Why Now is the Time to Get Certified in Adolescent and Young Adult Psychiatry
Jonathan Bauman, M.D., LFAPA
1995 ABAP Diplomate
Member ABAP Board of Directors
Two companion pieces by Matt Richtel in the Mothers’ Day 2022 edition of the New York Times, “‘It’s Life or Death’: The Mental Health Crisis Among U.S. Teens” and “Hundreds of Suicidal Teens Sleep in Emergency Rooms. Every Night.” are a wakeup call to parents and mental health professionals about the recent explosion of mental health emergencies in adolescents and the tragic lack of available treatment options.
In ‘It’s Life or Death’ Richtel writes, “American adolescence is undergoing drastic change. Three decades ago, the gravest threats to teenagers came from binge drinking, drunken driving, teen pregnancy and smoking. These have fallen sharply, replaced by soaring rates of mental health disorders.” He also writes that between 2007 and 2019 there was a 60% increase, to 13%, of teenagers reporting having had a major depressive episode, and sharp rise in ER visits by children and adolescents for anxiety and mood disorders, and for self-harm. Richtel points out that for people 10 to 24, suicide rates were stable from 2000 to 2007 but increased by 60% by 2018, according to the CDC. The crisis, he says, is often attributed to the rise of social media, but this is based on limited data, though some adolescents appear more vulnerable than others to the effects of screen time. Other factors, according to federal research, are that teens are getting less sleep and exercise and are spending less in-person time with friends, all crucial for healthy development. The drop in the onset of puberty over the past 30 years may also be a factor in fueling the crisis. Over the past 10 years rates of smoking, drug and alcohol use and sex have continued a decline started over a decade before, but there has been a rise in excessive smartphone and computer use over the last 10 years. Concurrent with this, feelings of sadness, hopelessness and suicidal ideation have increased, and the pandemic has only added fuel to the fire. Throughout the article Richtel interweaves the moving story of one teenage patient and their family.
In the companion piece, “Hundreds of Suicidal Teens Sleep in Emergency Rooms. Every Night.”, Richtel tells the stories of several teenagers, admitted to ER’s in various hospitals around the country for suicidal behaviors or intent, who remain as boarders for sometimes up to two weeks, waiting for admission to a psychiatric facility or residential treatment center. He reports that one researcher estimates that at least 1000 young people, and possibly as many as 5000, board nightly in the nation’s 4000 ER’s. Much of the problem can be attributed, in part, to the closing of some residential settings due to inferior quality of care, but also often to the closing of psychiatric beds because of inadequate and unsustainable levels of reimbursement. Unfortunately these losses have not been counterbalanced by increases in outpatient treatment options that would help keep adolescents out of the hospital. Richtel gives many examples of teens and their families having to cope with the stress and uncertainty of languishing in an ER.
For adult psychiatrists who work with adolescents and young adults it is THE time to enhance your treatment skills for this population. Obtaining your certification in adolescent and young adult psychiatry by ABAP, the American Board of Adolescent Psychiatry, is one way you can demonstrate your expertise at treating this vulnerable population to our patients and their families.