Dr Jacob Brent arrived for work only to find that a tent had been pitched outside the UPMC Children’s Hospital in Pittsburgh. Complete with supplies, staff and purple exterior logos, the makeshift space was erected in mid-September after a wave of children arrived in the emergency department.
Dr Ray Pitetti, director of the Children’s Pediatric Emergency Medicine division, called the influx of young patients “historic” in a statement.
A month after the construction of the children’s tent, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Association of Children’s Hospitals declared a national children’s mental health emergency, citing a significant increase in the number of emergency department visits for mental health emergencies in children and young adults. Representatives from AAP, AACAP and CHA, which have a total of 77,000 physicians and more than 200 children’s hospitals, cited fear, grief, physical isolation and persistent uncertainty as challenges facing them. young people today face.
The harsh realities facing young adults were well established before the pandemic or any public declaration of national emergency. In 2018, long before COVID-19 became part of everyday life, suicide was already the second leading cause of death among 10-24 year olds. As quarantine and isolation ensued throughout the pandemic, devastating new statistics emerged: As of May 2020, the number of emergency room visits for suspected suicide attempts had increased by 31% compared to the previous year in adolescents aged 12 to 17, according to the Centers for Disease Control and Prevention.
Data related to depression and anxiety raised a similar alarm. Compared to pre-pandemic estimates, the prevalence of symptoms of depression and anxiety doubled during COVID-19 – with rates increasing among older teens and girls, as the pandemic continued – according to the results of JAMA Pediatrics.
The data is “absolutely frightening,” said Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation. “All the indicators, all the variables, say teens are struggling.”
For Brent, a child psychiatry researcher and pediatric resident at UPMC Western Psychiatric Hospital and Children’s, the declaration of a national emergency came as no surprise. Brent described the increase in the number of cases and the hospital’s tent setting up as visible markers of a stressed system. He also recalled situations where even after the arrival of young adults in the emergency department and referrals, months passed before the necessary outpatient treatment was administered.
Dr Mindy Hutchinson, a Mount Lebanon-based psychiatrist with 30 years of experience, echoed Brent’s comments and denounced the lack of local hospital beds for children whose depression requires hospitalization.
Besides Western Psych, there is a private mental hospital in the South Hills (Southwood), but it lacks an emergency room or “a way to assess children immediately,” Hutchinson said. Even before COVID-19 arrived, “we were already sending children to Clarion, or sometimes beyond, to get them to the hospital if they really needed it, and they would wait for days.”
Take a step back
To understand the importance of a national emergency for children’s mental health, it is imperative to focus on the crisis leading up to the pandemic, said Dr Elizabeth Miller, director of adolescent and young adult medicine at The Children’s.
Long before COVID-19, access to mental health services for children and adolescents was “sorely lacking” as only a third of young people in need of mental health treatment were actually receiving treatment, Miller said.
The minimization and stigmatization of mental health, a lack of confidence in the system and a general shortage of services have contributed to this crisis. Once the pandemic struck, further turbulence ensued. Many young people, especially in communities of color, have lost a year of schooling and its supports. Even for students who took online courses, the social and emotional learning that occurred during in-person interactions was greatly reduced. Add to that the growing stressors families face when trying to balance work and childcare, or work and care for the elderly, as well as losses due to COVID-19 or violence. community, “and it’s been very hard living for almost two years in the pandemic,” Miller said.
When the 77,000 doctors and 200 hospitals issued a public statement on a national emergency, that was the backdrop. The current concern, Miller continued, is that there has been a return to the status quo. With students returning largely to face-to-face instruction, it is a misconception that school educators and counseling can meet today’s challenges.
The problem with this mindset is that school staff have been disrupted and overburdened by the pandemic, and children have gone over a year without learning the tools to communicate or build relationships. What teachers and counselors are now reporting, Miller continued, is an increase in disorderly behavior, such as verbal arguments and physical fights occurring in schools. What is clear is that “going back to the status quo is simply not enough. “
What happens after
Feinstein believes the road ahead requires several steps. In addition to providing a stronger pool of healthcare professionals, increasing the number of hospital beds, and ensuring every pediatric office has mental health counseling, Feinstein would like to see more support for organizations and entities. that help young people today.
Recent grants from the Jewish Health Foundation show a desire to put more resources upstream. In August 2021, Friendship Circle Pittsburgh received a $ 100,000 grant over two years to help create a community walk-in space where teens can access wellness supports and connect with their peers. In August 2021, the Jewish Healthcare Foundation also awarded a one-year grant of $ 180,000 to continue its PA Youth Advocacy Network and the Teen Mental Health Collaborative.
The PA youth advocacy network was established in 2018 and includes youth advocates and partner organizations including Stand Together, The Second Floor at the Jewish Community Center of Greater Pittsburgh, the Beaver County Youth Ambassadors Program, the Friendship Circle-Pittsburgh, UpStreet Pittsburgh, PA Care Partnership, Youth MOVE PA, The Mentoring Partnership and the American Foundation for Suicide Prevention.
The Adolescent Mental Health Collaborative was launched in 2020 and includes a group of 14 organizations – including Alliance for Refugee Youth Support and Education, Boys & Girls Clubs of Western PA, and Homewood Children’s Village – supporting adolescent mental health programs during the pandemic.
Sarah Pesi, adolescent engagement and outreach coordinator at the Jewish Community Center of Greater Pittsburgh and policy assistant at the Jewish Healthcare Foundation, touted the benefits of community organizations and said their staff and clients have the power to ‘helping today’s adolescents.
As advocates, people can let their legislators, hospital systems, health care providers and schools know how important this time is for young adults. Whether the reiteration of the tragic realities of the current crisis generates increased funding for school counselors or program changes that incorporate mental health awareness is a start, Pesi said.
Even on a small scale, individuals can drive dramatic change, agreed Deborah Murdoch, program manager at the Jewish Healthcare Foundation.
Harvard University researchers say, children facing great adversity are able to develop their resilience with the support of a single adult.
Murdoch hopes adults realize that being there and listening is essential, and that demonstrating these behaviors can make all the difference.
Be aware of the mental health needs of adolescents. Know the warning signs. Provide a safe space and encourage young adults to talk about their feelings. Teens today are under a lot of academic pressure, and schools aren’t necessarily equipped to provide all of the social and emotional support needed, Murdoch said.
The declaration of a national emergency in the area of children’s mental health should be a wake-up call to policymakers. The pandemic has exacerbated a problem that preceded labor shortages or quarantine. And, in many communities, there are still significant barriers to accessing mental health support, Murdoch said.
Adults need to ask themselves a question, Miller said: What does it take to create a thriving community?
People should realize that it is not enough for children to survive, children must thrive. A comprehensive response to this crisis is not just focusing on reporting, but on the holistic well-being of young adults around the world. We can’t forget, Miller continued, “while children are 20% of our population now, they are 100% of our future.” PJC
Adam Reinherz can be contacted at [email protected]