Pediatric Providers Have Growing Need for Virtual Psychiatric Consults

David John Joosten, MD, Pediatrician
Providence Medical Group, Spokane

The diagnoses of anxiety and depression have increased more than two- to three-fold in our pediatric practice. Social and financial insecurities are making the future uncertain, creating stress for patients and families. In general, the young population is much more cynical and much less hopeful about the future. The manifestations of anxiety have also become more severe: cutting, skin picking and hair pulling have become common. For the past several years, I have seen thousands of patients per year, with very low numbers of bulimia and anorexia diagnoses. In 2021, they were much more prevalent, directly related to anxiety. The number of teens hospitalized for suicidal ideation has also increased dramatically.

Mental health in children and adolescents is a national concern, as illustrated by a U.S. Department of Health and Human Services (HHS) study published in the American Medical Association’s journal JAMA Pediatrics.1 The research, conducted by the Health Resources and Services Administration (HRSA), cited that between 2016 and 2020, the number of children ages 3-17 years diagnosed with anxiety grew by 29 percent and those with depression by 27 percent. The findings also suggest concerning changes in child and family well-being after the onset of the COVID-19 pandemic.

The isolation children have experienced during the pandemic, as well as the breakdown of families in which the parents are struggling, and often unstable themselves, have caused depression and anxiety to increase exponentially. The academic inadequacies of remote learning have compounded the problem, especially in children with special needs.

Another factor is the improved cultural norm around the stigma of mental health, particularly with many high-profile public figures talking about depression and anxiety. This cultural awareness has made discussions between parents, schools and physicians more open, and treatments more streamlined. When schools approach parents with a concern, there are no longer the roadblocks that existed in the past.

The increase in mental health needs has resulted in a severe shortage of psychiatrists and counselors, creating significant bottlenecks in referrals. The system was taxed before COVID-19 and will be very slow to catch up. In the meantime, primary care providers are left with the primary responsibility on the medical side. The American Academy of Pediatrics encourages pediatricians to be prepared to take a larger role in addressing mental health problems and offers resources in Achieving the Pediatric Mental Health Competencies2.

The American Academy of Child and Adolescent Psychiatry (AACAP)3 recently released a study The Severe Shortage of Child and Adolescent Psychiatrists3 illustrating the magnitude of mental, emotional, or behavioral disorders in the nation’s children and adolescents:

  • One in 5 US children have a mental, emotional, or behavioral disorder in a given year.
  • Half of all mental health disorders show first signs before a person turns 14 years old, and 75% of mental health disorders begin before age 24.
  • In 2020, 1 in 6 young people experienced a major depressive episode and suicide was the 2nd leading cause of death for people ages 10-24.
  • Only half of children and adolescents with diagnosable mental health problems receive the treatment they need.
  • There are approximately 10,500 practicing child and adolescent psychiatrists in the United States. And the national average age of practicing child and adolescent psychiatrists is 52 years.
  • Ratios of child and adolescent psychiatrists per 100,000 children range by state from 4 to 65, with a national average of 14 child and adolescent psychiatrists per 100,000 children.

One positive outcome of COVID-19 is the virtual consult technology now widely available. Washington State offers comprehensive services. The Partnership Access Line (PAL)4 provided by Seattle Children’s Hospital, is a state-funded program providing mental health consultation for questions such as diagnostic clarification, medication adjustment or treatment planning.

Pediatricians have an increasing sense of responsibility to promote healthy emotional development of children and address their mental health conditions. While challenging, these unique opportunities can be extraordinarily rewarding when pediatricians begin to speak with patients and families about hope.

Editor’s note: WCAAP offers a collection of resources to help pediatric health care providers support children and teens with behavioral health conditions: Behavioral Health – WCAAP – Washington Chapter of the American Academy of Pediatrics

References

[1] New HHS Study in JAMA Pediatrics Shows Significant Increases in Children Diagnosed with Mental Health Conditions from 2016 to 2020

https://www.hhs.gov/about/news/2022/03/14/new-hhs-study-jama-pediatrics-shows-significant-increases-children-diagnosed-mental-health-conditions-2016-2020.html

[2] Achieving the Pediatric Mental Health Competencies Volume 144, Issue 5. November 2019 https://publications.aap.org/pediatrics/article/144/5/e20192758/38253/Achieving-the-Pediatric-Mental-Health-Competencies

[3] Severe Shortage of Child and Adolescent Psychiatrists Illustrated in AACAP Workforce Maps

https://www.aacap.org/AACAP/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx

[4] The Partnership Access Line (PAL) provided by Seattle Children’s Hospital https://www.seattlechildrens.org/healthcare-professionals/access-services/partnership-access-line/

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