Mental Health Crisis for Children and Adolescents – The Imperfect Storm of COVID and the Family First Act 

Nashville, TN – September 23, 2021: A recent CDC report identified a 31% increase nationwide in the number of children and adolescent mental health-related emergency room visits from pre-pandemic ER visits. Mike McCulla, CEO of Acute Behavioral Health, attributes this increase to the anxiety, social isolation, interrupted connectedness to schools, and social systems being experienced by young people because of the COVID-19 pandemic. “This increase in demand,” says McCulla, “spotlights the lack of resources needed to effectively meet the mental health demand of young people showing up in ER’s.”

There is a clog in the much-needed flow of young people through the mental health continuum of services. The CDC noted that the increase in ER visits has caused a backlog in young people waiting in ER’s to be admitted to psychiatric hospitals, oftentimes for days. Those not immediately meeting the criteria for inpatient psychiatric hospital admissions are sent to seek limited outpatient services in their community. What often happens is that young people have to remain in dysfunctional living situations, such as shelters and detention centers, while they wait for a treatment opportunity. 

Forbes picked up on the mental health crisis of young people in an article referring to the situation as a “Shadow Pandemic”, stating struggling ER’s ought to rethink how they manage the overwhelming number of young people visiting in psychiatric crisis. The article goes on to suggest that some regions of the country may need to piggyback on the use of the early COVID-19 pop-up hospitals and triage centers to help manage this crisis. Given this recent surge of psychiatric need, McCulla believes, “[that] this is going to be with us for a while after we are removing our masks as part of our daily wardrobe.”

The Family First Act (FFA) enacted just a few months prior to the pandemic, provides a much-needed refocusing of resources on keeping young people with mental health and substance abuse issues in their homes and communities at the cost of pivoting on the use of out-of-home placements like residential treatment. “I totally understand and agree with the refocusing and pivot”, says McCulla, “but the surge of mental health needs of young people brought on by COVID-19 has created an imperfect storm of challenges to meet those needs.”

Currently, many states are still in the process of strengthing their outpatient and in-home services to support the directives of the FFA. States are being forced to cut back on the use of out-of-home placements to afford the shift in new services. Consequently, this is causing a lack of space in residential treatment beds needed to accommodate the young people coming into the ER experiencing a psychiatric crisis. As a result, patients are waiting in problematic situations while waiting to be admitted to a facility for treatment. According to McCulla, this problem will only worsen before it gets better. He suggests that we rethink how mental health visits of young people are managed in the ER and work for an alternative to lengthy stays in psychiatric hospitals and long-term residential treatment facilities.

“I have long been an advocate in the use of Psychiatric Residential Treatment Facilities (PRTFs)”, says McCulla. Having been established by Centers for Medicare/Medicaid Services (CMS) as an acute level of care for young people in 200, PRTF have the capacity to admit and quickly transition young people back into their homes and communities more effectively than long-term residential treatment facilities. States like New Jersey and Minnesota are on the forefront in developing creative ways to use the PRTF model to meet some of the current mental health challenges, by opening small PRTF units as crisis stabilization centers for young people and opening the facilities in areas of high need. Initial results indicate that PRTF’s provide much-needed relief on the demand for psychiatric hospital admissions and have been more effective at ensuring that young people are engaged in outpatient and home-based services upon returning home. “Stepping back and rethinking how the PRTF model may be utilized to meet some of the current and future demands for treatment may just be what we need to be doing”, states McCulla.

Acute Behavioral Health is an owner/operator of behavioral health service centers for young people.