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Youth are in crisis, and our mental health system is failing them


Credit: Getty Images.

Credit: Getty Images.

Elva Etienne/Getty Images

You stare at the clock: The hour hand has once again moved, though you have not. It has now been four hours since you’ve entered the waiting room of your local ER, but getting a bed, let alone a room, isn’t even an option. 

Your daughter sitting next to you is begging to go home. “Mom, I didn’t mean it!”

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She didn’t mean to tell her pediatrician that she had a plan to take her life.  

Finally, you’re speaking with the ER doctor, who is on her third shift in a row and asking a short set of mental health questions in between yawns. Your daughter answers “No” to every question, even as you reiterate what the nurse practitioner told you earlier in order to get her seen. The ER doctor sighs in relief: one less admission. Besides, there’s no psychiatry consult available in the hospital and all the beds on the psych unit are full.

Tears fall as you sign your discharge paperwork and the recommendation to follow up with a therapist is tossed over the doctor’s shoulder on her way to the next patient. You’ve waited all this time, and nothing has changed.

It isn’t the doctor’s fault. The staff is overworked and underpaid, and the phone calls from the pediatrician’s office to the surrounding hospitals were a long shot. But you were told that if your child ever threatened to kill themselves, you should come to the emergency room. … So now what? 

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Sadly, this paints a typical day in emergency rooms across the country as the mental health crisis continues to rage on. While people focused on the COVID-19 pandemic, another pandemic arose: Many children are struggling with depression, and a lack of adequate staff and mental health resources has left providers burned out and picking up the pieces.

Studies suggest that depression is growing in children at younger and younger ages. The federal Centers for Disease Control and Prevention reported that from 2007 to 2021, the overall suicide and homicide rate among youth ages 10 to 24 increased; overall rates in this age group increased from 2019 to 2020 specifically. 

We providers continue to see waiting periods of six months or longer to get a child an outpatient appointment with a therapist or psychiatrist. Teens are waiting until their annual physical to tell someone that life has been too much and that they are looking for an escape. Children at 6 years old sit on the exam table looking at the floor as they tell you they hate themselves and are afraid to go to school.  

The Association of American Medical Colleges wrote in 2022: “Already, more than 150 million people live in federally designated mental health professional shortage areas. Within a few years, the country will be short between 14,280 and 31,109 psychiatrists, and psychologists, social workers, and others will be overextended as well.”

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Because of this shortage, pediatricians are resorting to providing mental health care at well-child and sick visits. Parents are now turning to those providers for medication requests, such as seeking antidepressants, because they’re at their wit’s end waiting for mental health assistance. 

We used to live in a world where wait times in our ER was 45 minutes, children would climb trees and play in the dirt rather than scroll, and a physical for your child was not all about suicide prevention.  

We pediatric providers not only have the responsibility of ensuring children are safe; we also have the privilege of being strong enough to make these problems known and push for change. Mental health care is on the verge of collapsing, and our nation’s children are being caught in the rubble. 

Victoria McMullen of South Bethlehem is a certified pediatric nurse practitioner and pediatric mental health specialist.

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