We all need to focus on our children’s mental health

Parents and pediatricians need the right tools, and communities need providers

As a doctor who works in a pediatric intensive care unit, I take care of a lot of extremely sick children. Typically, when a patient is memorable, it is because they have unusual symptoms or a rare illness or injury. But lately there have been several patients who haunt me because of their similarity.

Over the last decade of my career, I have seen a dramatic increase in children and teens who try to harm themselves. They have the same haunted look, the same worried parents, the same palpable sense of despair. I have seen children as young as 9 try to kill themselves. Suicide is the second-leading cause of death for those ages 10 to 24.

And if a child with mental health issues lives in a home with access to a firearm, especially one that is not stored safely, their chances of dying from suicide increases fourfold. Firearms are by far the most lethal method of suicide attempts, so most of those patients do not even make it to pediatric intensive care.

During the pandemic, children have suffered. More than 140,000 children have lost a caregiver during the pandemic, and Black youth have been disproportionately affected by this loss due to inequities related to systemic racism. It is not just the pandemic, though. There was a 60% increase in suicide in children and adolescents between 2007 and 2018.

I sit by the bedside and ask them their stories, and many of them are surprisingly forthcoming. There are often struggles at school, bullying, a sense people would be better off without them or concerns about things like gender or sexual identity. Each story is unique but each feels remarkably similar.

I only see the children who survive, those who told someone what they did or were found by someone, and those who ask for help. For every child who needs my care, there are an untold number who are struggling with mental health issues. The number of children and teens with depression has increased by about a quarter over the last five years, and those with anxiety by about a third. The American Academy of Pediatrics declared a national emergency in children’s mental health last year ....

There has always been a severe shortage of pediatric mental health care professionals. This leads to long waits and sometimes long drives for appointments. About 70% of U.S. counties do not have a single pediatric psychiatrist, and only half of kids with mental health conditions are cared for by mental health providers . ... Around 80% of pediatricians have lost at least one child under their care to suicide, and a growing number of providers are experiencing burnout themselves.

How do we help these children and adolescents?... Parents and families can look out for warning signs in their children, including withdrawing from friends, drastic changes in mood, behavior or performance in school, weight loss, difficulty sleeping, or especially hurting themselves or talking about death or suicide. If you see these signs in your child, please make an appointment with your pediatrician to discuss your concerns. If you have a firearm in the home, please make sure it is locked and stored separately from ammunition ....

Because pediatricians are increasingly treating these kids, we need to invest in giving them the resources and training to screen and treat all children, especially those in underserved populations, for mental health problems. We need to make sure hospitals have adequate staff and beds. We need to involve the community and schools in mental health promotion and suicide prevention by peer-to-peer support programs and awareness campaigns . ... It takes everyone to address this mental health crisis.