Children’s hospitals and health systems across the country have experienced an influx of young people coming into their emergency departments for mental health-related emergencies. Such increases add to growing concerns that the nation is now facing an epidemic within a pandemic of children with undiagnosed, unmanaged and untreated mental health disorders. Modern Healthcare’s population health reporter, Steven Ross Johnson, spoke with Dr. Tom Shanley, president and CEO of Ann & Robert H. Lurie Children’s Hospital in Chicago, about ways executives are handling these challenges, which could have long-term implications for how healthcare addresses this burgeoning crisis. The following is an edited transcript.
MH: What is Lurie Children’s current situation in terms of dealing with the capacity, staffing and care delivery challenges the pandemic has created within your behavioral health units?
Shanley: Both locally … and from our peers across the country, (we are seeing) a tremendous challenge in terms of the pandemic accelerating what we had already seen as mental health challenges in the pediatric, adolescent, young adult space. We have incurred similar types of challenges in the various domains in which we provide mental and behavioral healthcare, which includes both the inpatient setting and the outpatient setting.
We have a fairly multidisciplinary approach in terms of children who come for urgent or emergent care through the emergency department. We are able to leverage our emergency medicine experts in combination with our psychiatry experts, along with the social work support structure that we have within that environment. We have seen quite a bit of demand; our inpatient setting has pretty much remained at full capacity throughout the pandemic, but we were a little bit better prepared to deal with what many have seen as a real surge from that aspect by developing some programs that looked to move more upstream in what we called collaborative care program models.
I would (highlight) two of those, one in the outpatient setting where we’ve worked with a number of (primary-care physicians) within our clinically integrated network to enable them to better manage some of the fundamental basics around medication management, for example, for patients with anxiety or depression. We tried to do that earlier, even pre-pandemic. And I think that’s helped create a strong workforce to be able to partner with us in handling some of those expectations.
On the inpatient side for many years as well, we’ve recognized that mental health can sometimes overlay chronic illnesses or complicate those challenges. We’ve embedded (psychologists) and (psychiatrists) in our inpatient setting in some pilot models to be able to support those needs. We’ve actually had great success with that in reducing our length of stay, for example, and being able to get them connected to the appropriate mental health support structures that they needed.
There’s been an acceleration during this time, but even beforehand, I think we tried to strategically put in some programs to help offset some of those surges.
MH: There’s been a push within adult settings for integrating behavioral health within primary care. Have you seen that in the pediatric world?
Shanley: I can’t speak too broadly, but certainly that’s been our strategic approach. As we think about our partnership with the clinically integrated network, we have about 180 primary-care physicians (with whom) we have developed a module that enables them to learn. It’s actually very nice for them because it’s maintenance-of-certification qualified, so they also garner the benefit of that. But it’s really been working with those types of educational opportunities of arming them with the appropriate capabilities of being able to manage some basic stuff, and we’ve really seen that to be a strong attraction in terms of those practices.
The psychology and psychiatry trained workforce is too limited to meet the needs and the capacity demands of the current situation. We have to, I think, globally leverage different care models in different types of care providers, including primary-care physicians as you’re asking, but I think this extends into the school setting and the community-based setting as well, and other models that we can consider being able to meet these needs.
MH: What would you say has been the pandemic’s greatest impact on your behavioral healthcare services?
Shanley: What we’ve really seen are three types of scenarios. We see one where the majority of children in the current situation have had significant stress and strain related to the lack of the socialization opportunities—schools, clubs, sports, etc. It’s unraveled some risks toward anxiety and depression, but I think the vast majority, what we’re seeing as we get them connected to some of our programs, they’re continuing to do very well and they have great resiliency. And I think the majority of kids will do well through this pandemic. Certainly it’s going to be a memorable event, but I don’t think there’s going to be a long-term impact on the majority of those children.
We’ve also had a couple other scenarios: one with children and adolescents, young adults with mental health diagnoses and the lack of confidence in coming into the healthcare environment because of viral transmission risks, etc., which probably left them under-treated and under-managed, or there could be access issues as well that we’ve seen throughout this in terms of a contraction of pediatric mental health services.
And then there’s the third group in which the environment that has created a support infrastructure to help them manage and be resilient has been devastated by the pandemic. You can think about housing insecurity, food insecurity, the lack of school and socialization component of it, even unfortunately, the death of seniors who have been a stabilization force for a number of families. The loss of that supporting environment has created really significant impact on many of those children, undercutting their sources of resiliency and stability.
So many of our community-engaged activities that we have through our Patrick M. Magoon Institute for Healthy Communities are directed at trying to understand those and being able to plug some of those gaps and create a stronger source of foundation for those kids that are super high risk.