Increases in youth suicide linked to mental health worker shortage

A study found an association between shortages in mental health workers and increases in youth suicide rates, 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 of Chicago and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, told Healio that “swift action is needed to support youth mental health,” amid what the AAP and other groups have called a “national emergency” in pediatric mental health.

“Since the onset of the pandemic, hospital emergency rooms across the county, including my own, have been inundated with children and youth experiencing severe mental health crises,” Hoffmann said.

Hoffman and colleagues obtained data on 5,034 suicides that occurred among youths aged between 5 and 19 years, from the period ranging from Jan. 1, 2015, to Dec. 31, 2016. The data were from the CDC’s Compressed Mortality File and the U.S. Health Resources and Services Administration.

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

Following adjustment for county characteristics, mental health workforce shortage was associated with an increased youth suicide rate (adjusted incidence rate ratio [IRR] = 1.16; 95% CI, 1.07-1.26), with the rate increasing 4% for every 1-point increase in the score.

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

The association remained even in firearm suicides, Hoffman said.

“We thought that firearm suicides would not be related to mental health workforce shortages, since they are less likely to be preceded by a known mental health condition,” Hoffman said. “But we did find that youth firearm suicides occur more often in counties with shortages of mental health professionals.”

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

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

In areas with these shortages, Hoffman said, primary care pediatricians should “integrate prevention and treatment of mental health services within the medical home.” “Pediatricians should be prepared to support children waiting to see a mental health professional,” Hoffman said. “Pediatric Mental Health Access Programs are available in some areas to connect pediatricians with child psychiatrists for teleconsultation. Primary care providers should ensure all youth know the national three-digit dialing code 9-8-8 for the suicide and crisis lifeline.”

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

“We urgently need more federal investments to build the mental health workforce and to expand community-based services that focus on prevention, early identification, and treatment,” Hoffman said. “This will prevent youth from having mental health crises that lead to ED visits.”

She added that it would be urgent to fund the Children's Hospitals Graduate Medical Education Program, which supports training for half of the nation's pediatricians, and the Children's Health Insurance Program, to support insurance coverage for children, including mental health services.

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

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

References:

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