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A surge of kids struggling with mental health crises spent part of their summer in the emergency department at Children's Hospital Colorado -- a season medical professionals say is typically quiet with a lull in patients.
Children's Hospital Colorado reported a 26% uptick in children showing up at the emergency department because of mental health challenges between June and July this year compared with the same timeframe last year. And the number of kids needing inpatient care at the hospital system jumped more than 55% from 2020 to 2024, according to data provided by the hospital system.
Just as worrisome, mental health experts say, was the severity of kids' struggles over the summer as more students sought help in the emergency department for more complex mental health issues.
"What we're seeing is more acuity and more severity across the board," said Lyndsay Gaffey, vice president of patient care services at the hospital system's Pediatric Mental Health Institute. "We're seeing longer lengths of stays. We're seeing more kids in our health system that don't have a place to go to hand off to in the community after getting treatment."
A wide range of factors add to the deluge of kids with worsening mental health landing in Children's Hospital Colorado, according to Gaffey and other mental health specialists who work with children. Among them, kids are tuning into economic and political uncertainty as partisan divides continue to deepen. At the same time, Colorado's strained mental health care system, with limited mental health resources in schools and communities, simply can't keep up with the demand of students who need more advanced care.
On the rosier side, broader awareness of the mental health interventions families can access at Children's Hospital Colorado and younger generations' open attitudes around sharing what their mental health battles look like may have also compelled more students to raise their hand for help, Gaffey said.
Even as Colorado's youth suicide rate has dramatically fallen, reported by Colorado Public Radio, the "pediatric mental health state of emergency" the hospital system declared in 2021 during the pandemic is ongoing, according to Dr. K. Ron-Li Liaw, mental health-in-chief at Children's Hospital Colorado.
"If I'm telling you July is one of the busiest Julys we've seen in a decade, then something is still amiss here where kids are still needing to get hospital-based, higher-acuity help," Liaw said. "We have not figured this out earlier on in the prevention space and the community partnership space."
The volume of patients fluctuates, but the hospital system tends to follow a cycle that corresponds closely with the school year calendar, Liaw said. Visits usually spike at the beginning of the school year as kids prepare to enter a new grade and transition from summer free time to classroom expectations. They again ramp up later in the fall, Liaw said, when schoolwork becomes more challenging or kids encounter conflicts and problems with friends or peers. The hospital system sees a range of students at that time, including students coping with depression or anxiety, mood issues, suicidal thoughts, self-harming behaviors, eating disorders or substance use.
The number of patients typically drops during winter break and picks back up again when kids head back to school, later in the spring when daylight saving time disrupts sleep patterns, and toward the end of the school year as kids take final exams and other high-stakes tests, Liaw said.
Summer historically has ushered in an especially slow time for mental health programs and services at the hospital system, with some units practically becoming "ghost towns" while families enjoy vacation and kids generally are free from high-pressure environments. In past years, Gaffey said Children's Hospital Colorado has considered closing its partial hospitalization programs in the summer. Those programs give kids a higher level of support with a full day of group intervention, individual intervention, occupational therapy and family therapy, among other resources.
The significant increase in inpatient admissions over the past few years signals a need for greater focus on getting kids the help they need much sooner, she said.
"You really want to get to a place from a community prevention model that you're seeing kids earlier," Gaffey said, "You're seeing them in school. You're seeing them in the communities so they don't get to this place where they're coming into emergency departments and inpatient care settings."
Smart phones and social media pile onto the stressors kids have long faced, including academic pressure and peer pressure, and can exacerbate mental health issues. The research and data are clear that lots of time spent glued to social media is tied to "poor mental health outcomes" among kids, such as anxiety and depression, eating disorders and sleep disorders, according to Lauren Henry, a child and adolescent psychologist at Children's Hospital Colorado.
Students who scroll social media more than three hours a day have double the risk of mental health problems -- a particular point of concern as teenagers on average devote three and a half hours per day to social media, according to research highlighted by the Office of the Surgeon General.
During the school day, students spend an average of one and a half hours on their smart phones, with Instagram, messaging, TikTok and Facebook generally absorbing the most minutes of students' time on their phone at school, a study published in February by medical journal JAMA Pediatrics found. They spend an average of more than five hours on their smart phones over the course of a day.
Part of the reason cell phones and social media can be so damaging is because of how much they inundate kids with information, Gaffey said.
"Right now there's all this information coming in," she said. "I think it's more catastrophic than it's ever been in terms of the titles and the headlines. And then there's a lot of news out there that's not been validated. We're seeing more and more of things that have been altered, and kids' brains just aren't able to make sense of it on their own. And so we've seen that leading to increased rates of anxiety and depression, just that bombardment of all this negative information that may or may not be truthful."
Teenagers field a median of 237 notifications daily, with a quarter of them hitting a student's phone during the school day, Henry said, referencing a 2023 report from the nonprofit Common Sense Media.
Teens use social media in different ways, not all of which are harmful. When teens actively engage in social media -- leaving a positive comment on a person's post or connecting with peers who don't live close by -- that promotes better mental health, Henry said. Those who are more passive on social media and simply compare themselves to others while scrolling can suffer more anxiety and depression, she noted.
Parents and caregivers play a central role in helping kids navigate the bumpy terrain across social media outlets, mental health professionals say. That starts long before they hand their child their first phone by building a trusting relationship over time, listening to them and taking their concerns seriously, and by leaning into any problem they present with curiosity.
Monitoring how kids use their smart phones and social media is critical, Henry said, but open communication is even more important, particularly since kids can find loopholes around parental restrictions on their devices.
"We always prioritize communication, creating this space where a child does feel safe and comfortable coming to you and telling you about or asking you a question about what they saw online and in that less judgmental way versus absolutely no access to this," she said.
Gaffey encourages parents to embrace smart phone technology and walk kids through how to use it responsibly, potentially even developing a contract with their children that outlines hours of use and apps they're allowed to access.
"It's so important that we recognize that with our generation of kids, cellphones and social media are going to be a part of their life," she said, "and so also not struggling against that but helping kids really understand upfront what the dangers are."