The hospital where I practice recently admitted a 14-year-old girl with post-traumatic stress disorder, or PTSD, to our outpatient program. She was referred to us six months earlier, in October 2022, but at the time we were at capacity. Although we tried to refer her to several other hospitals, they too were full. During that six-month wait, she attempted suicide.

Unfortunately, this is an all-too-common story for young people with mental health issues. A 2021 survey of 88 children’s hospitals reported that they admit, on average, four teens per day to inpatient programs. At many of these hospitals, more children await help, but there are simply not enough services or psychiatric beds for them.

So these children languish, sometimes for days or even a week, in hospital emergency departments. This is not a good place for a young person coping with grave mental health issues and perhaps considering suicide. Waiting at home is not a good option either – the family is often unable or unwilling to deal with a child who is distraught or violent.

I am a professor of psychiatry and pediatrics at the University of Colorado, where I founded and direct the Stress, Trauma, Adversity Research and Treatment Center. For 30 years, my practice has focused on youth stress and trauma.

Over those years, I have noticed that these young patients have become more aggressive and suicidal. They are sicker when compared to years past. And the data backs up my observation: From 2007 through 2021, suicide rates among young people ages 10 to 24 increased by 62%. From 2014 to 2021, homicide rates rose by 60%. The situation is so grim that in October 2021, health care professionals declared a national emergency in child mental health.

Since then, the crisis has not abated; it’s only gotten worse. But there are not enough mental health professionals to meet the need.

The numbers behind the suffering

The American Academy of Child and Adolescent Psychiatry reported in May 2023 that there is a drastic shortage of child and adolescent psychiatrists across the U.S.

For every 100,000 children in the U.S. – with 1 in 5 of those children having a mental, emotional or behavioral disorder in a given year – there are only 14 child and adolescent psychiatrists available to treat them, according to the American Academy of Child and Adolescent Psychiatry. At least three times as many are needed.

There is also a significant shortage of child therapists – social workers, psychologists, licensed professional counselors – as well. This is particularly the case in rural areas across the country.

Studies show that young people in the U.S. are increasingly stressed and traumatized. The constant barrage of information via social media and the demand to participate in it is complex, and interactions can be harmful to a child’s mental health.

Young people deal with cyberbullying and endless exposure to social media content focused on body image.

But what children and adolescents see online is not the only problem. Much of life still happens offline, and a lot of it is not good. Millions of young people deal every day with alcoholic, drug-abusing or neglectful parents; peers who drink, vape and use drugs; violence at their schools or in their streets; and overwhelmed caregivers – whether parents or others – preoccupied with financial or other personal problems.

For an adolescent already struggling to make sense of the world, any one of these issues can be overwhelming.

Not enough time or money

The U.S. health care system does very little to support these children or their families. This pattern begins at the moment of birth, and it is baked into the system.

Ideally, prospective parents or those who are pregnant would receive parenting classes that continue through the child’s developmental phases. That generally does not happen. Then, many new parents do not have nursing and maternal care visits or paid parental leave. And for those families struggling financially, there is not an adequate safety net.

Nor can some families afford mental health treatment to support their children’s needs. Many mental health providers don’t take insurance and instead opt for out-of-pocket payments from patients. This is due to the low reimbursement rates from most insurers, which makes it very difficult to sustain a practice. Depending on the service, the cost could be anywhere from US$100 to $600 per session.

To see providers that do take insurance, there are usually co-pays – typically between $20 to $50 a week. But it can often be challenging for the insured to find a suitable in-network provider to meet a child’s needs.

The payments add up, particularly when mental health treatment takes many months, and sometimes years, to have an effect. There is a reason why it takes so long. Unlike medical doctors, mental health professionals do not simply make a diagnosis and provide medication or surgery. Instead, for treatments to work and to change the outcome for young people who are struggling, an ongoing – and lengthy – relationship between the therapist and the patient is needed.

Treating a child is significantly more difficult than treating an adult. That is, in part, because children are constantly developing and changing. But perhaps the most formidable challenges are the multiple entities a child therapist may have to work with: caregivers, the school system, the courts and child welfare agencies. What’s more, getting a diagnosis, treatment or both often involves working with multiple providers, such as a primary care doctor, individual therapist, family-focused therapist and psychiatrist.

In the institute where I work, the psychiatry department loses money on almost every patient we treat. If it weren’t for fundraising and fostering relationships with donors, the department could only provide care to a select few.

