Trends in Inpatient Psychiatric Treatment of Children and Teens Post-Pandemic

Did Pediatric Mental Hospitals Admit More Teens During COVID Than Before COVID?

When the coronavirus pandemic arrived in the U.S. in early 2020, very few people knew what to expect. Among experts and laypeople alike, almost no one had any confidence in making long-term projections about what would happen.

Here’s a list of the primary questions everyone wanted answers to:

How long would it last?
How many people would die?
Who is most vulnerable?
Who is least vulnerable?
How can I protect myself and my loved ones?

Before long, we had answers to several of these questions. To answer the last question first, we learned that wearing masks, maintaining social distance, and decreasing non-essential contact with others could slow the spread of COVID.

Hence all the public health measures all of us know about and are all to familiar with.

Unfortunately, the first question remains unanswerable. It’s a source of frustration for every single one of us. With regards to the second question, the answer is both ever-increasing and tragic. The loss of life we’ve seen from COVID-19 is heartbreaking. It’s something it will likely take years to come to terms with – and initial data says it’s already decreased life expectancy in the U.S. by close to two years.

With that said – and acknowledging there’s no smooth transition from talking about a nationwide death toll of almost a million people – we can list what we have learned about who’s most at risk of contracting COVID and developing severe complications. According to the Surgeon General’s Advisory on Youth Mental Health published in January, here’s what we know about who’s most vulnerable.

COVID-19: Increased Risk of Serious Illness

  • The elderly
  • Elderly in group care facilities
  • People with pre-existing health conditions
  • People with pre-existing mental health conditions
    • Depression
    • Bipolar disorder
    • Schizophrenia
  • Racial and ethnic minority groups
  • Frontline, essential workers
    • Healthcare providers
    • Service industry professionals
  • People living in urban areas
  • LGBTQ+ youth
  • People with a history of trauma

The answer to the question Who’s the least vulnerable? is not as simple as it seems. What we do know is that while everyone on earth is at risk of contracting the virus, without exception, those who are at lowest risk of developing serious illness or dying include children, adolescents, and healthy young adults with no risk factors or complications. As we learn more, though, that may change: as time passed, we’ve seen increased incidence of severe illness in young, healthy adults, which is cause for concern.

Adolescent Mental Health During COVID: Increase in Depression, Anxiety, Suicidal Ideation

While all physical health indicators told us our teens were among the least vulnerable to the worst aspects of COVID-19, mental health indicators told use the opposite. Early in the pandemic experts in adolescent and teen mental health warned us that mitigation measures would have a significant negative impact on adolescent mental health.

When the research began to appear in early 2021, the numbers proved they were right. By almost all measures, youth and adolescent mental health deteriorated during the pandemic. Here are the key metrics from the Surgeon General’s Report:

  • Anxiety among adolescents increased
  • Depression among adolescents increased
    • Moderate depressive episodes increased
    • Major depressive episodes increased
    • Severe depressive episodes increased
  • Non-suicidal self-injury increased
  • Suicidal ideation increased
  • Suicidal behavior increased
  • Stress levels around school, grades, and the future increased

Expert agree the mitigation measures caused these negative consequences for the following reasons:

  • Missing important social and developmental milestones
  • Virtual school
  • Isolation at home with family
  • Decreased social contact, which caused:
    • Less peer support
    • Less unsupervised teen time
    • Fewer opportunities to simply hang out and have fun, supervised or unsupervised
  • Parental stress due to:
    • Worry over illness
    • Job loss
    • Income insecurity

Right now, we’re dealing with all these consequences: as our teens return to school and we all seek to find a balance in the new normal, we’re in a place where our teens need our help more than ever. To learn more about the current state of teen mental health in the U.S., please read this article:

Adolescent Behavioral Health: The Current State of Teen Mental Health after Two Years of Pandemic Mitigation Measures

These reports led us to research another question on this topic:

Did admissions to teen psychiatric hospitals increase or decrease during COVID?

Two new studies have answers.

