AAP Voices Blog

Imagine awakening in a sterile, cold hospital room. The scratchy paper scrubs covering your body offer little warmth and leave you uncomfortable and feeling exposed. You have no way to communicate with your family.

An unfamiliar, masked figure watches you from near the doorway, illuminated only by the light from a nearby computer.

No one you know can visit you because you have COVID-19. Your mood and mental health are in upheaval because of the worsening global pandemic. You must wait, and you have never felt lonelier because of your severe depression.

Unfortunately, this scenario is one I have seen several times and it has been experienced by many children as they wait in hospitals for acute care psychiatric facility placement across the country.

It is our duty as pediatricians to advocate for a better bridge to therapy while our young patients await psychiatric care.

A recent study in the journal Pediatrics found that over the first three months of the 2020 COVID-19 pandemic, there was a significantly higher rate of suicidal ideation reported in pediatric emergency rooms when compared to the same months in 2019. Prior to the pandemic, an average wait for pediatric psychiatry bed on an inpatient service was 2 to 3 days; since the pandemic began, these wait times have only increased.

For patients who test positive for COVID-19, these wait times extend 10-14 days as the children await clearance of the virus to avoid outbreaks in psychiatric units. As pediatricians, we recognize that our patients admitted for psychiatric care already have faced challenges due to limited psychiatric care facilities and difficulties with care coordination, and the COVID-19 pandemic has magnified these pre-existing problems.

In a 2016 American Psychiatric Association position statement, it was noted that the CDC estimated that 1 in 5 children had experienced a debilitating mental health crisis. Over the past 15 years, pediatric emergency room visits for psychiatric crises have doubled. As a result of this rise and the lack of growth in mental health resources to match, more and more pediatric patients are admitted for psychiatric holds on pediatric units.

For years, patients needing psychiatric care have had prolonged hospital stays while waiting on a psychiatric bed placement after medical clearance. In fact, 94% of pediatric patients awaiting psychiatric bed placement are admitted for boarding prior to going to a specialized pediatric mental health unit. In the interim, many facilities provide psychiatric consultations before this transfer.

Now, in the wake of the COVID-19 pandemic and with availability of health care providers further restricted and stretched thin at hospitals, most of these interventions have been put on pause to minimize the risk of infection.

So now, our patients wait alone and without the care they need.

Pediatric hospitalists typically are tasked with admitting COVID-19-positive pediatric psychiatric patients to general pediatric wards teams before psych placement. It is our duty as pediatricians to advocate for a better bridge to therapy while our young patients await psychiatric care. We must work to develop and adapt a supportive, therapeutic milieu for these patients who are restricted to their room but still in acute need of the care that only a psychiatric ward provides.

Beyond medication management, psychiatrists and behavioral therapists need a platform to interact with these patients daily. Not only does this level of therapeutic interaction require personnel but also ways to communicate meaningfully with minimal risk of COVID-19 exposure.

Health care institutions need to increase the availability of digital devices for telecare and support staff to communicate with patients using virtual platforms. Telepsychiatry and telepsychology have evolved during the pandemic to offer resources for outpatient care through online provider visits. Adaptation of these services and the addition of clinical social workers who are a key presence on inpatient units with video appointments could provide an alternate therapeutic milieu similar to the resources of a psychiatric unit.

This bridge to caring professionals could be an important lifeline to many young patients.

In this time of need, with a strain on hospital beds and with limited resources, it is important to adapt, use technology, and continue to serve and treat our patients. With these tenets in mind, pediatricians must be active partners with their psychiatry colleagues in approaching institutional administration to lobby for resources and personnel to provide digital interventions for interim care.

Together, we need to advocate for resources and a new pathway of care for our COVID-19 positive patients suffering from mental illness so that they do not continue to suffer alone.

Special thanks to my writing group who helped with this blog: Tamara Gayle, MD, FAAP, Priti Bhansali, MD, and Elizabeth Hubbard, MD.