Rise in youth suicides linked to shortage of mental health workers

A study has found an association between shortages of mental health workers and increased suicide rates among young people, according to findings published in JAMA Pediatrics.

Co-author Jennifer A. Hoffmann, MD, MS, an attending physician in the division of emergency medicine at Lurie Children’s Hospital in Chicago and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, told Healio that “quick action is needed to support the mental health of young people amid what the AAP and other groups have called a “national emergency” in pediatric mental health.

“Since the start of the pandemic, county hospital emergency rooms, including mine, have been inundated with children and youth suffering from severe mental health crises,” Hoffmann said.

Hoffman and colleagues obtained data on 5,034 suicides that occurred among young people between the ages of 5 and 19, from January 1, 2015, to December 31, 2016. The data came from the CDC’s Compressed Mortality File and the US Health Administration resources and services.

Of the 3,133 U.S. counties included in the study, more than two-thirds were designated as areas experiencing mental health workforce shortages.

After adjusting for county characteristics, mental health workforce shortages were associated with an increased youth suicide rate (adjusted incidence rate [IRR] = 1.16; 95% CI, 1.07-1.26), with the rate increasing by 4% for each 1 point increase in score.

“We found that two-thirds of US counties have significant shortages of mental health professionals,” Hoffman said. “Young people living in counties lacking mental health professionals are more likely to die by suicide. This remains true even after accounting for other county characteristics such as rurality and poverty.

The association remained even in firearm suicides, Hoffman said.

“We thought gun suicides would not be linked to mental health workforce shortages because they are less likely to be preceded by a known mental health condition,” Hoffman said. “But we found that youth gun suicides occur more often in counties that lack mental health professionals.”

Increased shortages of mental health professionals were also more severe in rural areas and communities with “lower household incomes and low levels of education,” Hoffmann said.

“Unfortunately, these are the same communities where children are more likely to have poor mental health outcomes,” Hoffman said. “The fact is that mental health service pay and reimbursement rates are far too low.”

In areas experiencing these shortages, Hoffman said, primary care pediatricians should “integrate prevention and treatment of mental health services within the medical home.” “Paediatricians need to be prepared to support children who are waiting to see a mental health professional,” Hoffman said. “Pediatric mental health access programs are available in some areas to connect pediatricians to child psychiatrists for teleconsultation. Primary care providers should ensure that all young people know the national three-digit 9-8-8 dialing code for the suicide and crisis line.

More lasting solutions, Hoffman said, must begin at the federal level.

“We urgently need additional federal investments to strengthen the mental health workforce and expand community services focused on prevention, early identification and treatment,” Hoffman said. “This will prevent young people from having mental health crises that lead to emergency room visits.”

She added that there is an urgent need to fund the Children’s Hospitals Graduate Medical Education Program, which supports the training of half of the country’s paediatricians, and the Children’s Health Insurance Program, to support insurance coverage. children, including mental health services.

Hoffman also named three pieces of legislation to pass: Strengthen Kids’ Mental Health Now Act (HR 7236), which would create new federal programs to train, develop and grow the pediatric mental health workforce, and increase reimbursement for pediatric mental health services to attract and retain mental health professionals; and the Helping Kids Cope Act of 2021 (HR 4944) and the Children’s Mental Health Infrastructure Act (HR 4943), which would make long overdue investments in strengthening the pediatric workforce by mental health by expanding community services to support prevention, early identification and treatment.

“Workforce challenges need to be addressed urgently so children can access mental health care no matter where they live,” Hoffmann said.

References:

Hoffman J, et al. JAMA Pediatrician. 2022; doi:10.1001/jamapediatrics.2022.4419.