Adolescent Mental Health During COVID: Psychiatric Hospital Visits

Two studies published recently examined data from two different types of hospitals: one looked at hospital visits to regular hospitals for all reasons before and during COVID, while the other looked at visits to a psychiatric hospital before and during COVID.

We’ll share what the researchers found, starting with the study that examined hospital visits by teens before and during COVID for all reasons. That study is relevant to us because to the size and scope. It examined records from adolescents for 2010-2019 for the before COVID data, and during 2020 for the during COVID data. Researchers had access to almost five and half million patient records from 49 hospitals that contribute to the Pediatric Health Information Systems database.

Here’s what they found:

  • An overall 45% reduction in visits to pediatric hospitals for all pediatric conditions
  • A 27% decrease in billing for all pediatric conditions
  • A decrease in winter increases for:
    • Asthma
    • Bronchiolitis
  • A decrease in summer increases for:
    • Trauma (i.e. accidents)
  • A decrease in overall visits for mental health conditions

Researchers explain all these reductions in terms of the mitigation measures. Asthma and bronchitis numbers were down due to masking and decreased contact, and summer visits for trauma were down due to decreased group activities such as competitive sports. Researchers expressed surprise at the decrease in visits for mental health conditions, in light of the gathering data indicating significant increases in mental health disorders among teens.

However, a patient survey included in the first study indicated that over a third of parents delayed seeking treatment for their adolescents during COVID, because of fears of contracting COVID at the hospital.

Now let’s have a look at that second study.

Inpatient Mental Health Hospitalization For Teens Before and During COVID

This study did not have the enormous samples size the first study had, but it did look at specific metrics that are important to us. They examined the records of over five hundred youth – average age of 14 – admitted to an inpatient psychiatric hospital in Houston, Texas. What’s helpful about this study is that they kept records on the prevalence of specific mental health diagnoses both before and during COVID, which helps us make valid comparisons.

Here’s what they found. The regular numbers represent total admissions for that disorder, while the percentages represent the prevalence of that specific disorder among all admissions. Reminder: these numbers come from a specialized inpatient mental health facility for youth, teens, and minors.

Trends in Psychiatric Hospital Admissions Among Youth: Pre-COVID and During COVID

(Pre-COVID: March-August 2019/During COVID: March-August 2020)

  • Total Admissions:
    • 2019: 323
    • 2020: 193
  • Suicidal Ideation:
    • 2019: 2 (2.10%)
    • 2020: 2 (2.01%)
  • Suicidal Behavior:
    • 2019: 1 (1.27%)
    • 2020: 1 (1.23%)
  • Abuse:
    • 2019: 118 (35.8%)
    • 2020: 69 (36.5%)
  • Schizophrenia/Psychotic Disorders:
    • 2019: 41 (12.7%)
    • 2020: 20 (10.4%)
  • Bipolar Disorder:
    • 2019: 22 (6.8%)
    • 2020: 9 (4.7%)
  • Depressive Disorders:
    • 2019: 138 (42.7%)
    • 2020: 89 (46.1%)
  • Anxiety Disorders:
    • 2019: 9 (2.8%)
    • 2020: 9 (4.7%)
  • Obsessive-Compulsive Disorders:
    • 2019: 2 (0.6%)
    • 2020: 2 (1.0%)
  • Trauma-Related Disorders:
    • 2019: 91 (28.2%)
    • 2020: 50 (25.9%)
  • Gender Dysphoria:
    • 2019: 2 (0.6%)
    • 2020: 3 (1.6%)
  • Disruptive, Impulse Control, and Conduct Disorders:
    • 2019: 55 (17.0%)
    • 2020: 32 (16.6%)
  • Substance Use Disorder:
    • 2019: 56 (17.4%)
    • 2020: 58 (30.1%)
  • Neurodevelopmental disorders:
    • 2019: 80 (24.8%)
    • 2020: 45 (23.3%)

When we first saw these studies, before we examined the data, we expected increases in admissions – but that’s not what we saw. Our expectations were based on the preponderance of data indicating increased mental health issues among teens. The explanation extracted from the patient survey we mention above goes a long way to explaining the decreases we see.