Possible solutions

Struggling children and teens in the U.S. need earlier interventions. Although schools are ideal places to teach social skills, they still do not offer enough activities to help young people develop resilience to cope with adversity.

Sometimes, young patients see primary care doctors who don’t have enough training in this area. Telephone hotline programs, which offer these doctors free consultations from mental health professionals to help assess problems in young patients, should be available throughout the U.S. But right now, only 19 states have such programs. One bright spot: The 988 Suicide and Crisis Lifeline, which launched in July 2022, is available 24/7.

When a young person needs treatment, parents should prioritize finding a mental health provider right away. Asking the child’s primary doctor and school counselors for a reference is a good start. If the child is already on a waiting list, a parent or guardian should call the provider weekly to check in and make sure the child is not forgotten.

The process can be discouraging and daunting, but in our current environment, which provides limited support, that’s the way it is. And without a heavy lift from parents, the child remains at great risk.

Steven Berkowitz, Professor of Psychiatry, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Black women were more likely to die during pregnancy or soon after in every year from 1999 through 2019, compared with Hispanic, American Indian and Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and white women. That is a key finding of our recent study published in the Journal of the American Medical Association. The risk of maternal death increased the most for American Indian and Alaska Native women during that time frame.

Maternal deaths refers to death from any cause except for accidents, homicides and suicides, during or within one year after pregnancy.

Notably, maternal mortality rates more than doubled for every racial and ethnic group from 1999 through 2019. Most maternal deaths are considered preventable because, in the U.S., maternal deaths are most often caused by problems that have very effective treatments, including bleeding after delivery, heart disease, high blood pressure, blood clots and infections.

Previous research has focused on high rates of maternal mortality in the Southern U.S., but our results showed that there are high-risk populations throughout the country.

For Black women in 2019, the states with the highest maternal mortality ratios – meaning the proportion of maternal deaths per 100,000 live births – were Arizona, New Jersey, New York and Georgia, along with the District of Columbia. Each had a maternal mortality ratio greater than 100 for Black women. In comparison, the national maternal mortality ratio for all women in the U.S. was 32.1 in 2019.

Among American Indian and Alaska Native women, the states with the largest increases in maternal mortality between the first half of the time period (1999-2009) and the second half (2010-2019) were Florida, Kansas, Illinois, Rhode Island and Wisconsin. In each of these states, risk of maternal death increased by more than 162%. Across the whole U.S., maternal mortality for American Indian and Alaska Native women was higher in 2019 than in all other years. Some individuals other than women, including girls, transgender men and people who identify as nonbinary, are also at risk of maternal death.

Why it matters

In order to prevent maternal deaths in the U.S., it’s crucial to understand who is most at risk. Prior to our study, estimates of maternal mortality for racial and ethnic groups within every state had never been released.

The U.S. has a high rate of maternal mortality compared to other high-income countries, despite spending more per person on health care. Disparities in maternal mortality have persisted for many decades.

Because most maternal deaths are preventable, interventions have the potential to make a significant difference. Better prevention of related events, such as preterm birth, is also necessary. We hope that our research continues to help policymakers and health care leaders put solutions in place to better prevent these deaths from happening.

Recently, U.S. Democratic Senators Cory Booker and Bob Menendez of New Jersey, Raphael Warnock of Georgia, and Alex Padilla of California reintroduced the Kira Johnson Act to improve maternal health outcomes for racial and ethnic minority groups and other underserved populations, citing our study.

What’s next

We would like to investigate how the most common causes of maternal death, such as blood clots, high blood pressure and mental health issues, are contributing to the overall estimates.

Understanding these trends will help clinicians and policymakers tailor solutions to be as effective as possible.

Our study did not include data from the pandemic years. So far, maternal mortality has only been reported at the national level for those years, but reports suggest that maternal mortality rates have increased since the start of the COVID-19 pandemic and that racial disparities have only gotten worse.

The Research Brief is a short take about interesting academic work.

Laura Fleszar, Public Health Researcher at the Institute for Health Metrics and Evaluation, University of Washington; Allison Bryant Mantha, Associate Professor of Obstetrics, Gynecology and Reproductive Biology , Harvard University; Catherine O. Johnson, Research Scientist in Public Health, University of Washington, and Greg Roth, Associate Professor of Medicine and Adjunct Associate Professor of Health Metrics Sciences, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The formerly pristine reputation of the U.S. government’s debt lost a little more luster after another prominent rating agency demoted Uncle Sam from its AAA perch.

