Adolescents are undergoing a mental health crisis in the US.
They’re experiencing them at a higher percentage than adults. A survey by the Substance Abuse and Mental Health Services Administration, commonly known as SAMHSA, found 12% of adolescents ages 12-17 experienced serious thoughts of suicide in 2023, compared to 5% of adults.
Almost half made plans to attempt suicide, attempted suicide or both in 2023.
I’m researching the adolescent inpatient psychiatry experience for my thesis in the Psychology and Human Rights departments at Barnard College, Columbia University. The study includes an initial survey of participants with lived experience and one-on-one interviews with interested survey participants after data collection is complete.
It is the first study to evaluate the adolescent psychiatric inpatient experience of institutional betrayal — a concept coined by psychologist Jennifer Freyd and defined as the experience of personal betrayal and harm by an institution one trusts and depends on.
While institutional betrayal has been studied in contexts ranging from cultures of sexual harassment in workplaces and universities to governmental involvement in policy brutality, it can also be applied to healthcare settings. Members of the Shields Lab at Washington University were the first to study institutional betrayal in inpatient psychiatry, whose footsteps I am following in studying the concept in adolescent inpatient psychiatry.
Suicide is the second leading cause of death for adolescents. Sexual and gender minorities, Indigenous and Latino populations, youth in foster care systems and youth with adverse life experiences are at higher risk for suicidal ideation and behavior.
Suicidal ideation and attempts often result in psychiatric hospitalization, which can provide safety monitoring and mental health treatment but is also associated with iatrogenic harm (i.e., harm as a result of medical treatment). A meta-analysis of 100 studies found that during the first three months after discharge from a psychiatric hospital, suicide rates of former inpatients were about 100 times that of the standard global suicide rate.
For people admitted due to suicidal ideation or attempts, the post-discharge suicide rate was about 200 times the global rate.
As people experiencing suicidal ideation or attempts are most commonly routed to psychiatric hospitals with exorbitantly high post-discharge suicide rates, what is causing these risks and what can we do differently?
A meta-analysis concluded that less than half of participants with suicidal ideation disclosed their ideation to others and disclosure was even lower in people who died by suicide. Nonetheless, research shows that nearly 80% of adolescents with suicidal ideation “felt better” after disclosure.
One of the largest barriers to disclosing suicidal ideation or attempts is the fear of involuntary hospitalization. (One alternative approach to traditional psychiatric hospitalization includes peer respites, which are community-based residential support programs for people in crisis, run by people with lived experience of crisis mental healthcare. Members of peer respites are less likely to be rehospitalized.)
Perception of psychiatric hospitals can be affected by past experiences with and assumptions about relationships with staff and other inpatients, the hospital environment (e.g., safety, built environment and boredom), coercion (e.g., seclusion, physical restraint, forced medication) and personal autonomy (e.g., freedom of movement, choice in treatment decisions). Past research, as well as results gathered by the Shields Lab, where I am involved in research at Washington University in St. Louis, have illustrated themes of iatrogenic harm due to such experiences of coercion and restricted autonomy.
The adolescent experience of crisis mental healthcare — which can encompass anything from psychiatric inpatient treatment, mental health boarding in an emergency department, to interactions with mobile crisis teams and first responders — is unique compared to adult experiences. As adolescence is marked by a lack of independence and high reliance on adult authority figures, it can be daunting to experience time in a hospital setting away from parental or guardian figures and the routine of home and school life.
Reintegration into school life can be especially difficult after discharge due to pressures on academic performance and socialization.
To date, few studies have explored the adolescent inpatient psychiatry experience in the form of qualitative interviews or focus groups. These methods are distinct from quantitative research, which evaluates hard data such as psychiatric inpatient numbers and rates of follow-up care engagement. In the context of a field with a history of significant iatrogenic harm, it’s crucial to center the lived experiences of former psychiatric inpatients to envision what a more patient-centered, trauma-informed approach to crisis mental healthcare could look like.
With $11.4 billion enacted (rescinded Covid public health grants) and more than $24 billion in proposed federal cuts to mental health and substance use disorders, the already dire adolescent mental health crisis can be expected to worsen. Furthermore, evidence shows that the current system of psychiatric hospitalization is not successfully addressing people in crisis, especially those with suicidal ideation. It’s imperative to conduct more research on and invest in effective crisis mental healthcare.
Bringing former inpatients into research and policy settings can help accomplish this participatory approach and more qualitative studies of people with lived experience are necessary for this reason.
My survey explores participants’ personal background (e.g., mental health history, demographics, life events), psychiatric hospitalization experiences (e.g., experiences of care, logistics of hospitalization) and outcomes (e.g., trust in psychiatric hospitals, readjustment to daily life).
I plan to publish the results in academic journals and online publications and advocate for including testimonies from those with lived experience in discussions surrounding crisis mental healthcare reform.
Those interested in participating in the study can find more information here.
