Colorado's pediatric mental health crisis continues, professionals say

May 24—A year after Children's Hospital Colorado declared a state of emergency for pediatric mental health on May 25, 2021, officials say the situation has worsened, as record demand for treatment continues to overwhelm capacity.

"The number of children who are coming to us for emergency department care who are in crisis is higher, and our inpatient unit continues to be full," said Zach Zaslow, senior director of government affairs for Children's Hospital Colorado, which operates 16 urgent, emergency and specialty locations statewide.

In the first quarter of this year, the system has seen a 23% increase in patients coming to emergency departments with suicidal thoughts, major depressive episodes, psychotic breaks and other mental illness, compared to the first quarter of 2021.

That's a 103% increase above the first quarter of 2019, before the pandemic began, officials said.

Also, Zaslow said, more preteens and teenagers are staying longer in emergency departments or hospital beds than necessary because there's nowhere for them to go.

"They're ready to discharge, but they're not ready to go home, and there's no residential bed or community foster home willing to accept them," he said.

The state's most pressing challenge is the workforce shortage, said Minna Castillo Cohen, director of the Office of Children, Youth and Families in the Colorado Department of Human Services.

The office oversees child welfare and youth offender systems.

The need in Colorado is shifting from generalist providers to specialists, Castillo Cohen said.

"We recognize that our placement continuum for young people needs to have that right composition so we can meet individual needs of all kids, from community-based services a child can receive while living at home with their family up to most intensive treatment in psychiatric residential care," she said.

Psychiatric residential treatment facilities, which serve the most severely mentally ill children, are particularly lacking employees, Castillo Cohen said.

Data also show the need for providers who specialize in youth substance use disorder is exceeding capacity, she said.

The Pikes Peak region continues to see "significant mental health needs," said Cari Davis, executive director of the Colorado Springs Health Foundation.

The organization was established 10 years ago through the lease of Memorial Health System to University of Colorado Health and awards grants in El Paso and Teller counties that target immediate health care programs.

The 2021 Colorado Health Institute Colorado Health Access Survey showed that 35% of El Paso County residents ages 16 and older experienced a decline in mental health because of the COVID-19 pandemic.

"The need was great before the pandemic but is now even greater," Davis said. "All age groups have suffered, but youth seem to have been particularly affected."

About one-third of the Colorado Springs Health Foundation's grants — a payout of more than $8 million over the next three years — is allocated for mental health and substance use disorder programs in the community, she said.

Nationwide, teens are the saddest they've ever been, according to a 2021 study from the Centers for Disease Control and Prevention.

American high school students who said they experienced persistent feelings of sadness or hopelessness increased from 26% in 2009 to 44% in 2021, according to the study. And one in five high school students nationwide said they have contemplated suicide.

The CDC numbers coincide with what Children's Hospital Colorado emergency departments are seeing, Zaslow said.

Suicide remains the leading cause of death for children and young adults ages 12-24, according to the Colorado Attorney General's Office.

But Mental Health America's latest report on youth mental health released Tuesday ranked Colorado as 13th in the nation, indicating it's in the range of having a lower prevalence of youth mental illness and higher access to care than states listed below it.

Attorney General Phil Weiser credits in part the Department of Law providing nearly $1 million since 2018 on Sources of Strength, a school-based suicide prevention program involving peer leadership, emotional support, and the importance of adult connections and seeking help.

Such programs "play a pivotal role in empowering teens across Colorado," Weiser said in a statement.

Lawmakers took notice of the alarm industry leaders sounded last year, Zaslow said.

"We really have seen a remarkable increase in awareness and sensitivity that this is a problem that needs immediate solutions, from elected officials at every level of government," Zaslow said. "The reality is folks are seeing this in every community in the state."

A COVID-relief fund legislators designated in the 2021 session for behavioral and mental health partially was allocated in this year's session through 13 bills that include adding behavioral health services for juvenile offenders and increasing treatment beds.

State lawmakers also supported increases in Medicaid reimbursements, community-based behavioral health programs, workforce training and telehealth services.

Under system reform, duties of a new Behavioral Health Administration were set this session to build a more family-friendly and easier-to-navigate process and make other improvements.

Whether families use private-pay or government-subsidized insurance, Castillo Cohen said the goal is to find "solutions to provide community-based care first and foremost before anybody needs to access residential care."

But it takes time, industry leaders said, for changes to come online and start making a difference for children and families.

County human service workers continue to see the need expanding daily, said Lexie Kuznick, director of the Colorado Human Services Directors Association, which last year pled with state officials for relief for acute patients in the child welfare and juvenile justice systems awaiting treatment.

"Kids in crisis today cannot wait a month or two or six to end up in the most appropriate treatment setting," she said. "We need to come up with creative solutions to the hiring challenges in residential facilities and the severe shortage of appropriate placement options for our highest-need children and youth in the short-term, while we continue to expand prevention and early intervention supports in the longer term."

Advocates are pivoting attention to congressional lawmakers to back the Strengthen Kids Mental Health Now Act, a comprehensive proposal that would provide money for states to decide how best to spend the funding in their communities and boost school-based programs, the workforce and agency partnerships.

"We need more sustained investments as temporary COVID dollars expire and clinicians tell us we're going to see a cohort of kids impacted by stresses of the pandemic needing sustained support," Zaslow said.

"The crisis in youth mental health is a pandemic in its own right."

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