March 15, 2023 – The child mental health crisis, exacerbated by the COVID-19 pandemic, is at its worst, based on a new report from a number one US company in the sector of patient safety and research.
“Even before COVID-19, the impact of social media, gun violence and other socioeconomic factors led to increased rates of depression and anxiety among children,” Marcus Schabacker, MD, PhD, President and CEO of the research group ECRI, said in a press release“The challenges caused by the pandemic have turned a bad situation into a crisis. We are approaching a national health emergency.”
According to study in JAMA Pediatrics, Anxiety and depression rates amongst children ages 3 to 17 increased by 29% and 27%, respectively, from 2016 to 2020. The average variety of weekly emergency department visits for suspected adolescent suicide attempts was 39% higher in winter 2021 than in winter 2020, the CDC has documented. And a CDC Survey 2021 In a survey of U.S. highschool students, 30% of women said that they had seriously considered attempting suicide. That's twice as many as boys and almost 60% greater than ten years ago. Almost half of LGBTQ students said that they had considered suicide.
ECRI, an independent nonprofit organization that works to enhance safety, quality and cost-effectiveness in health care, has made several recommendations to handle the kid mental health crisis. Among other things, ECRI experts suggested that general child mental health screenings be conducted at every doctor and hospital visit. In addition, they beneficial that primary care physicians “kindly” refer patients and families to therapists they trust.
In an interview, Schabacker said it will not be enough for a family doctor to easily tell a baby's parents to decide on a therapist from the insurance company's list and make an appointment. The doctor should refer the patient to a psychologist she or he trusts, whether a therapist in private practice or an worker of a college or church. In addition, he said, the doctor should ensure that the therapist has the proper information concerning the patient and knows why she or he was referred.
Doctors also need to concentrate on the magnitude of the crisis and the long-term effects of untreated mental illness, Schabacker said, and have in mind that LGBTQ, minority and/or socially disadvantaged children are at far higher risk for severe mental health crisis than heterosexual white children.
Impact of staff shortages on safety
Since the start of the pandemic, staff shortages in hospitals and medical practices have influenced several of the highest 10 security problems, based on ECRI. In fact, staff shortages were the largest security problem in ECRI's 2022 report. Among other things, this shortage also played a task within the second biggest security problem this 12 months: “Physical and verbal violence against medical staff.”
For example, if an emergency room is understaffed, it might take an extended time to see a patient. Some patients or their families may turn into frustrated and indignant. They may then confront an emergency room nurse.
“We have seen a dramatic increase in violence against healthcare workers,” Schabacker said. When nurses and doctors are overworked because of staff shortages, they could lack the patience to calm people down and de-escalate situations.
Another results of staff shortages is that some health professionals are “expected to work in areas outside their scope and competence” (point 4 on the list). This can result in less effective care, Schabacker said.
“Staff shortages directly impact the roles of clinical staff, and gaps need to be filled,” he said. “And when you're constantly on your toes, constantly stressed, constantly on your limit, you're much more likely to miss things.”
Consequences of the Dobbs decision
Another example of how societal changes affect health care is concern number three on ECRI’s list: “The need for physicians in times of uncertainty in the field of maternal and child medicine.”
This refers back to the Dobbs decision of the US Supreme Court, which overturned the Roe vs. Wade case and returned the query of the legality of abortion to the states.
The ECRI report explains how this transformation affects patient safety: “In many countries there is now uncertainty about which reproductive services can be offered and when. This uncertainty can lead to Refusal or delay of care which ultimately cannot be considered a violation of the law. Although some states with abortion bans allow abortions to save the life of the pregnant patient or to cause her harm, there are often little orientation about where the border lies. If doctors wait too long, serious harm can come to patients.”
Of course, health care providers cannot change the law, but Schabacker said health care organizations have an obligation to tell doctors exactly what the law requires.
“If a woman experiences serious health problems during pregnancy and the doctor is unclear about what he or she may do in such a situation because of the uncertainty created by the Supreme Court decision, then this poses risks and can lead to safety incidents and harm to the mother,” he said.
Healthcare leaders must be proactive and provide clear guidance on what is and is not allowed.
Incorrect medication lists
ECRI also points to “medication errors resulting from inaccurate patient medication lists.” The report states that “inconsistent knowledge and records of medications cause up to 50% of medication errors in hospitals and up to 20% of adverse drug events.”
While these medication documentation errors do occur in hospitals, Schabacker said, medication lists in outpatient care may contain much more errors. “A study conducted in patients' homes before a physician's visit found that medication discrepancies ranged from 14 to 98 percent,” he said.
The most typical examples are the omission of medication from the medication list or the inclusion of discontinued medications.