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Advocating for our Child and Adolescent Patients and Psychiatrists

Winter 2020  |  Issue 45

Advocating for our Child and Adolescent Patients and Psychiatrists
By Sudhakar Shenoy, MD

Long before the COVID-19 pandemic, children’s mental health in America was already a crisis; the number of young people with mental health problems was rising while the number of well-trained child and adolescent psychiatrists (CAP) was decreasing. With the pandemic and high levels of stress and isolation, the crisis has now become a disaster. Compared to 2019, the proportion of mental health-related ED visits from April to October 2020 for children aged 5-11 and 12-17 years have increased by 24% and 31%, respectively (CDC Morbidity and Mortality Weekly Report). Once in ED, children suffering from depression, anxiety, and behavioral issues often wait days for psychiatric beds.

I am a CAP. I see child and adolescent patients with mental health issues of varying degrees of complexity, severity, and acuity. My patients come from more than 3 different counties of Illinois, where we only have 11 CAPs per 100,000 children below age 18 (AACAP Workforce Maps by State). Without me, there is every chance that my patients will go to ED in a crisis, with a crisis, when the ED itself is in crisis.

Today I start my clinic day with AJ, a 17-year-old struggling with opioid addiction. He has survived three overdoses; one of them was an intentional overdose. He had started learning coping skills while doing school work at a residential treatment center, which closed down due to a COVID-19 outbreak. Without the support he had at the center, AJ tells me he is afraid of relapsing.
My next patient is JI, a 7-year-old who’s losing bladder control. Both her school and day care have closed down due to the pandemic, and JI is scared. JI’s mom, TI, is a 35-year-old single mother who has survived depression and suicide attempts as a teen. TI recently lost her job at a restaurant after it was forced to close indefinitely due to the pandemic. TI becomes tearful – “all my child sees is this crying, hopeless woman who cannot be a good mom.”

Then I go see EB, a non-verbal 14-year-old with severe autism. She smiles and gives out her loud shriek; that’s her language to tell me she’s happy. But her parents look concerned. They say EB has been biting herself on her left arm. Since her behavioral school closed due to the pandemic, her self-injurious behaviors have returned.

In between these three patients, I answer three phone calls; two patients are in crisis, and another patient needs a medication refill sent to their pharmacy. Throughout the work day, my colleagues in pediatrics, family medicine, internal medicine, and OBGYN like to pick my brain as many of their patients remain on months-long wait lists to see CAP psychiatrists; there is not enough of us.

Our young people deserve equitable, safe, high-quality patient care. At IPS CAP Committee, we are aware of the dire need to increase access for our children to specialist knowledge and medical expertise provided by competent, well-trained CAPs. We cannot achieve this alone. Our committee plans to form an alliance with Illinois Council of Child and Adolescent Psychiatry (ICCAP). Together, we hope to reach out to our physician colleagues in allied specialties, such as family medicine and pediatrics, for innovative solutions like consultation and collaborative care models. We need support from our adult psychiatrist members as well, especially when it comes to advocacy and mental health policy. We are working on building an “unofficial- advocacy-team”. With this team of physicians, we should be able to correspond with our lawmakers and would like your support in this effort. Remember, the lawmakers value us as physicians and the expertise we bring to the table. If you’d like to join and support this effort by the IPS CAP Committee, or even if you think you can be on this list of the advocacy-team and provide support in whatever way you can, please reach me at dr.sudhakarshenoyk@gmail.com.
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