First Person with Psychiatrist John Walkup
John Walkup, MD, is Chair of the Pritzker Department of Psychiatry and Behavioral Health and the Margaret C. Osterman Board Designated Professor in Child & Adolescent Psychiatry. Hear what he has to say about the connection between the pandemic and the youth mental health crisis, the scale of the need and what inspires him about his work.
Q: We hear so much about the pandemic causing a youth mental health crisis. What’s your perspective?
A: Even before the pandemic, the demand for pediatric mental health care was already higher than the supply across the state. In the city it was even worse because Chicago lost 84 pediatric psychiatric inpatient beds due to hospitals closing those units, so there just wasn’t the capacity to meet the acute needs of kids who were really suffering. All those kids started to come to Lurie Children’s. We had regular increases in our psychiatric emergency department visits over five years, but a 20% increase in the first year of the pandemic. And it wasn’t small problems that these kids were presenting with. These were large scale problems--many more suicide attempts or kids who were a risk to others, kids who really felt disconnected from school and family.
Keep in mind that about 20% of kids have a mental health problem before they graduate from high school. Most of them don't get assessed or treated, but they are held together by their families, by school, by afterschool activities, by peer relationships. And when all of those things went away during COVID-19, kids didn't have the support they needed to stay functioning. And so their mental health problems began to rise to the surface and they sought care but because of the pandemic, many places closed down or restricted access.
Q: Now that kids are back in school, isn’t the demand decreasing?
A: I've heard that people say now that the pandemic's over, we don't need to worry about behavioral health with kids, but I don't agree. I think parents now are much more aware of the behavioral health needs of their children. They realize how fragile some kids are. And they're much more aware that their kids actually have a mental health problem that could benefit from treatment. So there's no turning back. We have to build a mental health system that has the capacity to address kids' problems and manage them effectively. It's so important to our kids, important to our families, important to our community at large, that we have a really good mental health system.
Q: But if 20% of all kids will have a mental health problem at some point, that’s 300,000 kids in Chicago and 600,000 in the State of Illinois. How can Lurie Children’s begin to meet the needs of all the kids who need help?
A: We are putting together a plan to address this level of need and we’re doing it by going beyond our traditional set of services, which are extensive: inpatient unit, partial hospitalization program, intensive outpatient program, treating kids in the emergency department, a big outpatient program and a consult service for kids who are in the hospital with medical conditions.
For instance, one innovation beyond traditional services is our collaborative care program, which began before the pandemic. With the support of philanthropy, we have been training our pediatricians to provide basic mental health care and assessment. Most of our pediatricians see about a thousand kids a year. If our estimate is correct that 20% will have a mental health problem, that’s 200 kids. Pediatricians will see those kids and diagnose them much earlier than a psychiatrist ever will. They are a trusted source of help and guidance for families already and can help address problems early.
The other key element that’s different at Lurie Children’s is that we work in the community in a big way. There’s the Magoon Institute for Healthy Communities, which is our umbrella organization that focuses on improving the outcomes for kids across the city. We also have the Center for Childhood Resilience that has a long-term relationship with Chicago Public Schools and school systems around the state, working with teachers and counselors to build the mental health system within public schools, which are key places for kids to be identified and get treatment and care.
We're also working with community agencies, particularly youth groups, to identify their personal challenges and what kind of services and supports they need. Youth speak loud and clear about their behavioral health needs and about the impact structural racism has had on them and their families and their community. Through our pediatric partners, we are getting increasingly engaged at the local level in communities that are often underserved from a behavioral health point of view. For me, that's the biggest challenge and the most exciting thing about being here at Lurie Children's. We have a bigger vision about being in the community and taking care of kids where they live and play.
I think Lurie Children's is already leading the country in terms of what we offer. Our next phase of development is launching our research initiative in child and adolescent psychiatry. We have very good treatments, but we need to really develop the research infrastructure to take what we know about the best practices today and improve upon them and make them more available to every kid who needs them.
Q: What inspires you or gives you hope in your work?
A: I have the best job in the world. I have the chance to not only take care of kids here, but impact how kids are treated in Chicago and Illinois and create exemplary programs that will impact how care is delivered nationally and internationally. I work with great people and we're doing important things during some of the most trying times. We see kids get better every day and what most people don't see is we save lives every day. We make families function every day. You tend to hear more about psychiatric problems than you hear about psychiatric successes. But kids can be treated for anxiety and depression, the two most common mental health issues, and go on to function at optimal levels. That's what's so important to understand about treatment--it's not just a little thing that we do. It's a big thing and makes a big difference.