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Tracking Map of the Child Psychiatry Youth Mental Health Crisis

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This is the first tracking of the Youth Mental Health Crisis – as there are no established metrics. In fact, geographic information system (GIS) data is lacking. Data provides a meaningful assessment to establish the extent of the crisis, the needs, and to measure the outcomes of future interventions. This is on the heels of the Covid pandemic which demonstrated the importance of crisis data to save lives. This supports that the Youth Mental Health Crisis is much underappreciated.

On October 19, 2021, a declaration from the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association announced the Youth Mental Health Crisis.

Over 15 million children are waiting to be seen by a child psychiatrist. The Youth Mental Health Crisis is an acute-on-chronic crisis, decades-long and worsened by covid-19. The WHO and FDA define Youth as the 15 to 24 years of age group.

1. What is Measured is Done: Wait Times for Adequate Care

Wait Times of the Youth Mental Health Crisis
US Child Psychiatry Fellowship Programs Outpatient Clinic Locations

Crisis data. Most health systems have an easy website GIS map of their doctor providers – to aid their customers. This is a common approach that is even recognized by the most progressive technology enterprises. GIS maps of doctor providers within a health system aid with location, contact information, driving distance, affordability (ie. insurance acceptability), and doctor specialty. Currently, ‘the patient as the customer’ does not have a GIS map for the Youth Mental Health crisis for affordable & soonest outpatient child psychiatrist critical care. A map displaying locations, with wait times for adequate care – could first serve patients needing care. With telehealth, patients may have more options if informed.

For public health and clinical health, displaying wait times will benchmark the extent of the crisis, aid in funding, identify areas of greatest need, and overall monitor the effectiveness of interventions to reduce wait times to get Youth to Mental Health care.

What is measured, is done is a powerful saying in public health (there is a reason why we see all the covid maps because they measure the extent of the crisis and where and when intervention needs to be placed) to apply resources to the Youth Mental Health Crisis.

The Data: An Imperfect Storm

Data depiction
Imperfect storm of the mental health crisis. Source: Freepik Premium license.

We have an imperfect storm:

● Youth Mental Health Crisis – 15 Million Children Await a Child Psychiatrist

● Student Mental Health Crisis – 1+ Month Wait Times for Therapy

● Family Mental Health Crisis – 40% of Americans = No Access to Mental Health and Wellness, with affordability cited as the highest cause.

The Finances: $1=$4x Return on Productivity

Depression alone is reported to cost $1 trillion a year globally in lost productivity. Notably, a recent WHO-led study estimated that for every US$ 1 put into proper treatment for common mental disorders, there is a return of US$ 4 in improved health and productivity.

This is curious because companies with charitable infrastructure such as Google, Amazon, Microsoft, Target, IBM, etc. could be ‘all-out’ financing innovative solutions for their own internal health employee & family issues – and reaping a great financial & social reward, in doing so.

The US government also has large inefficiencies in the US welfare system in providing needed disability income and affordable housing due to mental illness – which could be preventable.

Needed Hard-$Dollar Approach

Youth Mental Health Crisis – Kids Cheering for Hard-Dollar Funding. Source: FreePik Premium License.

A prevention-based approach is lacking for a coordinated public health effort – involving public and private applied strategies, outreach, and monitoring for innovative system change. Current government “soft-dollars” monies are spoken for – allocated to large public entities, state-influenced, and non-profit hospitals that support and depend on existing infrastructure and annual funding. Without grants to private industry for ‘hard-dollars – for enterprise innovation self-sustainment, covid vaccines would never have been made or delivered. We need this same coordinated approach for mental health and wellness from all public and private funding sources.

In addition, exclusively throwing money at non-profits is not efficient, as a child psychiatrist cannot be manufactured. New social ventures are also needed. The US government spent 16 trillion dollars on covid-19, yet we have an incredible backdrop of WHO evidence that suggests 1 out of 3 college freshmen have symptoms of a primary mental illness disorder when surveying global college first-year students. This crisis is vast: any level of funding is not enough.

2. Create a $100mm Health System: a 10 Child Psychiatrist Team Delivering $0 Ongoing Universal Care.


“The future of all psychiatry is the doctor meeting the patient where they are.” – Thomas Campi MD

A focused team of 10 outpatient child psychiatrists under telehealth (see Check-in Telehealth™️ below) can act as their own health network to provide $0 universal care. This business model will be self-sustaining through Medicaid reimbursements, in time. Child psychiatrists will reach out to Youths via telehealth in their homes.

This is a $0 universal health system with a $100mm funding target via the Check-in Telepsychiatry Youth & Family Fund.

3. Hidden Supply: Check-in Weekend Clinic Teams of Child Psychiatrists + Fellows.

Child Psychiatry Hidden Supply:
Potential Staffed Check—in Telehealth™️ Clinic

This is generated map of all reported Attending & Child Psychiatry Fellows at US Child Psychiatry Fellowship Programs who potentially could support Weekend Telehealth outpatient care. Result of initial data collection April, 2022 – we are asking more programs to report data.

