Brown University faculty in psychiatry and pediatrics are leading a call to action urging policymakers to address the worsening child and adolescent mental health crisis. On April 19, the Rhode Island Council for Child and Adolescent Psychiatry (RICCAP); the Rhode Island Chapter of the American Academy of Pediatrics (RICAAP); Hasbro Children’s Hospital; and Bradley Hospital issued a joint declaration of emergency with six policy recommendations that could alleviate the widespread challenges families face.

In a press release, Dr. Henry Sachs, Vice President of Children's Behavioral Health for Lifespan, President of Bradley Hospital, and Clinical Assistant Professor of Psychiatry and Human Behavior, wrote: “Amidst the stress and disruptions caused by the COVID-19 pandemic, we are experiencing an unprecedented emergency in child and adolescent mental health here in Rhode Island.”

Added RICCAP President and Clinical Assistant Professor of Psychiatry and Human Behavior Dr. Michael Wolfe: “As a child and adolescent psychiatrist working with teens, it is clear that the stress and disruptions caused by COVID have pushed many of the patients I see to the point of experiencing mental health crises. Unfortunately, at the very time this is occurring, many of our state’s outpatient community providers are underfunded and are losing staff to higher-paying jobs in other sectors. This means our youth are not receiving the community-based care they need, leading to more mental health emergencies."

Brown Psychiatry and Human Behavior Associate Professor Dr. Elizabeth Lowenhaupt, immediate past-president of RICCAP who now serves as secretary, says the state has long struggled to meet the demand for mental health resources and services for children, adolescents, and their families.

“And now, with the increased numbers of patients needing support and the decreasing resources, we're in crisis mode at pretty much every level of behavioral health care for children and families,” she says.

The groups' statement mirrors a declaration of national emergency last fall by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the National Children’s Hospital Association.

“It resonated very much with us,” explains Lowenhaupt, and the local chapters formed a work group to draft a Rhode Island-specific emergency declaration of their own. Alongside their partners in pediatrics, several members of the Brown Psychiatry and Human Behavior community were involved in the work group, including: faculty members Lowenhaupt, Sachs, Wolfe, Dr. Gerald Tarnoff, Dr. Diane DerMarderosian, and Dr. Francine Pingitore; trainees Dr. Elizabeth Modde and Dr. Priya Gearin; and general psychiatry residency alum Dr. Daisy Bassen. The group then connected with Bradley Hospital, the nation’s first psychiatric hospital for children, and Hasbro Children’s Hospital for support.

The state of emergency declaration was covered broadly by local media, and Lowenhaupt says the work group “plans to utilize the momentum to work with our state government, local advocacy groups, and media to try to make a difference in this crisis.”

Read the full declaration, along with their policy recommendations, below:

Declaration of a Rhode Island State of Emergency in Child and Adolescent Mental Health

Rhode Island Chapter of the American Academy of Pediatrics; Rhode Island Council for Child and Adolescent Psychiatry; Hasbro Children’s Hospital (the Pediatric Division of Rhode Island Hospital); and Bradley Hospital

As health professionals dedicated to the care of children and adolescents in Rhode Island, we have witnessed soaring rates of mental health challenges among children, adolescents, and their families over the course of the COVID-19 pandemic, exacerbating the situation that existed prior to the pandemic. Children and families across our state have experienced enormous adversity and disruption. The inequities that result from structural racism have contributed to disproportionate impacts on children from communities of color at the same time as racial and ethnic diversity has increased in Rhode Island and is projected to rise in the future.

This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020. Rates of childhood mental health concerns and suicide rose steadily between 2010 and 2020 and by 2018 suicide was the second leading cause of death for youth ages 10-24. According to the 2019 Rhode Island Youth Risk Behavior Survey, 15% of Rhode Island high school students reported attempting suicide one or more times in the 12 months before the survey was administered. The pandemic has intensified this crisis: we have witnessed dramatic increases in Emergency Department visits for all mental health emergencies including suspected suicide attempts.

The pandemic has struck at the safety and stability of families. More than 140,000 children in the United States lost a primary and/or secondary caregiver, with youth of color disproportionately impacted. We are caring for young people with skyrocketing rates of depression, anxiety, trauma, and suicidality that will have lasting impacts on them, their families, and their communities. We must identify strategies to meet these challenges through innovation and action, focusing on state and local interventions designed to improve equitable access to care including mental health promotion, prevention, and treatment. Taking into account Rhode Island’s specific existing resources and our state’s unique strengths, we urge a particular focus and investment in community-based and community-responsive outpatient care designed to identify and treat youth earlier in their course of illness. This would reduce the burden on individual children and their families as well as the impact on our higher levels of care and schools by decreasing escalation to full-blown mental health crises.

The Rhode Island Chapter of the American Academy of Pediatrics (RIAAP), the Rhode Island Council of Child and Adolescent Psychiatry (RICCAP), Hasbro Children’s Hospital (the Pediatric Division of Rhode Island Hospital), and Bradley Hospital are joining together to declare a Rhode Island State of Emergency in Child and Adolescent Mental Health. The challenges facing children and adolescents are so widespread that we call on policymakers at all levels of state government, advocates for children and adolescents, and community stakeholders to join us in this declaration and advocate for the following:

• Increase state funding, including Medicaid rates, dedicated to ensuring that all families and children, from infancy through adolescence, can access evidence-based mental health screening, diagnosis, and treatment to appropriately address their mental health needs, with particular emphasis on meeting the needs of under-resourced populations.
• Fully fund and prioritize comprehensive, community-based systems of care that connect families in need of outpatient behavioral health services and supports for their children with evidence-based interventions in their home, community or school as well as follow-up with families to overcome any barriers to engagement in care.
• Accelerate strategies to address longstanding workforce challenges in child mental health, including innovative training programs developed collaboratively by Rhode Island’s existing healthcare professional programs, loan repayment and reduced/free tuition consistent with RI Promise grants, and intensified efforts to recruit and retain underrepresented populations into mental health professions as well as attention to the impact that the public health crisis has had on the well-being of health professionals.
• Increase implementation and sustainable funding of effective models of school-based mental health care with clinical strategies, including a mental health “warmline” for school staff to access care comparable with the existing PediPRN model for pediatricians, and models for payment.
• Accelerate and incentivize adoption of effective and financially sustainable models of integrated mental health care in primary care pediatrics, including clinical strategies and models for payment.
• Address the ongoing challenges of the acute care needs of children and adolescents, including shortage of beds and emergency room boarding, by expanding access to short-stay stabilization units and community-based response teams.