More Inpatient Beds Needed to Address Youth Mental Health Crisis

The number of pediatric inpatient psychiatric beds has not risen to meet demand amid a growing youth mental health crisis, according to a Northwestern Medicine-led study published in JAMA Pediatrics.

Young people’s mental health began worsening prior to the pandemic, according to survey data from the Centers for Disease Control and Prevention. By 2021, more than 40 percent of high schoolers reported feeling persistently sad or hopeless, and experts expect the trend to continue. Additionally, youth suicides are increasing, especially among girls and LGBTQ+ students, data shows.

The dearth of beds available for young people experiencing a mental health crisis came into clearer focus for Jennifer Hoffmann, ’13 MD, ’22 MS, assistant professor of Pediatrics in the Division of Emergency Medicine and senior author of the study, when the family of a patient explained how they had to leave their home state of Alaska to find psychiatric care for their teen in Washington.

“From them, I learned that there are no inpatient pediatric psychiatric beds in the state of Alaska,” Hoffmann said. “It was a financial burden, an emotional burden, and it really made me wonder how often this is happening to other families across the country.”

In the study, Hoffmann and her collaborators reviewed hospital data between 2017 and 2020 from across the country. Then, investigators mapped pediatric inpatient psychiatric beds per 100,000 children by state in 2020. They also assessed how the availability of beds in each state was related to median household income, percentage of children in rural areas, and pediatric racial and ethnic composition to assess for inequities in access to care.

There was no significant change in the number of pediatric inpatient psychiatric beds available nationally between 2017 and 2020, according to the study. The majority of beds available were in urban areas, according to the study, which raised concerns for rural children.

“The number of inpatient beds hasn’t changed to catch up with the demand,” Hoffmann said. “This fits with what I see as an emergency medicine physician. Many of my colleagues and I are seeing children get stuck in the emergency department waiting for an inpatient psychiatric bed.”

Insurance reimbursements for mental healthcare are often too low to fully cover the cost of care, Hoffmann said, which may be one reason why the number of beds is not rising quickly enough. Expanding Medicaid reimbursement for children’s mental health services could help the situation, Hoffmann said.

More research is needed to fully understand the financial and emotional toll this takes on children and families in crisis, Hoffmann said.

“Children should have access to mental healthcare no matter where they live in this country,” Hoffmann said. “I think the study illustrates the work that needs to be done to ensure that no matter where a child lives, they have access to mental health services.”

The study was supported by grants from the Pediatric Pandemic Network and the Children’s Research Foundation Junior Board. Additional funding was provided by the Agency for Healthcare Research and Quality.