Emergency departments across the United States are seeing alarming surges in children and adolescents seeking mental health care, according to new data from the Centers for Disease Control and Prevention. The increases—24% for children ages 5 to 11 and 32% for adolescents ages 12 to 17—reveal how profoundly COVID-19’s isolation, uncertainty, and disruption have impacted young people’s psychological wellbeing.
The CDC report, covering the period from March through October 2020 compared to the same months in 2019, documents a pediatric mental health crisis unfolding in real-time. But the data also exposes a structural problem that predated the pandemic: emergency departments lack adequate capacity to treat children’s mental health needs, and the broader pediatric behavioral health system has long been inadequate to meet demand.
As one of the few settings legally required to evaluate everyone who presents for care, emergency departments have become the default safety net for pediatric mental health crises. The pandemic surge is overwhelming systems already strained by pre-existing capacity shortages, raising urgent questions about how healthcare organizations, policymakers, and communities can better support children’s mental health before crises drive them to ERs.
The Numbers Tell a Troubling Story
The CDC’s findings reveal the pandemic’s disproportionate psychological impact on young people. Mental health-related emergency department visits increased 24% for children ages 5 to 11 during the March-October 2020 period compared to the same months in 2019. For adolescents ages 12 to 17, the increase was even steeper at 32%.
These percentages translate to thousands of additional children seeking emergency mental health care during a period when overall ED visits declined dramatically for other conditions. While adults avoided emergency departments for chest pain and other medical issues out of COVID-19 exposure fears, pediatric mental health visits surged in the opposite direction—suggesting crisis levels severe enough that families couldn’t delay care despite pandemic risks.
The age breakdown offers insights into how COVID-19 affected different developmental stages. The 32% increase among adolescents ages 12 to 17 likely reflects this group’s particular vulnerability to social isolation. Adolescence is a developmental period when peer relationships, school social dynamics, and identity formation assume critical importance. Removing teenagers from these contexts through school closures, activity cancellations, and social distancing disrupted fundamental developmental processes.
The 24% increase among younger children ages 5 to 11 is perhaps more surprising, as conventional wisdom might suggest this age group would be less affected by social restrictions. However, the data indicates even elementary-age children experienced significant psychological distress from pandemic disruptions to routines, school closures, parental stress, and the ambient anxiety pervading households.
What’s Driving Children to Emergency Departments
The CDC report attributes the surge to “the uncertainty and social isolation of the COVID-19 pandemic,” but this explanation encompasses multiple interconnected stressors affecting children’s mental health throughout 2020.
Social isolation removed children from peer relationships, organized activities, and school environments that provide structure, stimulation, and emotional support. For many children, schools offer the most consistent source of adult supervision, nutritious meals, physical activity, and mental health services. School closures eliminated these supports simultaneously.
Parental stress cascaded onto children as families dealt with job losses, financial strain, fear of illness, and the logistical challenges of managing remote work while supervising children’s distance learning. Parents struggling with their own anxiety and depression had less emotional bandwidth to support children’s wellbeing.
Increased family conflict emerged as households spent unprecedented time together in confined spaces without the usual outlets of work, school, and activities. Domestic violence reports increased during lockdowns, exposing some children to traumatic home environments with fewer opportunities for teachers or other adults to identify abuse and intervene.
Grief and loss touched many families as COVID-19 deaths approached 300,000 in the U.S. by year-end 2020. Children lost grandparents, parents, and other family members while being unable to participate in normal grieving rituals like funerals due to gathering restrictions.
These stressors affected children across demographics, but impacts fell disproportionately on vulnerable populations. Low-income families faced greater economic devastation. Communities of color experienced higher COVID-19 death rates. Children with pre-existing mental health conditions often lost access to therapy and support services when in-person care became unavailable and families lacked technology for telehealth.
The emergency department visits documented by the CDC represent children in acute crisis—those experiencing suicidal ideation, severe anxiety or depression, psychotic symptoms, or behavioral disturbances requiring immediate intervention. Behind each ED visit are likely many more children experiencing psychological distress that hasn’t yet reached crisis levels but still demands attention.
