Q&A with Dr. Tami Benton, Psychiatrist-in-Chief at Children’s Hospital of Philadelphia

by Dr. Tami Benton
On February 15, 2022, Tami D. Benton, MD, Psychiatrist-in-Chief, Executive Director, and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia testified before the Senate Finance Committee for its hearing on the state of youth mental health. Sound the Alarm for Kids presents this Q&A with Dr. Benton based on her testimony.
(For brevity, “mental health” is used to encompass mental, emotional, and behavioral (MEB) health throughout.)
Young children and adolescents in the U.S. are experiencing mental health stress at higher rates and with more dire consequences than ever before. 53% of adults with children in their household are concerned about their children’s mental wellbeing. In the first half of 2021 alone, children’s hospitals reported cases of self-injury and suicide in ages 5-17 at a 45% higher rate than during the same timeframe in 2019, and, for children under 13, the suicide rate is twice that for Black children than for white children.

Q: Dr. Benton, how well does our current health care system service children with mental health needs?

Clearly, our kids are falling through cracks in the system. While these cracks predate the COVID-19 pandemic, the additional traumas and challenges for children presented by the pandemic made them both worse and more visible. The reality is that we commonly only address pediatric mental health after the onset of a crisis.

 

Q: What are the consequences of mental health care that is delayed due to access barriers?

Delayed care is costly in many ways, including:
  • Emotional burden and social cost to the patient and their family;
  • Strain on our childcare and educational systems;
  • Excess cost and poor outcomes associated with providing inadequate care;
  • Delays in pediatric health care when medical hospital beds are overutilized for boarding children in a mental health crisis;
  • And wrongful placement of children in the juvenile justice system.

 

Q: You mentioned boarding. What is boarding in the context of mental health?

After arriving in hospital emergency departments (ED), kids experiencing a mental health crisis are kept in ED facilities  or medical hospital– a practice known as boarding – until they can be admitted into a psychiatric treatment program or transferred to another facility. While boarding keeps vulnerable patients physically safe from injury, waiting in an ED or medical hospital  does not provide the specialized mental health treatment kids need to help them recover.

 

Q: What can we do right now to help mitigate the youth mental health crisis?

In the short-term, we must rely more on those on the front lines—parents, teachers, general pediatricians, and other caregivers.  They need whatever proven tools we can give them, and they need them as soon as possible.
We also need more appropriately trained pediatric mobile behavioral health crisis units. These provide mobile, short-term, face-to-face, therapeutic responses to youth experiencing a behavioral health crisis and can help reduce psychiatric emergency department visits.
24-hour crisis hotlines, staffed with those trained in child and adolescent mental health, can assist with de-escalation and assessment. If linked with updated local resources and provider information, these crisis lines can also refer to treatment facilities.

 

Q: Are there systemic changes that can made to strengthen the system?

In the longer term, the whole continuum of care must be addressed so that the right types and levels of care are available. If we are doing things right, children will be treated outside of a hospital inpatient psychiatric setting, but this will only be possible if intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), day programs, a full range of additional step-down services, and preventive services are available.
Prevention is the best approach as it both serves our children better and it helps to alleviate an overburdened system.  Preventive mental health interventions reduce the risk of a child suffering a mental health crisis and are cost-effective.  Early intervention, services for young children that build upon the natural learning opportunities that occur within the daily routines of a child and their family, can effectively give children tools to overcome delays and manage disabilities. For older kids, there are several effective depression prevention programs, which, if more widely delivered, could prevent the onset of depressive episodes.
It is also important to acknowledge that there is a web of systems beyond health care that impact the wellbeing of children and adolescents. These include foster care, juvenile justice, childcare, education, food programs, and more, layering on additional complexities to achieving the end goal of doing better for our kids.  The many systems that touch our kids rarely collaborate, and, when they try to, these attempts are too often foiled by bureaucratic barriers or an unwillingness to acknowledge the interconnected nature of the services offered. We recommend a thorough examination of how various agencies intersect in children’s lives and policy recommendations aimed at making those intersections synergistic rather than counterproductive.