The exterior of Children's Hospital Colorado in Aurora, photographed on Oct. 18, 2019. (John Ingold, The Colorado Sun)

Children’s Hospital Colorado declared a “pediatric mental health ‘state of emergency’” last month, as the system now routinely runs out of beds for kids who’ve attempted suicide or presented with intense mental health needs.

While this is a crisis, it’s the result of one that was burning long before COVID-19. The stresses and isolation of the pandemic just massively fueled its flames. And reopening schools to restore mental health, the battle cry of the last year, has not solved the problem.

Paul Summergrad and Benjamin F. Miller

We should not be surprised by that fact. The Kaiser Family Foundation reports that more than 5 million U.S. children were living with anxiety disorder, and more than 2 million with depressive disorder, in the years before COVID-19 hit and when schools were functioning normally.

The mental health infrastructure in our nation and in Colorado is woefully underfunded and tragically underbuilt. Per the federal Substance Abuse and Mental Health Services Administration, nearly four in five children and adolescents with a serious emotional disturbance do not receive the necessary services. 

Of the young people who do receive mental health services, a third access them in schools, according to statistics collected by Inseparable, a growing coalition of people from across the country who share a common goal of fundamentally improving mental health care policy. 

When COVID-19 intensified and our hospitals were swamped, we saw a rapid mobilization of a government, public health, and health care response. 

The country stood up efforts to address surge capacity, allowing hospitals to care for those with less severe illness outside of the hospital, and repurposed the medical workforce to meet demand – even if it meant relaxation of certain specialty or licensure guidelines. 

We also stood up the scientific capacity to understand the causes of the pandemic and interventions to ameliorate it. That’s the kind of all-in response we need for our children’s mental health crisis.

To immediately address the problem at hand, we must model similar actions taken in the early days of COVID-19. We need to create surge bed capacity – Children’s Hospital Colorado, Colorado Springs has just half of the beds it currently needs – by making use of extra beds in children’s hospitals, unused college and school campus beds, and perhaps even beds from summer camps.

While we need beds now, beds alone are not the answer. We need to make sure we bring mental health to wherever our kids are – places like pediatric primary care settings remain a go-to first stop for many families in need.

And while we integrate care there, we also need to integrate care in our communities by rapidly training up everyday people to help people presenting with mental health needs using evidence-based trainings like those presented through Harvard’s EMPOWER program. It’s never been easier for us to provide digital and online support for caregivers on what does and does not work when interacting with a person in need.

We need to invest more deeply in our community, and schools are a big part of that solution. However, after a year of setting up platforms for remote learning and finding ways to make sure kids in need can keep getting breakfasts and lunches, educators and administrators are exhausted and in many cases all out of resources. 

That’s why state and local officials and Gov. Jared Polis need to help schools learn how to put regular screenings in place to identify problems early; offer accessible, tiered mental health supports and services to promote students’ academic, social, and psychological development; ensure a team of mental health professionals is in each school; equip educators with mental health literacy training; and work collaboratively with the community to create care pathways so students can build on progress made in school. 

Establishing a statewide youth mental health services program to increase access to mental health and substance use disorder services and reimburse providers for three sessions per youthas proposed in House Bill 1258, which passed in the Colorado legislature June 3 – will also be a huge, short-term help.

Finally, we need to have better epidemiology and data on the trajectory of the current child and adolescent mental health crises during the COVID-19 pandemic. A more complete understanding of the causes of this crisis will help us now and in the future, too – it is likely that all will not automatically return to normal this summer, nor by the start of the next school year.

We have a youth mental health emergency on our hands. Now, we need to work together to create a matching emergency response.

Paul Summergrad, MD, is the Dr. Frances S. Arkin professor and chairman of the Department of Psychiatry and professor of psychiatry and medicine at Tufts University School of Medicine and psychiatrist-in-chief at Tufts Medical Center. He is a past president of the American Psychiatric Association and a member of the Well Being Trust Advisory Board. Benjamin F. Miller, PsyD, is a clinical psychologist, chief strategy officer at Well Being Trust, and an advisor/board member for Inseparable and Mental Health Colorado.

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