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This is Chris with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Amy Wimpy Knight,
president of the Children's Hospital Association. Amy,
thank you so much for joining us today.
It's great to be here with you all. Thank you for having me.
Wonderful. In the meantime,
could you first give us a little bit about yourself and your background?
Sure. Um, I'm the president of the Children's Hospital Association,
so we represent over 200 hospitals, children's hospitals nationwide,
um, and the families and children that they serve.
So we have a focus on advocacy and policy,
on care delivery and on just improving the lives of children and,
and their families.
Amy,
what would you say are the most pressing concerns for youth mental health today?
I, I think, um, when you talk about children's mental health, it's,
it's a big topic and so if we had to focus on two things,
I think we've all seen it in the news lately.
Certainly it's all touched us in our personal lives, but I would,
I would focus on two things. First of all, it's the kids themselves.
So when we talk about youth, we're not only talking about adolescents,
but we're also talking about children and just how it's impacting them
and their own experiences should be of concern for all of us,
and that's one of the reasons we are all talking about it.
So if you look at the incidents of mental health crisis,
quite honestly in children, it's really grown over the past decade plus.
So we're dealing with a number of children who are along that continuum from
starting to experience some emotional distress to children that have actually
been in crisis and in our cases have shown up in children's hospitals,
emergency rooms, um, in our ambulatory areas, and even in our inpatient areas,
seeking, seeking care. So that's the tip of the iceberg.
If we're seeing it at that level and a number of children that we're seeing
today, which is two and three times what we've seen previously,
we know that children more broadly are in need.
So those in our schools and in our communities,
the second concern I think goes without saying is,
do we have the providers to meet that need? And by providers,
we both mean people and programs.
So at a time in our country where we know we have fewer mental healthcare
professionals overall, um, to serve our country's needs,
we actually have a disproportionate, fewer only 4%, for example,
of clinical psychiatrists are trained to take care of children.
And so we have an extreme shortage, not only of of licensed professionals,
but also of training in our communities and our schools and in our families to
be able to identify and cope with the early onset of potentially, um,
emotional challenges and then more long-term, severe mental illness.
Uh, you took over as the C HHA president in 2020.
Certainly that was a difficult time for everyone's mental health,
not only children,
but how do you think children's mental health has changed since the pandemic and
its onset?
Um, it's changed a lot,
and I think it's important to realize that even before the pandemic,
really the decade prior to that, we saw children's health, the need for, um,
children's health, mental health care increase quite a lot.
So demand was growing. Um,
really from the late early two thousands to 2019,
we saw a double in a tripling and that time of suicide ideation and children
attempting suicide. Um,
what happened really during the pandemic was an exacerbation of that.
So we saw it increased that same level in a very short period of time.
So children, um, faced all kinds of crises during the pandemic,
I think we all did if we're frank with ourselves. And so, um,
they're hit differently than adults are.
So issues of illness and financial strain, um,
being away from school,
being away from peer groups had a disproportionate impact on, on,
on our children.
And so what we saw during that time in particular was nearly a tripling of
suicide ideation and suicide attempts in our children's hospital emergency
rooms, um, which was quite concerning. We certainly saw, um,
more than a hundred percent increase really in, um, eating disorders, um,
particularly in young women and that situation. And then just children overall.
We saw it start to impact kids at a younger age.
So why typically you didn't see mental health issues come to the forefront maybe
until the early teens, we started seeing children ages six to 12, um,
show up with mental health conditions or early mental health conditions that
required an intervention as well. So, um,
it's a situation that has grown and unfortunately hasn't been subsiding. Um,
it's probably the biggest symptom of that from a children's hospital
perspective, again, is what happens in our emergency rooms.
And then unfortunately,
what happens when we're unable to get children immediate care. Um,
some children's hospitals have very intensive ambulatory programs, um,
outpatient programs and, um, inpatient care, but the,
the bed capacity to be able to treat these children today, um, is,
is far lower than what we need overall, um,
in most states and in most communities and certainly across the country.
And thank you for laying out those challenges and concerns that not only
children but hospitals and health systems are facing.
What would you say right now are the steps that are being taken to support
mental health in communities and what can hospitals and health systems do to
further that effort?
