A conversation with Dr. Leslie Hulvershorn

Last October, the American Academy of Pediatrics declared children’s mental health a national emergency. The need is particularly striking close to home. In Indiana, 82 counties are dealing with a mental health care shortage and as many as 500 families call Riley each week seeking outpatient mental health care for a child. In addition, death by suicide is the number two cause of death among Hoosier teens.

Leslie Hulvershorn, M.D., is director of child and adolescent psychiatry at Riley Children’s Health and chair of the Department of Psychiatry at Indiana University School of Medicine. She spoke with us about how Riley Children’s is championing the statewide response to this crisis, and the crucial role that donors serve in shaping a brighter future for Hoosier kids.

RILEY CHILDREN’S FOUNDATION: We know our children and adolescents are facing a national mental health crisis. What does that look like at Riley?

DR. HULVERSHORN: We have more families calling our outpatient services intake team to get in for assessment and outpatient treatment than ever before — as many as 150 a day. We have many more kids coming to the emergency room with concerns about suicidality, or who have actually harmed themselves and require medical admission. Then, if you look around the hospital, the medical teams are taking care of patients who harmed themselves intentionally in much greater numbers, and they’re seeing much more severe causes of that harm than we’ve ever had. It’s just a huge surge on top of an already difficult situation.

RILEY CHILDREN’S FOUNDATION: What is driving this dramatic increase? Has the pandemic played a role?

DR. HULVERSHORN: It’s an interesting question I don’t know anyone really has the answer to. Things were getting better in a lot of ways in the ’90s in terms of the suicide rate. Then, in the 2000s, it started to creep up and over the decade increased pretty dramatically for youth. It’s speculated social media access has fueled some of that. Exactly why now we’re seeing high volumes, it is really hard to say. The scariest part of the pandemic for most of us, before the vaccines were available, when we really didn’t know what was going to happen — we were very quiet. People were scared to come in. It’s been after the isolation has ended that we’re seeing the big numbers. It seems that distress tolerance for the society as a whole has been impacted by the pandemic and now we see this manifested in higher rates of interpersonal violence as well as more self-harm.

RILEY CHILDREN’S FOUNDATION: Tell me about a typical patient you might see.

DR. HULVERSHORN: I personally treat youth with substance use disorders. We’ve seen some very severe substance use issues recently as well. We know that recent data from the CDC finds that in 2021, more people died of opioid overdoses in the nation than ever before. A typical patient of mine would be between 14-17 and would have some serious difficulty functioning as a result of their substance use. Most patients also have at least one mental health issue. Most are not interested in engaging in therapy, but we use techniques that are designed to promote change within the often-unmotivated adolescent patient. Our patients usually respond well to medications to help with mental health concerns as well as substance use. After 12 weeks of family and individual psychotherapy and medication treatment, most patients and their families have substantial improvements in their lives.

RILEY CHILDREN’S FOUNDATION: What is Riley Children’s Health doing to respond to the surge in mental health cases, and how is the team uniquely positioned to address the crisis?

DR. HULVERSHORN: We have a long-standing tradition of doing this work. Psychologists and psychiatrists who come to Riley like working in an academic environment because there’s a lot of emphasis on utilizing evidence-based treatments and assessments. It’s a priority for us to make sure that we are delivering the best available treatments. We treat everybody. We may offer the type of treatment that no one else in the state can deliver; we might offer it to someone who comes from a very affluent family, and we may offer the very same treatment to someone who’s on Medicaid. I think in mental health that’s particularly notable because most people, if they were calling around to find a psychologist or psychiatrist for their child today, would only find openings in cash-pay practices. Many families find themselves in the position of either needing to pay cash to get a certain caliber of treatment or just not have it for their kids. Sixty-one percent of Indiana 12- to 14-year-olds are on Medicaid. They can’t pay cash. At Riley we deliver that caliber of treatment independent of one’s ability to pay and we’re very proud of that. One of our big focuses now is figuring out ways to optimize what we have available. Sometimes that means instead of us directly treating a patient, we might just have a quick conversation with their pediatrician. We give advice and allow that child to stay in their primary care setting. What we’re learning is that many kids can actually do very, very well with their mental health treatment via their primary care physician, and we’re continuing to develop mechanisms to support those pediatricians more and more.

RILEY CHILDREN’S FOUNDATION: When you think about the future of mental health support for Indiana children and adolescents, what is your biggest hope?

DR. HULVERSHORN: If every child received evidence based treatment, meaning something that has been studied and found to be effective, that would be an enormous improvement overall around the state. The second would be that our system is able to execute on our plan to provide integrated care — meaning mental health within the primary care setting — statewide. We really want to accomplish that over the next few years. The treatments we have now actually work pretty darn well for kids. The biggest problem I see is that families don’t have enough access to the high quality, evidence-based interventions that do work well. That’s something that an academic center like IU partnered with Riley is in a good position to focus on and try to spread the knowledge. We can harness the statewide footprint of Riley.

RILEY CHILDREN’S FOUNDATION: What is your message for Riley Children’s Foundation donors who support behavioral health at Riley?

DR. HULVERSHORN: We are enormously grateful. Any donations we receive from donors goes right back into the care of kids. We have so many needs, and we’re so grateful for the support. It directly impacts and improves the care of children in our state. No matter the amount, it means an enormous amount to us. We just don’t have a way to do this work without philanthropy. We are setting our sights on some very ambitious goals. It’s a really exciting time — nothing like we’ve seen before in behavioral health at Riley. It’s a solvable problem. We can absolutely make this better. Every bit of money counts and we can make big differences. One of the reasons I’m a child psychiatrist is I love that I can influence the entire trajectory of someone’s life. If I have a 13-year-old who quits vaping in my addiction program, I might have just prevented them from getting cancer, from dying 20 years earlier. The impact is lifelong and lasting. It’s a smart investment to fund youth behavioral health.