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November 2, 2021

'In crisis mode': How short-staffed hospitals are coping with a mental health surge

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    The Covid-19 pandemic has led to a worsening mental health crisis, especially among children, causing surges of mental health patients at hospitals already suffering from staff shortages.

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    Mental health reaching 'crisis levels'

    According to a survey from the American Psychological Association (APA), psychologists in 2021 are seeing increased demand for care since last year, when demand already spiked to new levels. Most commonly, care has been for depression, anxiety, and trauma- or stressor-related disorders.

    "The pandemic has created an extraordinary sense of loss in many people's lives, and it's created abrupt change with great uncertainty about when that change is going to end. And that has really turned many people’s lives upside down," Surgeon General Vivek Murthy said.

    Mental health has especially worsened among children, data shows, which led the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association to declare a national state of emergency in children's mental health last month.

    According to a statement from the three organizations, in the first half of this year, children's hospitals saw a 45% jump in reported self-injury and suicide cases among children ages five to 17 compared with the same period in 2019.

    In addition, mental health ED visits increased 24% for children ages 5 to 11 and 31% for children ages 12 to 17 between March and October 2020, the statement said.

    Meanwhile, a study released in October by the Child Mind Institute found that 55% of children reported feeling more "sad, depressed, or unhappy" because of the pandemic and around 70% of children and adults reported some level of mental discomfort that manifested in loneliness, irritability, or fidgetiness.

    According to CDC data, reports of anxiety and depression symptoms among children have been especially prevalent in children of color.

    "It really has reached crisis levels," said Lee Beers, president of AAP. "There was probably some hope that as kids returned to in-person schools, there would be access to some services in schools, but we're really not seeing it let up at all."

    One cause behind the crisis among children could be that many are experiencing added stress within their families, Axios reports. According to an NIH study, an estimated 140,000 children lost a caregiver to Covid-19 as of this summer.

    "Losing a parent is probably one of the most profound traumatic losses that can happen for a young person," said Tamar Mendelson, director of the Center for Adolescent Health at the Johns Hopkins Bloomberg School of Public Health. "Those kind of experiences are going to have a lasting impact."

    Hospitals struggling with increased demand

    As a result of the surging mental health crisis, many hospitals and health care providers are struggling to meet demand. According to APA's study, about two-thirds of psychologists said their waitlists have gotten longer since the start of the pandemic and that they don't have the capacity to see new patients. Almost half of the respondents also said they felt burned out.

    "Prior to the pandemic, we had a workforce system that could not meet the need when it comes to mental and behavioral health care, and the pandemic has only exacerbated that," said Vaile Wright, senior director for health care innovation at APA.

    Demand has hit some state-run psychiatric hospitals especially hard. For example, many mental health patients in Georgia have had to wait days in an ED until a bed was available in any of the state's five psychiatric hospitals. And roughly 10% of the state's beds are empty because there's no one to take care of the patients who would occupy them.

    "We're in crisis mode," said John Sy, an ED physician in Savannah. "Two weeks ago, we were probably holding eight to 10 patients. Some of them had been there for days."

    In July, an advisory committee in Texas reported a near-record number of people whom the court system had determined had a mental illness on the waitlist for state hospital beds. And last month, the National Guard was called into Oregon to help providers at the state's largest public psychiatric facility.

    EDs "have been flooded with patients needing psychiatric care," said Robert Trestman, chair of APA's Council on Healthcare Systems and Financing. "The current crisis is unprecedented in the extent, severity, and sweep of its national impact."

    More patients but fewer workers

    Much of the crisis has been driven by staffing shortages, as many state workers leave their facilities for psychiatric units with better pay and less stressful conditions, Kaiser Health News reports.

    Working in a state-run facility is "hard work and it's grueling," said Hannah Longley, community program director of the Maine chapter of the National Alliance on Mental Illness. State work also doesn't offer "a significant salary and benefit package," she added.

    "A lot of people are chasing the Covid money," said Netha Carter, a nurse practitioner in a Georgia state facility for people who are developmentally disabled. Carter added that some temp agencies are offering "triple the pay" offered by state facilities.

    Virginia has slowed admissions to state mental hospitals as a result of staffing shortages despite an increased demand for care. "I have never seen an entire system bottleneck this bad," said Kathy Harkey, executive director of the Virginia chapter of the National Alliance on Mental Illness. The strain on the state's hospitals is also affecting the private system, she added.

    And in Georgia, the backlog in mental health services at state-run facilities is spilling over into jails throughout the state, where patients are often being kept because they can't go to a mental health facility.

    "A lot of these folks don't need to be in jail, but they're stuck in there," said Bill Hallsworth, coordinator of jail and court services for the Georgia Sheriffs' Association. "There's no place to put them." (Owens, Axios, 10/30 [1]; Owens, Axios, 10/30 [2]; Miller, Kaiser Health News, 10/26; Owens, Axios, 10/30 [3]; Garfinkel, Axios, 10/21; Owens, Axios, 10/30 [4])

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    The Covid-19 pandemic is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need. Download our take to learn how health systems can prioritize addressing the immediate needs of both staff and patients, especially those with preexisting behavioral health needs or comorbid conditions.

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