|Emergency room visits for self-inflicted injuries,|
ages 10-19. (New York Times chart)
Richtel spent the last 18 months researching the phenomenon, interviewing teens and parents, health-care practitioners, scientists, policy experts and more, all of which informed a four-part series published over the past few weeks. It was a difficult project, Richtel writes in a brief explainer about how he and his editors tried to protect the privacy of those featured in the articles.
But, it's an important project, as mental-health disorders increasingly eclipse more traditional worries about teens such as binge drinking, drunk driving, pregnancy and smoking. "In 2019, 13 percent of adolescents reported having a major depressive episode, a 60% increase from 2007," Richtel reports. "Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60% by 2018, according to the Centers for Disease Control and Prevention."
Teenage girls are especially at risk (see chart), and are far more likely to visit the emergency room for self-inflicted injuries. But treatment is often difficult to access, especially in rural areas. Many teens who need in-patient psychiatric care can't access it and are forced to stay in hospital emergency rooms with no pediatric or mental-health specialists. In-patient programs are rarely found in rural areas, and there are fewer of them around these days anyway: The number of residential treatment facilities for minors fell from 848 in 2012 to 592 in 2020, a 30% decline resulting from "well-intentioned policy changes that did not foresee a surge in mental-health cases," Richtel reports. "Social-distancing rules and labor shortages during the pandemic have eliminated additional treatment centers and beds, experts say."
Preventative care can also be hard to find, Richtel reports. Mental-health practitioners are scarce in rural areas—70% of U.S. counties lack a psychiatrist who specializes in children or adolescents—and it can take months to get an appointment. Also, many don't accept private insurance, much less Medicaid. That means pediatricians with minimal mental-health training often bear the brunt of caring for teens with complicated psychiatric issues. Many told Richtel they feel poorly equipped to do so.
Richtel includes in the series a helpful Q and A for parents with guidelines on how to find a doctor, what to do if one's teen is feeling suicidal, and how to talk to teens about mental health. The Rural Health Information Hub has a resource guide on rural mental health that includes links to searchable databases on county-level availability of mental-health professionals.