Crisis Support: Riley Hospital's Teen Services Explored

In 2019, Riley Hospital for Children opened a psychiatric unit for adolescents with mental health issues, including anxiety, eating disorders, and bipolar disorder. However, the unit was closed soon after, leaving families in Central Indiana with one less option for teen crisis support. The closure occurred during a time of increasing teen suicide rates and a shortage of mental health professionals. While Riley Hospital continues to offer advanced therapy for adolescents, its inpatient mental health services have been affected by challenges common to behavioral health units, such as staffing and insurance reimbursement issues.

Teen suicide rates

Suicide is a leading cause of death among teenagers and young adults, with suicide rates among young people increasing over the past decade. In 2021, suicide was the third leading cause of death among US high school students aged 14-18, with 1,952 suicide-related deaths resulting in a rate of 9.0 per 100,000 youths. However, suicide attempts and suicidal thoughts among youth exceed deaths by suicide. The 2021 Youth Risk Behavior Survey (YRBS) found that approximately one-third (30%) of female high school students and 14.3% of male high school students had seriously considered attempting suicide in the year before the survey. Furthermore, over 42% of high school students experienced persistent feelings of sadness or hopelessness, and 29% reported poor mental health.

Certain subgroups of youth are more susceptible to mental health issues and suicide-related behaviours. For instance, female and LGBTQ+ students are more likely to experience poor mental health and consider suicide. In 2021, one-third of teenage girls contemplated suicide, and Black children were twice as likely to die by suicide. Additionally, LGBTQ+ young people living in rural areas are more likely to have considered suicide, with 39% of all LGBTQ+ youth seriously contemplating suicide attempts and 12% attempting suicide in the past year.

The rise of social media and the isolation caused by the COVID-19 pandemic are also contributing factors to the increasing rates of teen suicide. Firearms are the most common means of suicide in the United States, with over 27,000 suicides carried out by firearms in 2022. However, suicide by poisoning is more prevalent among women than men.

To address the teen suicide crisis, it is crucial to identify protective factors and foster positive mental health outcomes. The Jed Foundation's Campus program has successfully reduced suicidal ideation, planning, and attempts among college and university students. Additionally, Riley Hospital for Children in Indiana received an $8 million donation in 2024 to bolster youth mental health services and embed mental health professionals in primary care and pediatrician offices across the state. This initiative aims to treat patients with anxiety and depression before they experience a crisis.

Shortage of mental health professionals

There is a critical and growing shortage of mental health professionals worldwide, affecting both developed and developing countries. This shortage is impacting individuals, communities, and the healthcare system. The COVID-19 pandemic greatly amplified this issue, increasing the demand for mental health services. The pandemic caused a rise in social stressors, substance use, and mental illness, with drug overdose deaths and suicide rates increasing to near-record levels. Mental-health-related visits to emergency rooms jumped 31% in 2020 among children aged 12-17.

The shortage of professionals means that individuals seeking care face long waiting times and are often unable to access mental health services at all. This can lead to a worsening of mental health conditions due to delayed or inadequate care, as well as an increased risk of suicide. The shortage is particularly acute in rural areas due to a lack of funding and infrastructure, with many counties having no mental health professionals at all.

The shortage of mental health professionals is due to both dwindling supply and growing demand. Thousands of mental health professionals retire each year, and there are fewer younger professionals entering the field to replace them. This is partly due to a lack of financial incentive, as psychiatry is not well-paid. Additionally, the growing acceptance of mental healthcare and increased awareness of mental health issues have increased demand for these services.

To address the shortage, it is essential to increase the number of trained mental health counselors. This can be achieved through recruitment and training initiatives, such as partnering with schools and universities to educate and encourage young people to enter the field. Additionally, integrating mental health professionals into primary care offices and pediatrician offices can help treat patients with mild to moderate mental health issues before they experience a crisis.

Anxiety and depression

It is important for parents to be vigilant and notice any abrupt changes in their teen's behaviour, such as extreme irritability, insomnia, or panic attacks. If these signs persist for two weeks or longer, it may be advisable to seek professional help. Parental expectations can also be a source of stress for teens, and it is crucial for parents to express their unconditional love and support their children in overcoming their fears. Encouraging teens to face their fears in safe environments can help them build resilience.

When anxiety and depression occur together, known as "comorbid" depression and anxiety, they can be more challenging to treat. However, early intervention is critical, and a mental health professional can assess a teen's family history, individual temperament, and life experiences to identify the root causes of their symptoms. Treatment should address the underlying issues causing anxiety or depression and aim to prevent the development of dual diagnoses.

Self-harm

Riley Children's Hospital in Indiana has recognised this crisis and is taking steps to address it. They have partnered with PBS to produce a documentary film, "Racing to Respond", which addresses the mental health crisis among Hoosier teens, including issues of self-harm. The hospital is also working with 220 stakeholders in the state to develop Indiana's pediatric mental health strategic plan. As part of this plan, Riley Children's Health will invest in integrating mental health into primary care, developing programs for schools, creating parent support groups, and establishing training facilities to prepare healthcare professionals to provide evidence-based interventions.

In addition, Riley Hospital has received an $8 million donation from former Eli Lilly CEO John Lechleiter and his wife, Sarah, to bolster youth mental health services. This funding will be used to embed mental health professionals at Riley and IU Health primary care and pediatrician offices across the state, with the goal of treating patients with anxiety and depression before they experience a crisis. The hospital also offers a range of specialty clinics, including the Riley Pediatric Care Center in downtown Indianapolis, which provides diagnostic evaluations and treatment for children and teens with mental health disorders using evidence-based medication management and psychotherapy.

The Riley Multisystemic Therapy (MST) Program is another initiative aimed at helping youth aged 12-17 who are at risk of severe system consequences due to externalizing, anti-social, and/or delinquent behaviours. This program involves intensive family- and community-based treatment, where families work closely with their therapist to address the drivers of behaviour problems and make long-lasting changes.

While Riley Hospital has made significant strides in addressing the teen mental health crisis, including self-harm, it is important to note that they faced criticism in 2019 for closing their psychiatric unit, which included safe rooms specifically designed for patients who might harm themselves. However, experts noted that the closure was not unusual, as insurers often direct patients towards treatments that do not involve expensive hospitalizations.

Visitor restrictions

Riley Hospital for Children at IU Health will allow up to six designated visitors per patient. However, only two visitors may visit at any one time. Visitors must be 18 years or older. Some units may have additional visitor guidelines in place. Please review the additional information below or speak with a member of your/your child’s care team to answer any questions.

Pediatric inpatients may have two parents or guardians and up to four designated visitors. Only two parents or guardians can stay overnight. Maternity patients may have up to six designated visitors. Visitors under the age of 18 may be permitted by each unit based on considerations for end-of-life circumstances.

Designated visitors may not be changed throughout the patient's stay. However, those designated visitors can switch out as frequently as they wish outside the unit. Masks are not required but will still be available to those who choose to wear them.

Frequently asked questions