Shortages of mental health professionals across U.S. counties were associated with an increase in youth suicides, according to a Northwestern Medicine study published in JAMA Pediatrics, findings that could help inform suicide prevention efforts at local and national levels.
“Since the onset of the pandemic, hospital emergency rooms across the county, including my own, have been inundated with children and youth experiencing severe mental health crises. We urgently need more federal investments to build the mental health workforce and to expand community-based services that focus on prevention, early identification and treatment,” said Jennifer Hoffmann, ’13 MD, ’22 MS, assistant professor of Pediatrics in the Division of Emergency Medicine and lead author of the study.
Elizabeth Alpern, MD, MSCE, associate chair for Faculty Development and chief of Emergency Medicine in the Department of Pediatrics, was senior author of the study.
Investigators analyzed data obtained from the U.S. Centers for Disease Control and Prevention that included all youth suicides that occurred in all U.S. counties from January 2015 through December 2016. The investigators adjusted for the presence of a children’s mental health hospital and county-level characteristics, including health insurance coverage, education, unemployment, income, poverty, urbanicity, racial and ethnic composition and year.
During the study period, a total of 5,034 youth suicides occurred, of which 72.8 percent were male and 68.2 percent were white. Among the 3,133 U.S. counties, approximately two-thirds were experiencing significant shortages of mental health professionals.
After adjusting for other county characteristics, the investigators found mental health workforce shortages were associated with higher rates of both overall youth suicides and youth suicide from firearms.
“We found shortages of mental health professionals are more severe in rural areas, and in communities with lower household incomes and lower educational attainment. Unfortunately, these are the very same communities where children are more likely to experience poor mental health outcomes,” Hoffmann said.
The current youth mental health crisis represents a national emergency, Hoffmann said, and Medicaid reimbursement rates should also be increased to attract and retain mental health professionals across the U.S.
“We must urge policymakers to increase federal funding to ensure all children can access mental health services. Solutions include improving access to telemedicine, expanding school-based mental health services and supporting mental health care delivery within pediatric primary care offices,” Hoffmann said. “Workforce challenges must be urgently addressed so that children can access mental healthcare no matter where they live.”
Co-authors of the study include Megan Attridge, MD, ’22 MS, assistant professor of Pediatrics in the Division of Emergency Medicine, and Michael Carroll, PhD, research assistant professor of Pediatrics.
This work was supported by an Academic Pediatric Association Young Investigator Award.