Confused, frantic, overwhelmed, anxious. These are some of the emotions I have observed in the families of my behavioral health patients. They are also the emotions I have felt myself while attempting to guide patients and families through moments I do not yet fully understand.
I recall an adolescent, admitted for active suicidal ideation the day prior. Suddenly notified that they would be transported to an inpatient psychiatric facility within the hour, I was now tasked with their transition of care despite having barely met them.
Whereas morning pre-rounding with routine introductions and questions about overnight events typically feels comfortable, I instead faced tension and resistance. Flying by are urgent, unanswered questions by concerned and confused parents who did not anticipate such a quick turnaround time. “What is it like there? Can we visit? How long will they be there?” I did not have immediate answers. Despite turning to my more experienced colleagues for help – nurses, social workers, the inpatient behavioral health providers, my supervisor – answers remained unclear or unknown.
This common experience exposes a gap in our system. We, as a multidisciplinary team, are well trained to stabilize behavioral health patients, assess safety, coordinate care and prepare them for discharge. Yet, understanding the transition of our patients’ care beyond the walls of the hospital is like driving into fog, which we cannot accept. Therefore, I recommend curriculum reform or the addition of supplemental education during academic conferences by residency program leadership that addresses this important question: “What happens next?”
As a pediatric provider whose practice focuses largely on anticipatory guidance or return precautions, it is frustrating when I am unable to set clear expectations. I can only imagine a parent’s fear and anticipation on possibly the worst day of their lives.
The scale of mental/behavioral health crises over the past few years is astounding. According to the CDC, 16% of U.S. high school students in 2023 reported making a suicide plan in the past year, with nearly 1 in 10 attempting suicide. Additionally, the State of Mental Health 2025 report documents that 11.3% of U.S. youth 12-17 years old still experience a major depressive episode (MDE), despite some improvement in MDEs between 2023 and 2024. This is approximately 3 million adolescents – 3 million families who should not have to figure out next steps alone without some degree of priming from their bedside providers.
Moreover, over half of U.S. youth between 2022-2023 with an MDE did not receive treatment or counseling for depression, revealing the care gap in the clinic setting. This reality allocates a larger onus on emergency medicine and inpatient providers. From 2016 to 2019, the rates of emergency department visits with a mental health-related diagnosis increased from 784.1 to 869.3 per 100,000 patients 0-17 years old.
With deficiencies in outpatient care, we must maximize the quality of care received by our hospitalized patients with mental health crises. We can further support families by elucidating next steps, which we can do with more educational support from our training programs.
Curriculum changes for resident education have actively addressed a growing demand for mental/behavioral health training among pediatric resident physicians. However, what feels missing is further education in where our patients go. Not only is it our responsibility to understand where we send them, but our ability to answer basic questions reflects patient safety and strengthens trust.
Therefore, I urge program leadership and education directors to consider supplemental didactic sessions during trainee orientation or conferences. These changes could include inviting inpatient behavioral facility personnel to discuss the extent of their intake process and visitation policies. It could also include shadowing rotations at our local psychiatric facilities or intensive outpatient programs. Lastly, some of the onus also falls on us as resident physicians. We must continue assessing our gaps in not only medical knowledge, but also knowledge of the whole system. Let us ask specific questions to our more experienced colleagues and research our local facilities, so we can become more supportive providers for patients and families navigating the fog that is mental/behavioral health. I hope that, in time, we may be less confused, frantic, overwhelmed and anxious.
By Dr. Kyra Roa, first-year pediatric resident