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’s 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 the number of children and adolescents who attempt to harm themselves. They have the same haunted gaze, the same worried parents, the same palpable despair. I have seen children as young as 9 try to kill themselves. Suicide is the second leading cause of death among 10 to 24 year olds.
And if a child with mental health issues lives in a home with access to a gun, especially one that isn’t safely stored, their chances of dying by suicide increase fourfold. Guns are by far the deadliest method of suicide attempts, so most of these patients don’t 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 impacted by this loss due to inequalities linked to systemic racism. But it’s not just the pandemic. There was a 60% increase in suicides among children and adolescents between 2007 and 2018.
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I sit next to the bed and ask them for their stories, and many of them are surprisingly open. There are often struggles at school, bullying, feelings 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 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 countless who struggle with mental health issues. The number of children and adolescents suffering from depression has increased by around a quarter in the last five years, and those suffering from anxiety by around a third. The American Academy of Pediatrics declared a national emergency for children’s mental health last year.
Because mental health issues are so prevalent in children, it’s everyone’s problem. There is still a stigma associated with mental health issues that we need to overcome. We need to normalize the conversation about mental health and suicide. It is important to emphasize that talking about suicide does not lead to an increase in the number of suicides.
There has always been a severe shortage of pediatric mental health professionals. This leads to long waits and sometimes long journeys for appointments. About 70% of US counties do not have a single child psychiatrist, and only half of children with mental disorders are cared for by mental health providers. These children are often identified by families or schools and treated by primary care physicians. About 80% of pediatricians have lost at least one child in their care to suicide, and a growing number of providers are suffering from burnout themselves.
How do we help these children and adolescents? How do I reduce the risk of them ending up in my intensive care unit?
Parents and families can watch for warning signs in their children, including withdrawal from friends, drastic changes in mood, behavior or performance at school, weight loss, difficulty sleeping, or especially getting hurt 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 at home, make sure it is locked and stored separately from ammunition. Suicide attempts are often impulsive acts on the part of adolescents, and easy access to a firearm can significantly increase the risk of death from attempted suicide.
Because pediatricians are increasingly treating these children, 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 issues. We need to make sure hospitals have the right staff and beds to care for those who need us. We need to involve the community and schools in mental health promotion and suicide prevention through peer support programs and awareness campaigns.
I recently joined over 400 other pediatricians in calling and visiting elected officials to urge them to prioritize the needs of children and adolescents in any mental health legislation. More specifically, we voted in favor of two important bills: the Act to promote access to mental health care for children 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. These are bipartisan efforts, and they are gaining momentum. Let your elected officials know that you support them.
It takes everyone to deal with this mental health crisis.
Dr. Deanna Behrens is a pediatric intensive care unit physician in Chicago and a Fellow of the American Academy of Pediatrics.