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The American Medical Association (AMA) must work with the federal government, as well as state and local governments, to expand access to psychiatric care for children, members of the AMA's House of Delegates said Monday.

"This is a crisis," said Michael Simon, MD, a delegate from the American Society of Anesthesiologists, who was speaking for himself at the AMA's annual meeting. "Nearly every setting is seeing children suffering from lack of care. The pandemic exacerbated a problem we already had and made it a catastrophe ... We need to support our kids and the providers struggling to care for them."

Simon was referring to resolutions being offered by the American Academy of Pediatrics (AAP) delegation to address the child mental health crisis. One resolution called for the AMA to "advocate at the state and national level for policies to prioritize children's mental, emotional, and behavioral health." Another urged the AMA to advocate for a system of prevention, management, and crisis care to address children's mental health needs, while a third called for the AMA to consider supporting developed by the AAP and other children's healthcare groups.

Delegates told stories of their own troubles getting help for pediatric patients. "At my emergency department in Boston, we have about 60 beds, about half of those right now are full of mental health boarders, with another 50-plus upstairs in our hospital as inpatient boarding, waiting for mental health beds," said Samantha Rosman, MD, a delegate from the AAP, who presented the resolutions. "For the community hospital I cover, we've had to convert the educational conference room into a place for 15 adolescents to board awaiting beds ... There just aren't resources to refer these kids to right now. We are simply overflowing at the seams."

Raghuveer Puttagunta, MD, an alternate delegate for the AMA's Resident and Fellow Section, said that at the rural hospital he works at in central Pennsylvania, "it was not COVID-infected children overwhelming our ERs [emergency rooms] or inpatient beds, but pediatric patients waiting for psychiatric beds, with some of our patients waiting over 100 days."

Ken Certa, MD, a delegate for the American Psychiatric Association, noted that although the crisis was bad before, it was worsened by COVID "and the need for many programs that treat children to reduce their census and go from double-bedded rooms to single rooms ... We in child psychiatry fight for this every single day; we would love to have the rest of medicine come with us to the statehouses."

The delegates voted to approve the first two resolutions, but the resolution urging possible adoption of the AAP's mental health principles gave them pause. "I support the thought of this amendment but I don't know the specifics" of the principles, said Gregory Fuller, MD, a delegate from the Texas Medical Association who was speaking for himself. "And if this is changed in the future, we're going to be beholden to these same principles, so I'm speaking against this because I know none of the details."

Floyd Buras Jr., MD, a delegate from Louisiana, agreed. "As a matter of principle, we never want someone else's policy built into AMA policy," he said. The delegates voted to refer that resolution to the AMA Board of Trustees for a decision.

In other business, House of Delegates members:

• Passed a resolution calling for the AMA to work with the Centers for Medicare and Medicaid Services and state Medicaid programs to cover scheduled outpatient maintenance dialysis for undocumented patients with end-stage kidney disease. "Speakers noted that undocumented patients often present in emergency departments when they are acutely ill and in urgent need of dialysis and, at times, inpatient care that is significantly more costly than dialysis provided in the outpatient setting," AMA reference committee members said in their report, explaining why the committee recommended approval of the resolution.
• Referred to the Board of Trustees a resolution calling for the Medicare eligibility age to be lowered from 65 to 60, with a report due back to the delegates at the AMA interim meeting in November. "Our AMA deserves a clear stance on this proposal currently being discussed in the White House and in Congress right now," said Rajadhar Reddy, MD, an alternate delegate who spoke on behalf of the AMA's Medical Student Section in favor of the November deadline. "We strongly believe that this health reform proposal... is a high priority [issue] that we should study," he said. "And we are already 6 months into a new administration. Waiting a year for a report back risks reducing the power of any position we take on issue, or any advocacy we conduct because we would not have enough time to act on it effectively."
• Voted to adopt AMA policy stating that "the AMA believes current evidence does not support 'excited delirium' or 'excited delirium syndrome' as a medical diagnosis, and opposes the use of the terms until a clear set of diagnostic criteria are validated." The policy also states that the AMA "opposes the use of sedative/hypnotic and dissociative agents, including ketamine, as a pharmacological intervention for agitated individuals in the out-of-hospital setting, when done solely for a law enforcement purpose and not for a legitimate medical reason."

The House of Delegates meeting continues Tuesday and will include installation of the association's new president, Gerald Harmon, MD, on Tuesday night.

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