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The Kids Are Not Alright: New Report Shows Pediatric Mental Health Hospitalizations Rose 61%

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After more than two years of the Covid-19 pandemic, many parents and kids may feel grateful for the return to a relatively normal school year. But that sense of returning to normalcy may be masking real distress among American kids.

New research, released earlier this month from Clarify Health Institute, analyzed health insurance claims from more than 20 million children nationwide between the ages of 1 and 19. The analysis found stark increases in the utilization of mental health services between 2016 and 2021. Utilization was already increasing before the pandemic but spiked during the public health crisis.

“Social media, two-and-a-half years of pandemic life, and existential dread around climate change and political dysfunction in the U.S. have created a perfect storm for mental health issues to emerge,” said Niall Brennan, chief analytics and privacy officer at Clarify Health.

This perfect storm has driven dramatic increases in utilization of acute mental health care. Hospitalizations among kids under age 19 increased 61% from 2016 to 2021, jumping from 30 admissions per 1,000 patients each year to 48 per 1,000.

The biggest jump in hospitalizations was among teens ages 12 to 15, rising 84% among girls in this age group and 83% among boys. Despite the relatively consistent rates of increase in hospitalizations between boys and girls, the absolute number of mental health-related hospital admissions was 2.5 times higher for girls than for boys—125 hospitalizations per 1,000 patients among girls compared to 50 among boys.

Gender differences may relate to the diagnoses driving the increase in hospitalizations. According to Brennan, the analysis showed increases in acute care across all mental and behavioral health categories, especially common mental health conditions such as anxiety, depression, and related disorders. But, he said, the fastest growth was in hospitalization of patients with feeding and eating disorders, conditions more likely to affect girls than boys.

The analysis also found substantial regional differences in rates of increase in hospitalizations for pediatric mental health conditions. While hospitalizations went up in all regions of the United States, they increased the most in the mid-Atlantic and New England, which had 137% and 100% increases, respectively. The West North Central region had a 27% increase in mental health hospitalizations, the lowest increase of any region.

According to Brennan, many health systems around the country are seeking to increase the availability of pediatric hospital beds. But the current lack of beds creates serious unmet needs across geographies and sociodemographic groups.

Emergency room visits due to mental health conditions increased by 20% between 2016 and 2021, also spiking during the pandemic after an initial decline early on in the five-year period included in the data. Adolescents between 12 and 15 years of age were more likely to have visited an emergency room during this time compared to younger and older kids. Emergency room usage jumped 41% among 12-to-15 year old girls and 35% among boys.

“The growth in acute mental health events we document should be a serious concern for parents, and thus should be of concern to their employers, government officials, and other community leaders,” Brennan said.

The analysis found differences in mental health service usage by health insurance coverage. Hospitalizations doubled among kids with commercial health insurance but increased 40% among kids on Medicaid, the publicly funded health insurance program for lower-income people.

On the other hand, children on Medicaid used the emergency room twice as much as kids with private insurance. Emergency room visits increased by 20% among children on Medicaid but actually declined 10% among privately insured kids.

These findings surprised the Clarify Health team, according to Brennan.

“This points to not having adequate numbers of mental health professionals accepting Medicaid patients, as well as the general failure to integrate behavioral health into the primary care and school-based supports provided to these children,” he said.

Overall, use of outpatient mental health services increased by just 5% between 2016 and 2021, including sharp declines in 2020 with the onset of the pandemic. But rates of outpatient service utilization were substantially different by type of health insurance. Mental health office visits and outpatient care increased by nearly one-third for children with private insurance but declined by 2% among children on Medicaid.

The data on kids with Medicaid suggests a troubling dynamic. More emergency room visits and fewer office visits may imply that there are not enough pediatric mental health providers who accept Medicaid to serve all kids who need mental health care.

Insufficient numbers of mental health providers is a broader problem than in Medicaid alone, particularly as demand for mental health care has ballooned during the pandemic.

“Well before the pandemic took hold, the nation was already in the throes of a major mental health crisis,” said Dale Cook, cofounder and CEO of Learn to Live, a digital mental health platform. “There is compelling data indicating that over 150 million Americans suffer annually from a range of mental and behavioral health issues, yet only one in four seeks out treatment. That’s well over a 100 million ‘silent sufferers’—people who need or would greatly benefit from therapy but don’t get help due to stigmatization, access, costs, or other factors. The pandemic has only exacerbated this towering demand.”

With so many young people affected by mental health challenges, many of which begin in high school, Brennan suggests that parents, mental health professionals, and community members need to be aware of changing environmental factors that may exacerbate mental health challenges for teens.

“Health educators, including parents themselves, may need to develop plans to educate adolescents earlier about mental health concerns given the increasing rates of acute care events,” he said.

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