How Pediatric Hospitals Must Adapt to the Adolescent Mental Health Crisis.

In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic.1 Over the ensuing year, while adult hospitals filled with patients with severe acute respiratory syndrome coronavirus 2, a different epidemic drove hospitalizations in pediatric hospitals in the United States. This epidemic had been growing for years, although without the attention or resources needed to properly address it. When schools closed because of COVID-19 and millions of adolescents were forced into virtual learning, it disrupted one of the most important components of mental health for this population, namely, socialization with peers. Additional factors, such as family-member illness, altered family dynamics, lost parental wages, and stress and fear around the pandemic, compounded this problem. The resulting increase in depression and anxiety among adolescents has led to a spike in emergency department (ED) visits and hospitalizations for mental health crises, suicidal ideation, and suicide attempts.2–4 Indeed, in 1 study, researchers found a 50% increase in ED visits for suicide attempts among teenaged girls from February 2020 to February 2021.2 An already strained mental health system has become even more strained. Adolescents have languished for longer and longer periods of time in EDs and on inpatient medical wards while waiting for beds to open up at psychiatric hospitals. Appointments for outpatient mental health providers have booked farther and farther out. For pediatric hospitalists, the winter practice has transitioned, if briefly, from managing bronchiolitis to managing adolescent despair. Yet, even as the adolescent mental health crisis has worsened, opportunities for addressing it from an inpatient perspective have arisen. When a child is admitted to the hospital with a medical condition, the management is centered around correcting the pathologic process. For example, when a child is admitted with pneumonia, …