It is cited there are 858 child psychiatry fellows in programs. These could be potentially available for a weekend Check-in Telehealth™️ Clinic (see more below). Teams of Attending doctors could team together. If 1000 doctors were to gather in teams, an additional 3,000 – 6,000 appointment check-ins could occur weekly! This is tremendous. Lists of children to be seen are as long as 300+ long in major university child psychiatry centers. Programs above two weeks wait times could be assisted. The current bottleneck could be addressed, and then maintained with Check-in Telehealth™️ follow-up care.

The Data to Support a System-Changing Model

Suicide and all ages: Rising

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality. https://www.cdc.gov/nchs/products/databriefs/db398.htm

The suicide rate is increasing and too high, thus the current approach is not effective.   Both genders are rising and the total middle line – shows 12.5 suicides per 100,000 population in 2019.

Late Teen Female Suicides: Social media Potential Danger

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality. https://www.cdc.gov/nchs/products/databriefs/db398.htm

In females, the suicide rate of all ages is both increasing and too high.  Please pay attention to the bottom two lines – the rates are increasing highest for the early teens and the Youth.  It is arguable via study data that show an alarming association between screen time misuse and self-harm. Also, depression is prevalent in female teens, as high as 30 percent. Our system is failing Youth and young teens.

Percent of U.S. high school students with high depressive symptoms

Source: Jean M. Twenge. “Why increases in adolescent depression may be linked to the technological environment.” Current Opinion in Psychology. 32, (April 2020): 89–94.  https://doi.org/10.1016/j.copsyc.2019.06.036.

Safety: Needed Medical-Model Preventative Measures

Henry Ford Health System achieves zero suicide in 2009-2010 for 18 months after starting the zero suicide initiative in 2001. Source: Zero Suicide Guidelines (2019).

The Zero Suicide (ZS) protocols: notably, in 2001 the Henry Ford Health System in Detroit developed a landmark approach resulting in zero (0) suicides for 18 months in 2009-2010 after suffering from high suicide rates. The entire Health System practiced zero suicide, including outreach letters to homes called “caring cards” with ‘always here for you’ help. This evidence has been supported by a 2022 recent John Hopkins study, that used caring text messaging and youths reported that the messages helped reduce their suicidal thoughts and behaviors post-discharge from the emergency department. Surprisingly, caring messages and outreach still are not standardized, despite their high evidence – even when recommended for settings with few resources and limited staff.

4. Check-in Telehealth: Optimize Care, Enhance Patient Outcomes, & Reduce Future Needs.

Check-in Telehealth™️ under a patent-pending designed application, “checks-in” patients continually, seeing how they are feeling & providing hope that someone is there for them. This creates secure attachment, one of the most powerful theories of development. Over time this will pay dividends in terms of bettering their mental health and wellness so that they can be less in need of care (ie. a self-sustaining preventive care design).

Check-in Telehealth™️ will reach out to Youths (and families) to ask the caring age-old question “How are you feeling?” and remind them someone is always there.

Thank you. If you are able, please support our system-changing solution:

References:

Adolescent health. (2019, July 18). WHO | World Health Organization. https://www.who.int/southeastasia/health-topics/adolescent-health

Tracking value for GIS—Discussion and examples to inspire. (2021, September 2). ArcGIS Blog. https://www.esri.com/arcgis-blog/products/ops-dashboard/health/tracking-value-for-gis-discussion-and-examples-to-inspire/

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., Kessler, R. C., & WHO WMH-ICS Collaborators. (2018). WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362

Cheng, N., Mohiuddin, S. Addressing the Nationwide Shortage of Child and Adolescent Psychiatrists: Determining Factors that Influence the Decision for Psychiatry Residents to Pursue Child and Adolescent Psychiatry Training. Acad Psychiatry 46, 18–24 (2022). https://doi.org/10.1007/s40596-021-01554-4

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM – Population Health15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

Cutler, D. M., & Summers, L. H. (2020). The COVID-19 pandemic and the $16 trillion virus. JAMA324(15), 1495. https://doi.org/10.1001/jama.2020.19759

Investing in treatment for depression and anxiety leads to four-fold return. (2016, April 13). WHO | World Health Organization. https://www.who.int/news/item/13-04-2016-investing-in-treatment-for-depression-and-anxiety-leads-to-fourfold-return

Ryan, T. C., Chambers, S., Gravey, M., Jay, S. Y., Wilcox, H. C., & Cwik, M. (2022). A brief text-messaging intervention for suicidal youths after emergency department discharge. Psychiatric Services. https://doi.org/10.1176/appi.ps.202000559

United States Joint Economic Committee. (2021, December 1). Is Instagram causing poorer mental health among teen girls? https://www.jec.senate.gov/public/index.cfm/republicans/2021/12/is-instagram-causing-poorer-mental-health-among-teen-girls

Zero Suicide Guidelines (2019). Henry Ford Health | Henry Ford Health – Detroit, MI. https://www.henryford.com/-/media/files/henry-ford/hcp/henry-ford-health-system-zero-suicide-guidelines-2019.pdf?la=en&hash=BBA30412E552C3DBABBA0C5269162A30

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