Bonnie T. Zima

Improving access to child mental health care is a national priority area. The U.S. Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration (SAMHSA), recently awarded $68.5 million in grants that support behavioral health education, training and community programs to help address mental health and substance use conditions.

One of the 4 guiding principles of SAMHSA's 2023-2026 Strategic Plan is a commitment to data and evidence to inform resource allocation, with priority on timely, high-quality data. The Behavioral Health Services Information System (BHSIS) is an integrated statistical data system that provides information at national, state, and local levels on the facilities and services available for substance abuse and mental health in the United States, as well as characteristics of individuals receiving care.

In this issue of the Journal, research led by Mojtabai and Olfson summarizes findings from a secondary data analysis using the Mental Health-Client Level Data (MH-CLD), one of the 5 core components of the BHSIS. Using the first publicly available data in 2013 to 2021, the team examines trends in 8 diagnostic categories among individuals 0 to 17 years of age (hereafter referred to as "children") who received any mental health or support services during the reporting year.

Across this 9-year interval, the proportion of children with documented anxiety, trauma- and stressor-related, and depressive disorders increased, whereas the proportion of children identified as having bipolar, oppositional defiant, and conduct disorders declined. Roughly one-half (46.2%-49.9%) of the children were less than 12 years of age, and almost all children (consistently 99%/year) received services in a state mental health agency (SMHA)-funded community-based program.

Findings: In 2021, more than one-half of children receiving any care in community-based programs were documented to have a trauma- or stressor-related disorder (27.4%) or attention-deficit/hyperactivity disorder (25.4%), and an additional 19.3% and 16.9% had documented anxiety and depressive disorders, respectively. Anxiety disorders significantly rose between 2013 and 2021, especially among older children (12-14, 15-17 years of age), female youth, and non-Hispanic Black and non-Hispanic white children. A series of sensitivity analyses explored whether main findings substantially changed, increasing the study's robustness. To support consistency, the findings were set within the context of studies using hospital discharge data, commercial insurance claims, and the National Surveys on Drug Use and Health.

Overall, this study discovers a strong signal of a 9-year rise in documented anxiety and depressive disorders among children receiving care in SMHA-funded community-based programs.
 

The purpose of this study was to explore the experiences of LGBTQ + young people in mental health care and to understand their perspectives on what affirmative mental health care practice should look like. Between June and September of 2023, interviews were conducted with LGBTQ + young people ages 18–26 years in Los Angeles and Seattle. Interviews lasted 30 to 60 min and were transcribed verbatim for thematic analysis.

Findings: Four themes were developed from analysis of the interviews: (1) disconnection from community and self as an impetus for seeking formal mental health care; (2) marginalization during mental health service encounters; (3) the therapeutic power of belonging and mattering in the mental health care system; and (4) mutual human connection as the foundation for affirming mental health care experiences.

Affirmative mental health care was defined by LGBTQ + young adults as free of judgment with priority placed on the therapeutic power of genuine human connection. The need for trans-specific mental health care was also highlighted. Participants also expressed a preference for providers with shared identities and experiences to alleviate feelings of isolation and increase feelings of connectivity.

Mental health providers should emphasize connectivity and empathy to offer affirming care with LGBTQ + clients, such asking about client preferences for care, developing knowledge about sexuality and gender identity, and acknowledging provider limitations or knowledge gaps. Improving access to affirmative mental health care for LGBTQ + young adults (e.g., workforce development, training requirements) is needed to address the disparities in mental health care.
 

​Summary: This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19–related school closure orders.

This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations among children ages 3–17 years in 44 U.S. children’s hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar-week intervals.

Findings: Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (−24.8% vs. −49.1%), and MH hospitalizations declined 3.4 times less (−8.0% vs. −26.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for more than 50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points. By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively.

Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children’s hospitals after COVID-19-related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.
 

Read the Publication:

• Journal Article: Use of Acute Mental Health Care in U.S. Children's Hospitals Before and After Statewide COVID-19 School Closure Orders

​Summary: While many standardized assessment measures exist to track child mental health treatment outcomes, the degree to which such tools have been adequately tested for reliability and validity across race, ethnicity, and class is uneven. This paper examines the corpus of published tests of psychometric properties for the ten standardized measures used in U.S. child outpatient care, with focus on breadth of testing across these domains. The authors’ goal is to assist care providers, researchers, and legislators in understanding how cultural mismatch impacts measurement accuracy and how to select tools appropriate to the characteristics of their client populations. Authors also highlight avenues of needed research for measures that are in common use. The list of measures was compiled from (1) U.S. State Department of Mental Health websites; (2) a survey of California county behavioral health agency directors; and (3) exploratory literature scans of published research.

Findings: Ten measures met inclusion criteria; for each one a systematic review of psychometrics literature was conducted. Diversity of participant research samples was examined as well as differences in reliability and validity by gender, race or ethnicity, and socio-economic class. All measures showed adequate reliability and validity, however half lacked diverse testing across all three domains and all lacked testing with Asian American/Pacific Islander and Native American children. ASEBA, PSC, and SDQ had the broadest testing.

Read the Publication:

• Journal Article: Overview of Ten Child Mental Health Clinical Outcome Measures: Testing of Psychometric Properties with Diverse Client Populations in the U.S.