There's, there's a lot of energy around this right now, and I,
I think if we pause to look at, um, you know what,
one of the other things that's changed really since the pandemic is we've seen
more of a destigmatization of it.
So certainly we're having this conversation today,
and these conversations are happening in communities overall.
So we can think about the role of the health system, which is one piece of this,
the healthcare system, whether it's a children's hospital or,
or other hospitals within our communities.
But we also need to look at the community at large in many cases.
So just like any other, um, chronic disease, it happens early.
You may notice the signs of a child having, um, asthma,
for example, when they're younger.
The same thing happens with behavioral and mental health as well.
So you can start to see signs that maybe something's wrong,
maybe it's tossed out as though they're just upset or it's just a behavior. But,
um, that early intervention is gonna be really key.
So the healthcare system can be part of that solution,
but partnering in particular with our communities and our schools,
early childhood education and most of all our families to be able to, um,
to impact that.
The other thing that the healthcare system overall is doing right now is really
leaning in the health system and advocating for more training
for providers and for better reimbursement. Um, both from our,
um, publicly sponsored insurance programs like Medicaid and our commercially
sponsored programs as well.
So we just don't pay these providers enough to keep them to stay in their
profession, but also to continue to grow that workforce,
which we talked about earlier, is so incredibly important. Um,
health systems and hospitals across the country are leaning in and,
and training primary care physicians,
pediatricians to be more involved in this space as well.
So it's really building that village around our kids, um,
to be able to identify maybe a problem in school,
something that we can treat early, and so it doesn't become, um,
become a bigger issue as as they get older.
I'm glad you mentioned how important it's to see the signs early. Uh,
speaking of which, what trends do you think are going to develop on the horizon?
You know, it's really hard to predict the future, but I think we're,
we're living it a little bit right now,
and particularly in the mental health space. You know, I think, um,
one of the things that we talk about a lot,
and it's really hard to get your arms around is that about 50% of,
of mental illness begins before the age of 14.
So we just talked about early intervention, um,
and importantly it's over 10 years.
So just about 11 years between maybe the first signs of an emotional condition
or a mental health condition,
the shown nearly 11 years before someone gets treatment for that.
So if we stay on a current trajectory that we're on and we look at really the
past five years and what we've experienced as a nation,
and more importantly what each child has experienced in their own lives,
we're on probably a trajectory to see more mental health conditions than even we
have today.
The good news is everything else we just talked about is we have ability to
change that. So, um,
moving upstream and working with families and working with schools and working
with providers and building that workforce, um,
to build that support system for kids to teach them very early on coping skills
and recognizing how they can, um, one, soothe themselves, treat themselves,
and then ultimately to, um, be support systems for their families and, um,
for their friends in that same capacity. So l left to our own devices and,
and not enter, not, um, implementing some of these changes,
we're probably going to need more of a system going forward.
We know we don't have enough today, um, so we will need more of that,
but we certainly have an opportunity to invest in our kids and in our healthcare
system and in our other systems to be able to, to head that off if we so choose.
Here's something that's exactly what happens. Amy,
are there any other issues do you think that need a brighter spotlight right
now?
Yeah, I think, um, obviously mental health is a concern nationwide,
and that's both for adults and for kids. And so, um, probably we certainly,
obviously we're talking about kids today and would definitely focus our
spotlight there if at all possible. Our country has many needs and it's hard.
We have, we don't have unlimited resources, um,
but we would really kind of posit as,
as a community of children's hospitals and chi child health providers,
we can invest in our kids today to have a healthier future.
So oftentimes kids are the last one to receive care,
thank goodness most children are generally healthy, um,
and don't have some of the illnesses that that other adults and including some
of us have as well. Um,
but investing in that prevention early on will make them productive citizens,
productive military members, um,
and productive next generation of all of the talents that we have in our country
today.
So we would just really focus our efforts on kids and ensure
that when we're talking about legislation or when we're talking in a community
about resources, that we certainly, um,
carve out some of those specifically for our children.
Amy, thank you so much for sharing your insights today.
It was very much a pleasure speaking with you,
and we look forward to connecting with you soon.
All right.
Thank you very much for spending time on this incredibly important issue.