A Comprehensive Examination of Pediatric Behavioral Health Service Demand and Utilization in a Large, Academic Health System from 2019 to 2021.

Studies of the effects of COVID-19 on youth suggest a worsening in mental health globally. We performed a retrospective analysis of data from January 2019-November 2021 for all outpatient referrals, as well as outpatient, inpatient, and emergency department (ED) encounters for behavioral health (BH) reasons in children aged < 18 in a large academic health system in the United States. Mean weekly rates of outpatient psychiatry referrals, outpatient psychiatry visits, ED visits, and inpatient admissions for BH reasons were compared between pre-pandemic and pandemic periods. The average weekly rate of ambulatory referrals (8.0 ± 0.33 to 9.4 ± 0.31) and completed appointments (194.2 ± 0.72 to 213.1 ± 0.71) significantly increased during the pandemic, driven largely by teenagers. The weekly average of ED pediatric encounters for BH did not increase during the pandemic, although the percentage of all pediatric ED encounters that were for BH did increase from 2.6 to 4.1% (p < 0.001). Length of stay for pediatric BH ED patients increased from 1.59 ± 0.09 days pre-pandemic to 1.91 ± 0.11 days post-pandemic (p < 0.0001). Inpatient admissions for BH reasons overall decreased during the pandemic, due to a decrease in inpatient psychiatric bed capacity. However, the weekly percentage of inpatient hospitalizations for BH reasons that occurred on medical units increased during the pandemic (15.2% ± 2.8-24.6% ± 4.1% (p = 0.0006)). Taken together, our data suggest the COVID-19 pandemic had varying degrees of impact, depending on the setting of care.

Telehealth: Reducing Patients' Greenhouse Gas Emissions at One Academic Psychiatry Department.

OBJECTIVE: Academic and organizational leaders in psychiatry and all other medical fields are negatively impacted by climate change. The COVID-19 pandemic prompted a rapid shift to the use of more telehealth by behavioral health clinicians. The purpose of this study was to estimate the reduction of patients' greenhouse gas emissions during this rapid shift at one academic psychiatry institution. METHODS: The authors extracted data associated with all outpatient visits to all 26 psychiatry clinics from March 16, 2020, to December 31, 2020. Once the patients' travel miles saved by confirmed virtual visits were calculated, the authors used the standard ratio from the US Environmental Protection Agency (EPA) to calculate the total quantity of CO2 that would be emitted if the visits had occurred in person. RESULTS: During the study period, a total of 47,582 outpatient behavioral health visits with 3975 unique patients were completed. The majority of these departmental visits were telehealth (85%), with most of the telehealth visits conducted using real-time audio-video platforms (75.7%). Subtracting emissions from patient technology during telehealth visits from the estimated patient transport values produced a net savings of greenhouse gas emissions of 867,011 kg CO2. This amount is equal to the greenhouse gas emissions from 189 passenger vehicles driven for 1 year according to the EPA. CONCLUSIONS: This study shows that converting in person, face-to-face behavioral health visits to telehealth has the potential to increase both energy efficiency and conservation through a reduction in greenhouse gas emissions due to reduced patient travel. If these values were extrapolated to the total adult US population who have visits for behavioral health reasons, we estimate that conversion to virtual visits could save approximately 830,000 metric tons of CO2 annually. Organizational leaders should consider these societal benefits when making decisions regarding development and support of telehealth.