Integrating Behavioral Health into Pediatric Care: Hospital-led Solutions to a Growing Crisis
Children and adolescents are experiencing rising rates of anxiety, depression and other mental health conditions. The National Survey of Children’s Health found that between 2016 and 2023 the prevalence of diagnosed behavioral health conditions among adolescents rose 35%, with diagnosed anxiety increasing 61% and depression increasing 45%.1 The COVID-19 pandemic amplified these concerns, with children’s hospitals reporting increases in suicides, suicide attempts and self-injury cases among patients ages 5 to 18 between 2016 and 2021.2
Public health groups declared a national emergency in children’s mental health in 2021, and subsequent data has confirmed that emergency departments, inpatient units and clinics continue to see elevated demand.3
The Window for Intervention Is Narrow
Half of all individuals who will develop a mood, impulse control or substance use disorder show symptoms by age 14,4 with many indicators emerging during the years when children see pediatric primary care providers most consistently. When hospitals — particularly children’s hospitals — integrate behavioral health into primary care encounters, clinicians can recognize symptoms early, provide immediate support and reduce the chance of escalation into emergencies or longterm treatment. Early, coordinated care gives children a stronger foundation for healthy development.
Whole-person Care Improves Long-term Outcomes
Integration is especially critical for children at risk of severe conditions such as schizophrenia or bipolar disorder. Individuals with severe mental illness die 20 to 25 years earlier than the general population, often because unmanaged psychiatric symptoms interfere with treatment for chronic conditions such as diabetes or heart disease.5 When pediatric and behavioral health teams coordinate care, they can reinforce treatment plans and healthy behaviors, which may lessen the risk of complications later in life.
Integrated Care Is Whole Person Care — Across Multiple Settings
The United States faces severe behavioral health workforce shortages, with substantial gaps projected by 2037 across multiple professions, including addiction counselors, therapists, psychologists and psychiatrists. Currently, more than one-third of Americans live in areas designated as Mental Health Professional Shortage Areas. Families referred to behavioral health specialists often face months-long waits or fail to secure appointments at all.6 As a result, hospitals, particularly children’s hospitals, are redesigning how they provide behavioral health care. Some connect children to care during the school day through telehealth. Others embed therapists in pediatric clinics so families can get help immediately. Still others operate coordination hubs that track available treatment slots across a region, helping providers place children more quickly. All successful initiatives to improve access to youth behavioral health.
Investment and Philanthropy Accelerate Progress
Philanthropy and public investment have accelerated this work. Fortunately, philanthropic contributions have become more common in behavioral health. In 2016, Big Lots donated $50 million to Nationwide Children’s Hospital to expand behavioral health services for children and adolescents, one of the largest corporate gifts ever made to a children’s hospital.7 Similar gifts, along with state appropriations and community fundraising, have empowered hospitals to launch, scale and sustain behavioral health services.
Additional Resources
Integration: For more information on the value of integration and best practices of current hospitals and health systems, visit: www.aha.org/behavioral-health-physical-behavioral-health-integration-resources.
Community partnerships: Resources on www.aha.org/behavioral-health-community-partnerships showcase successful initiatives and key components to creating collaborative behavioral health community partnerships.
Building Solutions: Examples from the Field
While the challenges are national, many children’s hospitals are already putting integration into practice in ways that reflect the needs of their communities and patient populations. The following case studies demonstrate how integrated models are taking shape and what hospital leaders, particularly those in children’s hospitals, can learn from them.
1 Olivia Sappenfield, Cinthya Alberto, Jessica Minnaert, Julie Donney, Lydie Lebrun-Harris, and Reem Ghandour. Adolescent Mental and Behavioral Health, 2023. National Survey of Children’s Health Data Briefs. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. National Library of Medicine published October 2024. https://www.ncbi.nlm.nih.gov/books/NBK608531
2 Children’s Hospital Association. The State of Pediatric Suicide: Trends and Implications. Pediatric Health Information System (PHIS®) data, 2016–2021. https://www.childrenshospitals.org/content/behavioral-health/summary/the-state-of-pediatric-suicide
3 Children’s Hospital Association. “The Latest Pediatric Mental Health Data.” Children’s Hospitals Today, April 21, 2023. Pediatric Health Information System (PHIS®) data. https://www.childrenshospitals.org/news/childrens-hospitals-today/2023/04/the-latest-pediatric-mental-health-data
4 Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS. “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication.” Archives of General Psychiatry, doi:10.1001/archpsyc.62.6.593. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208678
5 National Institute of Mental Health. “Mental Illness.” NIMH. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/mental-illness
6 HRSA “State of the Behavioral Health workforce: 2024” National Center for Health Workforce Analysis. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/state-of-the-behavioral-health-workforce-report-2024.pdf
7 The Wall Street Journal Custom Content. “Courage for a Cause.” Sponsored by Nationwide Children’s Hospital, 2023. https://partners.wsj.com/nationwide-childrens-hospital/next-generation-philanthropy/courage-for-a-cause/