“For a long time, the culture has been, in the hospital, that medical emergencies are the real emergencies,” said Dr. Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center, who was not involved in the study.
Mental health training, he said, should be provided hospital-wide, “sort of like all medical staff are trained to do CPR.” And, she said, hospitals should be incentivized to add inpatient psychiatric units, which, because of reimbursement rates, “shunt the money.”
The study found a significant change in the types of mental health problems being treated in hospitals, with depressive disorders increasing from 29.7% in 2009 to 56.8% in 2019. Hospitalizations for bipolar disorders, of conduct and psychotic disorders such as schizophrenia decreased, which could reflect better outcomes due to early intervention programs and more comprehensive care.
Rates of suicidal behavior are a “marker of distress” among children who lack coping skills to manage stress and “big emotions,” said Dr. Crawford, who is also an assistant professor at the University of California School of Medicine. Boston University.
“When you really talk to kids who are self-harming, impulsively ingesting Tylenol, they are often talking about an argument they had with a peer or a disagreement they had with an adult,” she said.
In most cases, he said, these children have suffered from diagnosable depression for “many, many months” without receiving treatment. “The kids we’re seeing in the ER are impulsively doing this in the context of some discussion,” she said.
