On the Pulse

Responding to Our State's Youth Mental Health Emergency

4.7.2021 | Dr. Alysha Thompson

A patient contemplates their future while staring out of a window.

Dr. Alysha Thompson is the clinical director of the Psychiatry and Behavioral Medicine Unit (PBMU) at Seattle Children's. She's seen first-hand the impact the pandemic has had on youth mental health. She shares how dire the situation has become and provides advice for parents.

We are a year into an unprecedented pandemic that has taken a toll on all our lives. Children and adolescents are feeling this acutely – over the past year, we've seen a significant increase in mental health-related visits to the emergency room and an increase in youth suicide.

Even before the pandemic, children and adolescents had the most significant rise in suicides over the past two decades compared to other age groups. However, as schools have moved to virtual learning, as people have been isolated from their friends and family, and all the normal structures that bring joy to our lives and give us things to look forward to have altered dramatically, we have seen an even further increase in suicide and suicidal ideation in youth.

A Dramatic Rise in Mental Health Issues

Suicide rates in King County are up 30% for youth. On March 15, Governor Inslee declared a state of emergency for youth mental health.

Seattle Children’s has developed innovative programs like the Behavioral Health Crisis Care Clinic to address the need we see every day in our Emergency Department; these programs are largely funded through private donations.  Even with these incredible innovations and donations, we aren’t keeping pace with the number of youth and families coming to our Emergency Department.

This increase in the need for services has put a significant burden on our state’s mental health system. Outpatient providers often see more youth than they typically can to try to meet their needs. This is not sustainable.

Partial hospitalization programs and intensive outpatient programs can help bridge the gap for kids in crisis who can’t wait for an outpatient clinic visit but who don’t need hospitalization, combine therapies, skill-building, family groups, and support in transitioning youth back home to their communities. But the few partial hospital and intensive outpatient programs that exist in Washington are funded through self-pay or some select commercial insurance carriers, limiting access to only those who have the ability to pay. These programs have long wait times, sometimes taking months to get a child or teen into a program. In addition, some of these programs have closed, increasing the demand for the few spots that are available.

With many of these programs at capacity, youth and their families are not as likely to get the care they need to prevent a mental health crisis. Often, the safest option when their child is in crisis is to go to an emergency room; our state’s emergency rooms have seen a significant rise in youth presenting for psychiatric emergencies since the start of the pandemic.  Inpatient psychiatry units (including Seattle Children’s) have been full without our usual seasonal lulls. New inpatient beds have not been created, which means that youth who need inpatient care must wait in emergency rooms and on medical floors until an inpatient bed is available. This was already a seasonal issue in our state – children and adolescents have often had to wait in emergency rooms throughout Washington for an inpatient bed to open, sometimes for days. The increase in need over the past year means that waiting in an emergency room or on a pediatric floor for a psychiatric bed is now the norm rather than a seasonal issue.

How Washington compares to other states

Compared to other states, Washington does not have a robust system of care for youth mental health. In a well-functioning system, children and their families would be able to access the support they need before they experience a mental health crisis. Our state’s system needs programs that support youth and provide intensive levels of outpatient care – such as partial hospitalization programs and intensive outpatient programs.  These programs should be available regardless of a family’s insurance status or ability to pay.

Our state has a huge equity issue – families who live in poverty, who don’t have the right insurance, or who use Medicaid can’t access intensive outpatient programs. This disproportionately impacts People of Color, as People of Color are more likely to use Medicaid. Quite literally, these groups cannot get the care that is needed for their children. This may help explain why, nationally, Black youth are seeing the highest increase in suicide and why homeless youth attempt suicide at three to six times the rate of housed youth. Not only do these groups have greater risk due to the discrimination and stressors they face, but they also can’t access services that they need.

So, what do we do?

When we raise awareness of the mental health issues among youth, we are frequently asked “what can we do?”  The encouraging news is that there are actions each of us can take.  There are actions we can take to improve Washington State’s youth mental health system and things we can do to support the children and youth in our lives.  Now is the time to act.  The pandemic has made addressing these issues even more urgent.  These services were necessary before the pandemic and are critical now.  Our children and youth need more options for care.

Advocate to Improve the System

The state of Washington needs to build out our mental health care system for youth. We are behind other states and quite frankly have lots of work to do to catch up. One of the first steps is to fund partial hospital and intensive outpatient programs for youth through Medicaid. Washington is one of the few states that doesn’t cover these programs through Medicaid right now. You can help push this forward by calling or writing your state representatives and asking them to fund this benefit. During the last legislative cycle, pilot funding was made available from the state for initial intensive outpatient and partial hospitalization pilot programs here at Seattle Children’s and another hospital located in eastern Washington. We are excited that this funding may be continued, and these programs are underway. We know from research on successes of these programs in other states that they work and are hopeful that the legislature will expand this funding beyond the pilot funding.

Support Your Child or Teen

Talk to your child and ask about suicide – check in with your child or teen. Ask how they’re feeling and how things are going in life. Listen to their words, and also pay attention to their behavior. Listen more than you talk, and truly hear what your child is saying. It’s important to ask directly if your child or teen has had thoughts about suicide. Asking does not increase the risk of suicide and in fact can be the difference between life and death. It offers relief to someone who may be struggling and helps them feel noticed and heard. Stay calm if they say they are thinking about suicide and:

  • Call the National Suicide Prevention Lifeline for help: 1-800-273-8255.
  • Reduce the risk of suicide by removing pills and firearms from your home. If you can’t remove them, place them in a safe, lockbox or other secure place.
  • If they are in immediate danger of harming themselves, don’t leave them alone. Call 911 or a local crisis line, or take them to an emergency room.

Get help – If you think your child or teen is struggling, getting connected to an outpatient therapist is important. Start by asking your child’s doctor for a referral or check if your insurance plan has a list of therapists, psychologists, or psychiatrists who are in your insurance network. You can also contact Washington’s Mental Health Referral Service for Children and Teens to find providers in your local area who fit your child’s mental health needs. Start looking for help when you first notice that your child or teen is struggling, this may help prevent a crisis.  Here are some tips on what to watch for and how to help your child.

Remove access to things that youth could possibly hurt themselves with. Lock up medicines (even over-the-counter medicines and vitamins), make sure guns are triple safe (unloaded, locked in a safe, ammunition locked in a separate safe) or removed from the home completely (for example, through a temporary transfer). This is important even if you don’t think your child or teen is at risk of hurting themselves; you never know what they may be struggling with, and unfortunately we hear all too often of youth who were struggling without anyone knowing. We also know that removing access to things youth can hurt themselves with is one of the best ways to prevent suicide.

Educate yourself and others about youth mental health issues and how to support youth who might be struggling.  You can take a free virtual Youth Mental Health First Aid class offered in partnership between King County and Seattle Children’s, read up or take a class on Learn Saves Lives through University of Washington’s Forefront.

Provide validation and reduce the stigma.  Validate your child’s emotions and experiences – it’s hard to be a teenager, especially in a pandemic.  Talk about mental health in your home, in your community, and with your peers.  It’s okay not to be okay, and it is okay to ask for help.

If your child or family needs help right away, call your county’s mental health crisis line or text HOME to 741741.


Seattle Children's Mental Health Resource Hub