Children's Hospital Colorado sounds alarm on 'unsustainable' spike in pediatric mental health cases

An unprecedented surge of acute behavioral health presentations during the last three to four months has the pediatric health system and its community partners pleading for increased state and federal resources. (Children's Hospital Colorado)

A children’s hospital system in Colorado is pleading for increased state and federal government assistance to treat an overwhelming spike in pediatric mental health cases across its communities.

In a press event held this week, Children’s Hospital Colorado CEO Jena Hausmann said her system’s pediatric emergency departments and inpatient units have been “overrun with kids attempting suicide and suffering from other forms of major mental health illness” over the last several months.

Demand has outstripped the system’s supply to the point where the system has about one dozen to two dozen children waiting to access an inpatient behavioral health bed at any given time, David Brumbaugh, M.D., the system’s chief medical officer, said.

“I’ve been in practice for over 20 years in pediatrics and I’ll tell you I’ve never seen anything like the demand for mental health services we’ve seen at Children’s in the last 15 months,” he said. “But in the last three or four months, something has changed even more dramatically. Our acute behavioral health presentations across our children’s hospital system have increased 90% in 2021 compared to 2019.”

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There have also been numerous weeks this year where the No. 1 presentation at Children’s Hospital Colorado’s emergency department is a suicide attempt, “which is really extraordinary,” an emotional Brumbaugh told reporters in between pauses to compose himself.

For many of these patients, he said normal adolescent hardships such as not being named to the high school baseball team have been amplified by pandemic stressors and other disruptions to normal emotional development.

“Our kids have run out of resilience. Their tank is empty. That’s where we are right now as a system and a state,” he said.

Chief Nursing Executive Pat Givens echoed Brumbaugh’s characterization of the crisis and noted that newly built units and programs have already been tapped out. The system has brought on temporary staff to meet the immediate challenges, she said, but continuing to do so will be “unsustainable” for the system as it plans ahead for seasonal increases in physical health services demand and, potentially, a resurgence of COVID-19.

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The situation has led Children’s Hospital Colorado’s CEO to declare what she called the first “pediatric mental health state of emergency” of the system’s 117-year history. By doing so, Hausmann hopes that the state government and other partners will be willing to come together to support overloaded providers, schools and other community programs across the state.

“Please know, there are so many other organizations across our state that are equally overwhelmed. The sheer magnitude of this situation warrants a different level of support—it’s required by state and federal government,” she said. “The current system is simply unsustainable and it’s failing our children.”

The health system’s call to action had the backing of some local-level government officials.

Tamara Pogue, commissioner for Colorado’s Summit County, told reporters that community mental health resources across the rural region have been stretched to their limits. Summit County’s school-based programs have been unable to attract additional behavioral health providers, she said, and a program providing children’s mental health therapy to those unable to pay had issued more vouchers by April than it did across the entirety of 2020.

Several other counties in the state are facing similar challenges, Pogue continued, but may not have the same safety net social programs or mental health budget support as Summit County does. For each of these regions, she said more resources and support from the top are desperately needed to address preventable deaths among children.

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“These deaths are tragedies, but for me, an equal tragedy, perhaps an entirely different tragedy, is that we are not spending the financial resources we need to spend on building a safety net, on building a system of care that can actually address this epidemic,” she said. “I beg for all partners to come to the table to make deeper investments in creating a safety net, in creating the deep level of care that we would treat any other illness with. We are desperate in communities across Colorado … for help and partnership and collaboration.”

A release from Children’s Hospital Colorado highlighted $3.9 billion allocated for Colorado under the American Rescue Plan Act signed by President Joe Biden in March. The hospital system wrote that “a fair amount” of that federal relief must be directed toward pediatric mental health resources in addition to other support from the state and other partners.

The system’s cry for help is a clear example of the rising prevalence of pediatric mental health conditions during the COVID-19 pandemic as well as the strain it’s placing on providers.

A Centers for Disease Control and Prevention report from November outlined an increase in the proportion of mental health presentations across children’s emergency department visits during the early days of the pandemic. Although claims data from the Centers for Medicare and Medicaid Services suggested new use of virtual behavioral health services among children, more recent data indicated a 34% decline in mental health services use among beneficiaries under the age of 19.

In a Kaiser Health News report from January, Children’s Hospital Colorado and other pediatric care providers such as Children’s National Hospital in Washington, D.C., and Cincinnati Children’s Hospital Medical Center in Ohio gave early warnings of the increased burden their behavioral health units were facing. Other providers said they have had to shutter inpatient psychiatric units completely due to the financial strain COVID-19 placed on their organizations.