The mental health of children is currently in crisis. According to an investigation reported in 2021 in JAMA Pediatrics, one in four children globally is experiencing elevated depressive symptoms and one in five is experiencing elevated anxiety. In the United States in 2020, anxiety diagnoses for children aged 3 to 17 years increased 29% and depression diagnoses increased 27% compared with 2016, according to a 2022 investigation in JAMA Pediatrics. This equates to 5.6 million children with anxiety and 2.7 million with depression—numbers that are far too high.
Pediatric mental health was already a concern during the 2010s, but the COVID-19 pandemic exacerbated an expanding crisis as children who were experiencing the mounting pressures of social media, increasing gun violence, and other stressors now had to cope with social isolation, disruption to education and other daily activities, and fear and uncertainty surrounding the novel virus.
ECRI highlighted the pediatric mental health crisis as its number one item in its Top 10 Patient Safety Concerns for 2023.
Caring for this population’s mental health needs to begin long before these children present to emergency rooms for psychiatric treatment or suicide attempts. While some solutions to the current crisis may fall outside the pediatric primary care office, steps can be taken to protect our youngest and most vulnerable population.
- Recognize that mental health is an essential part of overall health.
Pediatric primary care providers already play a vital role in promoting the healthy development of children. As part of this care, organizations must ensure that providers are looking beyond physical ailments and tracking developmental milestones. It should be emphasized that primary care providers can help promote positive mental health as part of overall health and well-being.
As part of this effort, providers can empower their young patients and caregivers to recognize, manage, and learn from difficult emotions. They can also share education and resources, such as the new 988 Suicide and Crisis Lifeline, as well as other local behavioral health services and support groups. By doing so, these providers will be able to nurture their ongoing relationships with their patients and caregivers and strengthen their trust and willingness to share sensitive information. - Implement universal screening for depression, anxiety, abuse, substance use, and suicidal ideation for pediatric patients during every office visit.
Primary care providers can also play a crucial role in detecting emerging mental health problems. The American Academy of Pediatrics’ (AAP) Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families during the COVID-19 Pandemic recommends: “Behavioral and mental health surveillance and evidence-based screening should…be integrated into every office visit. Surveillance can take the form of incorporating questions about the impact of the pandemic on the well-being of the child (including any behavioral difficulties) and family.”
AAP also recommends universal screening for suicide risk for children aged 12 or older and screening when clinically indicated for children ages 8 to 11. The organization recommends assessing “for suicidal thoughts/behaviors if warning signs are present” in children under 8.
Pediatric primary care providers should implement the screening, brief intervention, and referral to treatment (SBIRT) approach for all patients, regardless of an identified mental health disorder, so that they can effectively care for all patients, including those not actively seeking treatment for mental health problems. Patients who are then determined to be at moderate to high risk after screening can be referred to brief intervention, while those who are determined to be at severe risk can be referred for further diagnostic assessment and treatment. - Assess for social determinants of health, and provide additional support to children and caregivers identified at increased risk.
Social determinants of health (SDoH) are conditions that can affect an individual’s health and well-being. These nonmedical factors include access to food, housing, or transportation; language or literacy level; financial status or income; level of education; and social support. SDoH can contribute to health disparities, which are the differences in health outcomes and causes among different groups of people.
Screening for SDoH should be standard practice for primary care practices. Providers should then provide additional support to children who have been identified at increased risk and their caregivers. This may include conducting a warm handoff with internal or external services (e.g., substance use or behavioral health treatment services). Practices may also consider designating a liaison, such as a patient advocate, who will organize and manage the organization’s list of available resources and will follow up with patients to ensure they attend referral appointments.
Providers should also be made aware of the health disparities that certain pediatric populations experience. For example, according to the Trevor Project, those who identify as gay, lesbian, or bisexual report higher rates of being bullied at school and higher rates of feeling sad or hopeless than their heterosexual peers. Further, transgender children are more likely than their cis peers to report experiencing violence and have higher rates of substance use and suicidal ideation. LGBT youth are more than four times as likely to attempt suicide than their peers, with 1.8 million children seriously considering suicide every year. This means that at least 1 child attempts suicide every 45 seconds. Therefore, pediatric primary care providers should be vigilant in their care of this population to best support them and their vulnerabilities.
Download our Top 10 Patient Safety Concerns for 2023 Special Report to identify safety challenges in your organization and learn how to address them.