to his goal of “doubling” school-based mental health practitioners.
“We are making a big bet on supporting, attracting, developing and retaining our school psychologists, social workers, [and] counselors to really work in support of our students,” Rodríguez said.
Anne, a mom from Rockville, Maryland, who asked that her last name not be used, said she wonders what would have happened with her own 16-year-old child if mental health was treated differently in the U.S.
In one instance, the child — whom Anne asked not be named — experienced suicidal ideation, and Anne said they waited several days in a local hospital’s emergency department trying to be admitted to a mental health treatment center.
“Immediately, you are depersonalized, put in a space that has nothing that can be used as a hazard and you sit there, and you sit there, waiting to be assessed,” Anne said of her family’s experience in the ER.
“Ultimately, the psychiatrist, in meeting with my child, she determined that there was a lot of a lot of stuff my kid was having to deal with, and the thought of suicide and the plans for suicide were the only things that my child knew to go to, to cope, because they hadn’t learned coping strategies anywhere.”
Training pediatricians to be first responders for children’s mental health
With schools also facing a stark shortage of mental health professionals — at a ratio of 1,162 to 1 compared to the 500 to 1 ratio recommended by the National Association of School Psychologists — one organization is working to train another population that reaches children daily: pediatricians.
To date, the REACH Institute, a New York-based nonprofit organization, has trained more than 6,000 pediatricians and primary care providers in delivering scientifically proven mental health care, according to Lisa Hunter Romanelli , Ph.D., CEO of REACH and a licensed clinical psychologist.
“Unfortunately, the typical pediatrician, through medical school and their training, they don’t get a lot of training on mental health, but increasingly, because of the children’s mental health crisis, that’s where families are turning,” Hunter Romanelli told GMA. “So REACH’s training program aims to increase the knowledge and comfort of pediatricians so that they are able to to spot early signs of children’s mental health illness and manage and help those kids within the scope of their pediatric practices.”
The scope of REACH’s training, according to Hunter Romanelli, extends from learning to identify mental health struggles in kids to treating them, whether by helping the patient and family learn different skills to alleviate symptoms or, if indicated, prescribing medication.
“We’re not trying to turn [pediatricians] into therapists,” Hunter Romanelli said, adding, “Our training empowers them to do something that they are already being asked to do and gives them more comfort and confidence in being able to help the kids in their practice.”
Hunter Romanelli said REACH, which is funded by donations as well as grants and fees for its training programs, estimates that training one pediatrician can help 250 kids with mental health issues, meaning the need is still great.
“Today, our impact has been that we’ve trained 6,000 pediatricians, which means they are helping 1.5 million kids, which is good, but there’s still a crisis,” Hunter Romanelli said. “We’d love to make sure that every pediatrician has gone through our training program because obviously that would make a dramatic impact on the number of kids to have access to to mental health services.”
What parents can do now
Hunter Romanelli, as well as Prinstein and Gurwitch, stressed that there are steps parents can take to try to protect their child’s mental health.
First, parents should know that they have the right to ask questions of providers about the mental health treatment their child is receiving, according to Prinstein.
“It’s really, really important that folks, when they go to get help, that they’re looking for a licensed professional and also asking, ‘Did you go to an accredited institution,?’ and, ‘What is the kind of therapy that you’re providing? Is there science to demonstrate that therapy works,?'” he said. “Parents have every right to ask.”
Second, parents should be sounding boards for their kids, and be proactive in speaking to them about mental health, including suicide, according to Prinstein.
“Talk with your kids about suicide because there is a big misconception that we’re going to somehow put an idea in our kids’ heads and it’s going to make them more likely to do something risky or bad. That is absolutely incorrect,” he said. “You’re not putting an idea in their head, but what you are doing is communicating when they talk with you about it, they’re going to feel safe and they’re going to feel like they can open up to you.”
Gurwitch echoed Prinstein’s advice, saying simply, “Talk to your kids.”
“Check in with them about how they’re doing when events happen,” she said. “Whether it is another shooting, whether it’s a disaster, whether it’s the impact of climate change, whether it’s the war in Ukraine, check with your kids about how they’re doing and they can know that you’re available to talk to about the tough things.”
Likewise, Gurwitch said parents should feel comfortable talking to their child’s pediatrician and school officials about mental health.
“You know your child better than anybody else, so if you see a change in their behaviors and their functioning and how they’re doing in school or with peers or with you, talk to somebody to see, ‘Should I be concerned?'” she said. “Children don’t come with a manual, so it’s unfair [for parents] to think, ‘I know what to do.'”
If you or someone you know are experiencing suicidal, substance use or other mental health crises please call or text 988. You will reach a trained crisis counselor for free, 24 hours a day, seven days a week. You can also go to 988lifeline.org or dial the current toll free number 800-273-8255 [TALK].
ABC News’ Arthur Jones II and Kelly Livingston contributed to this report.
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