There are also three things we’d like to point out, in the larger context of the decreased numbers:

1. Depression

The percentage of admissions for depression increased by 4 percent.

2. Anxiety

The percentage of admissions for anxiety increased 2%. That’s a numerically small increase, but compared to pre-COVID, it’s double

3. Substance Use Disorder (SUD)

The percentage of admissions increased around 13%. That’s also nearly double, compared to pre-COVID.

All this data points to something the Surgeon General makes clear in his report: right now, in the U.S., teens need more mental health support than at any we know about. Meaning that since we started keeping records on adolescent mental health, our teens are at their most vulnerable – despite the overall decrease in visits to hospitals for mental health reasons indicated in the first report.

We’ll explain why.

Increased Stress, Delayed Treatment, Increased Problems: A Cycle to Avoid

We’ll be one hundred percent honest.

When we found the studies and began researching the data in this article, we expected something completely different. We expected to write a different article. One with a simple message that we thought would go something like this:

With the new evidence from the surgeon general and these two new studies indicating increases in inpatient psychiatric hospital visits for teens during the pandemic, our teens are clearly in crisis – and they need our help.

Then we read the studies, and what we learned changed the first part of that message. But it did not change the last phrase at all.

What we learned is that during the pandemic – even though mental health symptoms increased across the board for adolescents – their increased symptoms did not lead to a substantial increase in visits to hospitals for mental health reasons. We expected to see an increase in visits to inpatient psychiatric hospitals, children’s inpatient psychiatric units, inpatient mental health facilities, and mental hospital for teens, minors, and kids.

We didn’t see that.

What we saw, though, trips alarms for us.

Why?

From where we stand, an increase in need paired with a decrease in seeking treatment is not a good combination. It’s a recipe for the kind of mental health crisis among teens the Surgeon General warns us about in his January report.

Our simple message now is this: our teens need us now more than ever.

Evidence-Based Treatment for Teens

We want to make sure parents reading this article – those new to reading and learning about adolescent mental health – understand that evidence-based treatment for mental health, behavioral, and/or addiction disorders works and is available right now.

Integrated, individualized treatment is appropriate for teens with the following:

  • Mood Disorders:
    • Depressive Disorders
    • Bipolar Disorder
    • Mood Disorder + Substance Use Disorder
  • Anxiety Disorders:
    • Generalized Anxiety Disorder
    • Social Anxiety Disorder (Social Phobia)
    • Panic Disorder
    • Post-Traumatic Stress Disorder (PTSD)
  • Behavioral Disorders:
    • Oppositional Defiant Disorder (ODD)
    • Disruptive Mood Dysregulation Disorder (DMDD)
  • Addiction:
    • Alcohol Use Disorder (AUD)
    • Substance Use Disorder (SUD)
  • Non-Suicidal Self-Injury
    • Self-harming behaviors such as cutting
  • Suicidal Ideation

For parents who think their teen may have developed a mental health issue during the pandemic, we recommend arranging a full psychiatric evaluation performed by a mental health professional. They’ll be able to diagnose or rule out any existing mental health issue. If they diagnose a severe mental health disorder, they may recommend inpatient treatment in a behavioral health facility for teens, a mental hospital for kids, or an inpatient psychiatric unit at a children’s hospital. Teens with moderate or mild mental health issues may receive a referral for a less immersive level of care, such as outpatient treatment, an intensive outpatient program (IOP), or a partial hospitalization program (PHP).

In all cases, parents should understand that delaying treatment – even during COVID – is not a good idea, and leads to more problems later. Mental health, behavioral, and addiction disorders rarely resolve by themselves. In fact, when left untreated, they typically grow more severe and disruptive. That’s why we remind all parents of this treatment axiom:

The sooner a teen with a mental health disorder get the treatment they need,

the better the outcome.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.