“For so long, the culture has been, in the hospital, that medical emergencies are the true 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, she said, should be given throughout the hospital, “kind of like how everyone in the medical staff is trained on how to do CPR.” And, she said, hospitals need to be incentivized to add inpatient psychiatric units, which, because of reimbursement rates, “hemorrhage money.”
The study traced a major shift in the kinds of mental health problems being treated in hospitals, with depressive disorders rising to 56.8 percent in 2019 from 29.7 percent in 2009. Hospitalizations for bipolar disorders, conduct disorders and psychotic disorders like schizophrenia decreased, which could reflect better outcomes due to early intervention programs and more wraparound 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 Boston University School of Medicine.
“When you actually talk to kids who engage in self-harm, who impulsively ingest the Tylenol, they oftentimes talk about an argument that they had with a peer, or a disagreement that they had with an adult,” she said.
In most cases, she said, these children have suffered from diagnosable depression for “many, many months” without being treated. “The kids we’re seeing in the emergency room are doing this rather impulsively in the context of some argument,” she said.