What does a downgrade of U.S. creditworthiness like this actually mean?

While the downgrade is unlikely to have much of an impact in the short term, its implications about the state and size of U.S. indebtedness will likely reverberate on Capitol Hill, where stalled negotiations over the budget could mark a step toward the Biden administration’s first government shutdown.

Fitch Ratings’ decision on Aug. 1, 2023, led to small declines in the stock and bond markets. But as an economist who studies the effects of monetary and fiscal policies, I’ve got longer-term concerns about the downgrade’s implications for U.S. economic growth.

To understand why, you have to look at both the reasons for Fitch’s downgrade and what it means for U.S. borrowing going forward.

Why Fitch downgraded the US

Just like people, the federal government has to balance the income it takes in and the money it spends for each fiscal year. Most federal income consists of tax revenue.

Since 2001, that revenue has rarely covered enough of the costs of everything the U.S. government pays for, from roadways to wars. When federal income falls short, the government fills the gap by borrowing money from investors.

That gap has gotten a lot bigger in recent years as the U.S. has spent trillions fighting COVID-19, contending with financial crises and funding several wars. As of Aug. 1, the U.S. Treasury owed US$32.6 trillion, both to bondholders and other parts of the federal government.

That’s part of the reason that Fitch cut the U.S. government’s long-term creditworthiness by one notch, from AAA – its highest rating – to AA+. Fitch also cited an “erosion of governance,” specifically pointing to recent efforts by conservatives to prevent the U.S. from raising its debt ceiling.

What happened last time

This was not the first time that a rating agency lowered the credit of the U.S. government.

In 2011, Standard & Poor’s, one of Fitch’s competitors, also downgraded its rating for the U.S. from AAA to AA+. S&P similarly blamed governance issues – that downgrade followed a similar debt ceiling standoff – as well as the burden of rising government debt.

At the time, Fitch issued a warning but it didn’t cut the U.S.’s credit rating until now.

The 2011 episode had no long-term effects on financial markets, including Treasury bonds – meaning investors remained happy to continue lending to the U.S. at favorable rates.

Does that mean Fitch’s downgrade will similarly have little long-term impact? Not necessarily.

Why things might be different

Any country seeking to borrow money in perpetuity needs lenders who are happy to lend.

For the U.S., that means it needs a constant supply of buyers for Treasury bonds and the other securities it sells. These securities are sold in auctions and then traded on global financial markets.

Investors of all kinds around the world find Treasurys attractive. They’re seen as safe, because the U.S. government is considered less likely to default than, say, a company going bankrupt.

Rating agencies like Fitch assess these risks and periodically adjust their credit rating scores based on their assessment on the ability of the federal government – and other borrowers – to keep up with their debt obligations.

“Repeated debt-limit political standoffs and last-minute resolutions have eroded confidence in fiscal management,” Fitch said in its announcement, in a reference to recurring fights among lawmakers over raising the debt ceiling.

But if economists and financial analysts deem Treasurys to be growing riskier, then investors may become less interested in buying them. Alternatively, they may demand a higher interest rate in exchange for taking on the risk that the U.S. may default on its debts.

So, however the market reacts, I believe that this downgrade reflects the real deterioration of America’s fiscal standing as well as its ability to safeguard it.

And as economists and financial analysts decide Treasurys are becoming a riskier security to hold – whether because of the size of overall U.S. debt or because political brinkmanship is making a once-unthinkinkable default more likely – then investors may become less interested in buying them. Or, at least, they may demand the U.S. pay them more to take on the risk, resulting in higher borrowing costs for the government.

Ultimately, this means there will be less money for everything else the U.S. might want to spend money on – or the overall debt load will rise even faster.

Limited options

To cover its growing borrowing costs, the federal government has few options – none good.

It can borrow more money, which is seen as riskier – like taking out one loan to pay off another – and could result in an even lower credit rating and a continuous spiral of rising borrowing costs. Or it could hike tax rates or cut spending, both of which have political consequences and could be hard to accomplish given the degree of polarization in Congress.

Furthermore, research has shown that higher government debt is generally associated with lower long-term economic growth, which reinforces the problem by reducing revenue and thus requiring more debt.

So, while Fitch’s downgrade doesn’t signal an imminent financial crisis, it does serve as a warning as Congress engages in its fiscal fights – including the one over the budget that will heat up in September.

Hakan Yilmazkuday, Professor of Economics, Florida International University

This article is republished from The Conversation under a Creative Commons license. Read the original article.