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 that people would be better off without them, or concerns about things like gender or sexual identity. Each story is unique, but at the same time, 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.
Because mental health issues are so prevalent in children, it is everyone’s problem. There is still a stigma associated with mental health problems that we need to overcome. We need to normalize the conversation around mental health and suicide. It’s important to emphasize that talking about suicide does not lead to an increase in suicide.
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. These kids are often identified by families or schools and treated by primary care physicians. 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? How do we decrease the risk that they end up in my intensive care unit?
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 that it is locked and stored separately from ammunition. Suicide attempts are often impulsive acts by adolescents, and ready access to a gun can drastically increase risk of death from suicide attempts.
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 that hospitals have adequate staff and beds to take care of those who do need us. We need to involve the community and schools in mental health promotion and suicide prevention by peer-to-peer support programs and awareness campaigns.
I recently joined more than 400 other pediatricians to call and visit elected officials to urge them to prioritize the needs of children and adolescents in any mental health legislation. Specifically, we spoke up in support of two important bills: the Supporting Children's Mental Health Care Access Act and the Youth Mental Health and Suicide Prevention Act. These bills would increase access to mental health care services and provide direct funding to schools for mental health promotion and suicide prevention. They are bipartisan efforts, and they are gaining momentum. Let your elected representatives know you support them.
It takes everyone to address this mental health crisis.
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ABOUT THE WRITER
Dr. Deanna Behrens is a Pediatric Intensive Care Unit doctor in Chicago and a member of the American Academy of Pediatrics.
