The Mental Health Crisis from COVID Continues, Now with Our Workforce
Robert Hilt, MD
PAL Clinical Director
For all of you on the front lines of healthcare, to make a statement like “the mental health crisis continues for kids” is just stating what you already know. But I think it is worth taking a moment to reflect on our current state.
Children and families have been under a lot of increased stressors during the COVID pandemic. It was hoped in general that as children returned to school this fall that their life experiences would normalize and the youth mental health crisis would start to return to a prior baseline. Unfortunately, that has not been the case from what we have seen so far.
Previously observed elevated rates of Emergency Room visits for suicidality for youth have not shown signs of improvement, resulting in a very common experience of youth in need of inpatient care boarding in ERs for days or even weeks while waiting for hospital bed availability. You all have been reporting to us very high rates of mental health visits in your primary care practices (for some of you approaching 50% of your practice), and qualitatively seeing more high acuity cases who are not engaged in other mental health care.
We used to think this was simply driven by increased family and youth stressors impacting kids, but over time state agencies and others have come to recognize we also have a COVID-related workforce problem.
In essence, there are many individual outpatient therapists who have chosen (for a variety of personal reasons) during the pandemic to restrict or to completely close down their outpatient practices which makes outpatient therapy availability a worsening problem. For instance the WA state community mental health agency system, which serves most of the state’s Medicaid covered youth, has identified that their available workforce has decreased by as much as 40% throughout the pandemic. Commercial health plan outpatient provider access is not much better, for instance in WA the Mental Health Referral Service finds it can easily take 20 different calls to “covered” providers to find one therapist with any current availability—something families are rarely able to do on their own. This significant decrease in workforce has essentially broken what was an already strained system.
There is a lot of talk happening and steps being taken to alleviate the crisis, such as increasing outpatient behavioral health care rates to entice therapists back into the profession, increasing training program supports, increasing school based early interventions/supports which might aide in prevention, and enhancing crisis support services which could deliver care families may find more practical/useful than an ER visit.
For now, when you hear from a parent that they are struggling to find a therapist for their child, I just think it is helpful to add to your awareness that there really are fewer therapists available to families. What may have once been considered an unacceptably long wait to get in to outpatient care, might now be seen as a youth’s best option.
• National Suicide Prevention Lifeline: Call 800-273-8255 (English) or 1-888-628-9454 (Español).
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News & Notes
Holiday Closures
PAL will be closed in observance of the following holidays:
- Thursday, November 25 - Thanksgiving
- Friday, November 26 - Day after Thanksgiving
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PAL Spotlight
 David Camenisch, MD/MPH has been a member of the PAL team since 2010. He enjoys the collaborative aspects of peer consultation as it is a valuable source of learning for him. Training in both pediatric and child psychiatry has provided many opportunities to consider the relationship between medical and mental health issues. As a result, he has been drawn to practice opportunities where he can work at the interface. In addition to PAL duties he currently works at the Seattle Children’s Autism Center and is a psychiatric consultant for Catholic Community Services of Western Washington.
David attended medical school at Tulane University in New Orleans. Prior to starting his medical education, he received a Master’s in Public Health, also at Tulane; with an emphasis on cross cultural psychiatry. He completed the combined training program in pediatrics, general psychiatry and child and adolescent psychiatry at Brown University. David lives in the Capitol Hill neighborhood of Seattle with his wife, Laurie and dog, Reggie. David enjoy traveling, biking, gardening and all gustatory endeavors.
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Upcoming CME Conferences
Conferences:
Conference: Webinar
February 26, 2022
Vancouver, WA
April 30, 2022
Spokane, WA
June 11, 2022
Conferences run 8:00 AM - 12:30 PM and are FREE to attend.
Registration opens two months in advance.
CME credits are available.
Visit our website for the most updated information on upcoming conferences and to view slides from our previous conferences.
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