When Phoenix Children’s Hospital opens its multi-specialty outpatient clinic in January in Gilbert, it will bring much-needed behavioral health care to children and teens.
The East Valley — like the rest of the country — is seeing skyrocketing mental health diagnoses among children and adolescents in emergency departments.
The problem is exacerbated by a shortage of professionals to deal with them — adding to the anxiety of parents who try to help their children.
ER visits “for kids who come in for complaints of suicide and behavioral problems in the past 10 years continue to increase,” said Dr. Randall Ricardi, chief of psychiatry at Phoenix Children’s Hospital.
“Partly, (population) growth is a driver and also I think better recognition of disorders in kids and adolescents and as a result more people come forward for care,” he added.
The need can be seen in the number of pediatric patients who attempted suicide — and the rising number who complete it.
In the East Valley alone, 35 teens — some as young as 13 — have taken their lives in the last two years.
In 2008, two pediatric patients were brought to Phoenix Children’s emergency department for attempted suicide. In 2016, that number reached 497, according to hospital data.
And in 2008, Phoenix Children’s registered 64 pediatric patients in its emergency department with suicidal thoughts. By 2016, that number jumped to 553 patients.
Overall, an estimated 17.1 million U.S. children are affected by a psychiatric disorder, making mental health ailments among the most common pediatric illnesses, according to a 2018 study by Children’s National Health System in Washington, D.C.
Roughly 2 to 5 percent of all emergency department visits in the nation by children are related to mental health concerns.
That underscores the importance of improving access to outpatient mental health resources and expanding capacity in emergency departments, according to the study.
Some steps being taken now
Phoenix Children’s has already taken steps to address the crisis. At its main campus in Phoenix, a Bridge Clinic opened almost 1.5 years ago.
“The idea behind the Bridge Clinic is to take the kids seen in ED and don’t require in-patient care but can’t wait the weeks or months to get a psychiatry appointment and we bring them to Bridge for 60 days,” Ricardi said.
“While they are waiting for a psychiatry appointment for longer care, we stabilize them by seeing them more frequently and starting either medication or therapy,” he added, noting the program would “transition them long-term to a psychiatrist or a therapist.”
Approximately 420 patients came for help at the Bridge Clinic last year, according to Ricardi.
The program is being expanded to the East Valley at the multi-specialty building on the Dignity Health Mercy Gilbert Medical Center’s campus.
Until that building opens and to meet an ongoing shortage of mental health providers, Ricardi is spearheading a program that he hopes to launch in early fall to train pediatricians on how to handle routine behavioral issues with their patients.
“We’re going to invite interested pediatrician practices to participate in a year-long faculty learning community, where we teach about identifying, treating and managing attention deficit disorder, depression and anxiety,” Ricardi said.
“The pediatrician can be a valuable resource, and collaborating with a psychiatrist, in managing the increase number of kids with behavioral health needs,” he explained, noting:
“Some of them are managing patients in their practice. This is a more formalized way to help train them further.”
The American Academy of Child and Adolescent Psychiatry last year released a report showing a severe national shortage of child and adolescent psychiatrists.
Shortage still dire
While nearly 1 in 5 U.S. children have a mental, emotional or behavioral disorder in a given year, only about 20 percent of children with disorders see a specialized mental health care provider, it said.
The country has approximately 8,000 practicing child and adolescent psychiatrists with a median of 11 per 100,000 children, the academy reported.
East Valley pediatrician Darcey Winterland knows first-hand the value of such a training program.
“I’m seeing more and more mental health issues every year,” said Winterland, who’s been in private practice for 12 years.
“And I’m seeing kids at an earlier and earlier age. I think this is something we scratch our heads about,” she added.
Winterland was at loss for why the nationwide increase in youths experiencing mental health issues.
“There’s lot of discussion among pediatricians and the mental health community on the role of social media on kids and what impact that has — specifically like Instagram and Snapchat and what role they play related to anxiety and depression,” she said, noting:
“It’s a prevalent issue for adolescent girls in particular - the constant need to know if someone liked what they did.”
According to research published this year by the American Psychological Association, certain types of mental disorders have risen significantly among kids.
“Cultural trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations compared with older generations,” the association said.
The lead researcher suspected the trend could be partially due to increased use of electronic communication and digital media.
The researcher noted that older adults’ social lives are more stable and might have changed less than teens’ social lives have in the last 10 years.
Wait times stress families
Until there are enough mental health professionals to address the growing caseload, continual strain will be seen in emergency departments and pediatrician offices, experts fear.
The average wait time for families to see a psychiatrist is three to four months.
The waiting lists for a mental health therapist and psychologist are no better and can stretch up to three months, forcing parents to bring their kids to pediatricians, according to Winterland.
Also, for some families, she said, it’s a cheaper option to bring their children to a pediatrician than a specialist.
A majority of the nearly 20 physicians, including Winterland, at Mesa Pediatrics’ four offices handle mental health concerns to some degree with their young patients, according to the doctor.
“I take care of a variety of ADHD, anxiety and depression (cases),” Winterland said. “I feel comfortable handling straightforward cases of anxiety and depression.”
But in more severe cases, including bipolar or multiple mental disorders, a psychiatrist is needed to determine appropriate medication, she said.
Winterland said that during her residency she was not trained to deal with behavioral and mental health issues in patients.
As recently as 2013, 65 percent of pediatricians surveyed by the American Academy of Pediatrics indicated they lacked training in recognizing and treating mental health problems.
Winterland said doctors are responding to the crisis by taking continuing medical education.
Training pediatricians to do the work of mental health professionals, however, may not be an effective long-term solution.
It takes longer for pediatricians to deal with a case involving mental health than treating a kid with an ear infection or strep throat, Winterland said.
“The amount of time spent, 45 minutes to an hour to discuss all the issues, I can’t do that in the middle of the morning or middle of the afternoon or I’ll get behind,” she said. “There’s a certain amount of spots allowed for these in our practice.”
Cost of treatment a factor
And, because the practice is booked weeks in advance, families needing immediate help for their children turn to the emergency room instead.
“Most kids don’t get presented to us until the parents view it as an emergency situation and they can’t get them in because of the wait time,” Winterland said. “A lot of these kids end up in the ER.”
She said her husband, Dr. Blake Bulloch, division chief of the Pediatric Emergency Department at Phoenix Children’s, sees six kids a day on average waiting to be admitted to a mental health facility because they’ve been deemed unsafe to go home.
Winterland also sees the cost of mental health care as a stumbling block for families.
Cost, insurance coverage and the time and effort involved make it hard for parents, according to the Centers for Disease Control and Prevention.
“A lot of families can’t afford to pay the $150 to $300 for the initial visit and the $100 to $150 for subsequent visits for therapy,” Winterland said, adding:
“It’s a pretty pricey endeavor for these families, especially those without insurance and even if they have insurance, it provides only for three visits.
“We just don’t have enough providers to provide care and lots of providers don’t accept insurance. In my experience (families) try to sacrifice in other places to pay for it or go without therapy if it’s hard to see a psychiatrist or psychologist,” she said, adding:
“Unfortunately, there’s not enough emphasis placed on mental health.”
Phoenix Children’s pccnprovider.org/cme/ for physicians to submit their information if they are interested in the training courses in screening/diagnosis for pediatric behavioral health conditions.