Many children who survive gun violence face barriers to mental health care

John Yang:

Children's firearm related injuries are on the rise. According to the gun safety group Brady, every day in America, 17 children younger than age 18 survive a gunshot wound. Ali Rogin has the latest on what this is doing to the mental health of children across the country.

Ali Rogin:

Since 2020, guns have been the leading cause of death for children in America. While many tragically lose their lives, child survivors of gun violence can endure a lifetime of physical and mental health challenges.

A new study from the American Academy of Pediatrics points to the urgent need for connecting children to mental health services following a firearm injury. The study analyzed Medicaid data of children aged five to 17 who suffered a nonfatal firearm injury. It found that 63 percent of these children do not receive mental health services within six months after a firearm injury.

The research noted black youth are less likely to have any mental health follow up than white youth.

Jennifer Hoffmann is a pediatric emergency medicine physician at Lurie Children's Hospital of Chicago. She's also one of the lead authors of the new study. Jennifer, thank you so much for joining us.

First of all, this seems like such a no-brainer that if children are going through a traumatic event like a firearm experience, that they would have access to mental health services. Why is this not the case? Why is this not ubiquitous?

Jennifer Hoffmann, Lurie Children's Hospital of Chicago: You know, unfortunately, there are so many barriers for children to access mental health care in the United States. We know that one in five children in the U.S. has a mental health condition, but only half receive needed mental health services. And there are many reasons for this, ranging from under recognition to stigma, but also structural barriers, such as workforce shortages of mental health professionals.

Ali Rogin:

For this study in particular, why look at mental health services following a firearm injury?

Jennifer Hoffmann:

You know as a pediatric emergency medicine physician, it's devastating to me every time I have to care for a child who's experienced a firearm injury. And if the child is lucky enough to survive, the experience can be very traumatizing for them.

Research shows that firearm injuries can have lasting impacts on child mental health. So we wanted to understand which children were able to connect with mental health services and which children could do so in a timely manner.

Ali Rogin:

And what did you find in terms of the differences between children who received follow up mental health care and those who didn't following a firearm injury?

Jennifer Hoffmann:

So we found that children who had mental health needs detected during their injury visit were more likely to receive timely mental health services. So that means if mental health needs were recognized during the emergency department visit or hospitalization, they were able to connect sooner with mental health care.

That's important because early treatment is more effective, and it allows children to respond to more simple interventions, such as outpatient therapy, rather than waiting for symptoms to progress and become more severe, requiring intensive treatment like psychiatric hospitalization.

Ali Rogin:

What does that early intervention look like in the aftermath of a firearm injury? If a child is receiving mental health services, what sort of interactions are we talking about?

Jennifer Hoffmann:

So it can vary. It can be simple treatments provided in the primary care office, it can be a referral to a therapist for outpatient therapy, or it can be more intensive care as needed based on what the child's experiencing, such as a day program or occasionally even a hospital stay if needed.

We found that some of the most common mental health conditions that occurred after a firearm injury were traumatic related disorders such as PTSD. We also found increases in substance use among children after their firearm injury and double the rates of serious mental illness, such as schizophrenia and suicidal thoughts and self-harm.

Ali Rogin:

And what are some of the barriers to children receiving this type of care following these incidents?

Jennifer Hoffmann:

There are too many barriers. And one reason is that there are significant workforce shortages of mental health professionals in the U.S. but particularly in high poverty areas in those communities where most firearm injuries occur.

And this is also compounded by limited reimbursement rates for mental health services, particularly those offered by Medicaid relative to private health insurance. And the reason that we focus study on Medicaid enrolled youth is that most youth in the U.S. who sustain firearm injuries are enrolled in Medicaid.

Ali Rogin:

Wow. And that leads into my next question, I think, which is what did you learn about the racial disparity in these numbers? The fact that black youth are less likely to experience mental health services in the aftermath than other races are?

Jennifer Hoffmann:

You know, this is a troubling finding. But unfortunately, it wasn't surprising to our research team, given a large body of evidence showing there are disparities in access to mental health care among U.S. black youths.

And there are many possible reasons for this, ranging from familial factors, stigma, cultural barriers, but more importantly, structural barriers, such as a lack of mental health providers in the communities where black children live, and a substantial lack of diversity in the mental health workforce.

Ali Rogin:

And so what does that mean in terms of what policymakers can do? What would you like to see change?

Jennifer Hoffmann:

So, first of all, I think that policymakers should make more substantial investments to improving access to mental health services for children. And this includes meeting children where they are investing in school based mental health services. Also telehealth mental health services that can connect to children in communities that don't have an in person mental health provider. Also, policymakers need to increase research funding to address and prevent firearm injuries by applying a public health approach. We know that research on firearm injuries is substantially underfunded relative to the morbidity and mortality burden.

Ali Rogin:

Absolutely. And lastly, Jennifer, what types of resources should parents and caregivers be aware of when it comes to mental health related to these sorts of events?

Jennifer Hoffmann:

It's important for parents to have open and honest conversations with their children. And if you have any concerns about your child's mental health, talk to your pediatrician first. They can provide an initial assessment and referrals if indicated. Also, if your child experiences a mental health crisis, don't leave them alone. Call the National Mental Health Hotline, 988 to be connected to a trained counselor 24/7.

Ali Rogin:

And of course, we could talk much more about the spate of gun violence incidents in this country, but we will leave it there. And Jennifer Hoffmann with Lurie Children's Hospital of Chicago. Thank you so much for your time.

Jennifer Hoffmann:

Thank you for having me.