The Emergency Department Capacity Problem
The CDC authors noted a critical structural issue: “The majority of EDs lack adequate capacity to treat pediatric mental health concerns, potentially increasing demand on systems already stressed by the COVID-19 pandemic.”
This capacity shortage isn’t new—it’s been a persistent problem for decades. Most emergency departments aren’t equipped with child psychiatrists, pediatric mental health specialists, or environments designed for children in psychiatric crisis. Many ERs have limited space for behavioral health patients, forcing children experiencing mental health emergencies to wait in general emergency department bays designed for medical and surgical emergencies.
The boarding problem compounds capacity issues. Children often wait hours or days in emergency departments because psychiatric inpatient beds aren’t available. During these extended waits, they occupy ED beds needed for other patients while receiving suboptimal care in environments ill-suited for pediatric mental health treatment.
Emergency physicians and nurses lack specialized training in pediatric mental health assessment and crisis intervention. While they can stabilize medical emergencies, they’re not optimally positioned to conduct comprehensive psychiatric evaluations or provide therapeutic interventions for children in mental health crisis.
The COVID-19 pandemic made these pre-existing problems worse. Emergency departments faced overwhelming medical patient volumes during surge periods. Staff experienced burnout, exhaustion, and their own mental health challenges. Resources were stretched thin managing infection control, personal protective equipment, and testing protocols. Into this stressed system came 24-32% more children needing mental health care.
The result is predictable: longer wait times, more children boarding in emergency departments, burned-out staff trying to manage patient populations they’re not trained to serve, and families experiencing frustration and trauma from seeking help in crisis and finding systems unable to respond adequately.
The Pre-Pandemic Pediatric Behavioral Health Shortage
Emily Melton, co-founder and managing partner of Threshold Ventures, described the pediatric behavioral health market as “woefully overlooked” even before COVID-19. This characterization reflects both inadequate services and insufficient investment relative to the scope of need.
Children’s mental health has historically received less attention and fewer resources than adult behavioral health, which itself is underfunded relative to physical health. Several factors contribute to this neglect.
Stigma around children’s mental health remains particularly powerful. Parents and communities often resist acknowledging that children can experience serious mental illness, viewing behavioral problems as discipline issues or normal developmental phases rather than treatable conditions requiring professional intervention.
Workforce shortages constrain access. Child psychiatrists represent one of the smallest and most in-demand medical specialties, with severe geographic maldistribution leaving many communities without access. Pediatric psychologists, therapists, and counselors face similar shortages, particularly in rural and low-income areas.
Insurance coverage limitations restrict access even when providers exist. Many child mental health specialists don’t accept insurance due to low reimbursement rates and administrative burdens, creating financial barriers for families who can’t afford out-of-pocket rates of $200-300 per therapy session.
School-based services represent critical access points for many children, but school counselors and psychologists are overwhelmed with caseloads far exceeding recommended ratios. Many schools lack adequate mental health resources, forcing families to seek care in community settings where availability is limited.
The infrastructure for pediatric mental health care—specialized inpatient units, residential treatment programs, intensive outpatient services, and community-based supports—has never been adequate to meet demand. Private insurance and Medicaid reimbursement often don’t cover the full continuum of care children need, creating gaps between outpatient therapy and inpatient hospitalization where many children fall through.
Market Response: The Brightline Example
Threshold Ventures’ investment in Brightline illustrates how market forces are responding to the documented need for pediatric behavioral health services. The firm co-led a $20 million Series A funding round for the virtual pediatric behavioral health startup, signaling investor confidence that addressing this “woefully overlooked” market represents both social impact and business opportunity.
Founded in 2019, Brightline originally planned to launch services gradually but accelerated timelines due to COVID-19 demand, beginning patient treatment in June 2020—four months ahead of schedule. The company initially served only California but expanded to additional states by August, demonstrating rapid scaling enabled by virtual care delivery models.
Brightline’s approach addresses several barriers simultaneously. Virtual delivery eliminates geographic constraints, allowing families anywhere with internet access to connect with pediatric mental health specialists regardless of local provider availability. This is particularly valuable for rural and underserved communities where pediatric specialists are scarce or nonexistent.
Technology-based solutions also offer scheduling flexibility that traditional office-based care struggles to provide. Families can access services around school schedules, work commitments, and childcare constraints. The elimination of travel time and waiting rooms reduces burden on busy families.
Melton’s description of Brightline’s model emphasizes comprehensive, cross-disciplinary approaches: “Brightline’s cross-disciplinary team is uniquely capable of delivering science-backed behavioral and mental health care for children leveraging virtual solutions that are equally accessible and effective.”
The framing of “mental health is a family affair” reflects recognition that children’s mental health doesn’t exist in isolation. Effective treatment often requires engaging parents, addressing family dynamics, and supporting caregivers who are managing their own stress while trying to help their children.
The substantial Series A funding indicates that investors believe virtual pediatric behavioral health represents a large, growing market opportunity. The pandemic has validated telehealth effectiveness, reduced regulatory barriers, and accelerated consumer and payer acceptance—creating favorable conditions for companies like Brightline to scale.
What Healthcare Organizations Should Do
The CDC’s findings carry clear implications for healthcare systems, payers, schools, and policymakers. Several interventions could address the crisis documented in the emergency department data.
Expanding community-based pediatric mental health services would reduce reliance on emergency departments for non-urgent care. Investment in outpatient therapy, school-based services, and preventive programs could help children access support before crises develop.
Improving emergency department capacity for pediatric mental health requires specialized training for ED staff, dedicated spaces designed for children in psychiatric crisis, and better integration with inpatient psychiatric units and outpatient services to reduce boarding times.
Making telehealth permanent for pediatric behavioral health would preserve access gains achieved during the pandemic. Regulatory barriers and reimbursement limitations that previously restricted virtual care should be eliminated to allow continued expansion.
Increasing psychiatric inpatient capacity for children would reduce boarding in emergency departments. Many communities lack adequate pediatric psychiatric beds, forcing children to wait in EDs or travel long distances for inpatient care.
Supporting schools as mental health service sites recognizes that schools reach all children and can identify problems early. Funding for school counselors, psychologists, and social workers at recommended ratios would expand preventive and early intervention services.
Addressing social determinants affecting children’s mental health requires interventions beyond healthcare. Economic support for families, food security programs, safe housing, and community resources all influence child wellbeing and can prevent mental health crises.
The Road Ahead
The CDC data documents a pediatric mental health crisis that COVID-19 exacerbated but didn’t create. Children’s mental health needs have long exceeded available services, creating a gap that manifested in overwhelmed emergency departments even before the pandemic.
The 24-32% increases in mental health-related ED visits represent thousands of children in crisis. Behind these numbers are families desperate for help, emergency departments struggling to respond, and communities grappling with how to support young people’s psychological wellbeing during unprecedented challenges.
The crisis creates urgency but also opportunity. The pandemic has broken down barriers—regulatory, technological, and cultural—that previously constrained innovation in pediatric mental health service delivery. Virtual care models have proven effective. Investment capital is flowing into the space. Policymakers and the public recognize mental health as essential to overall health.
The question is whether this moment of recognition and innovation translates into sustained system change or whether attention and resources fade as the acute pandemic phase passes. Children’s mental health needs won’t disappear when COVID-19 recedes. The developmental impacts of prolonged disruption, trauma, and stress will persist for years.
Healthcare organizations, investors, policymakers, and communities face a choice: continue treating pediatric mental health as afterthought relegated to overwhelmed emergency departments and inadequate community services, or finally build the comprehensive, accessible, adequately funded system that children deserve.
The CDC’s data makes clear what’s at stake. Emergency departments filled with children in mental health crisis aren’t sustainable or acceptable. Better solutions exist—they require will, resources, and sustained commitment to implementation. The question is whether the recognition of need documented in these troubling numbers will finally drive the systemic change that has been needed for far too long.
