Pediatric health leaders are sounding the alarm over a growing number of mental health crises in children as the coronavirus pandemic continues.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association jointly declared a national emergency in children’s mental health in October.
The groups pointed to an increasing number of childhood mental health crises and suicide rates from 2010 to 2018. The pandemic intensified those issues and worsened inequities, especially in communities of color, a news release from the groups stated.
“Children and families across our country have experienced enormous adversity and disruption,” the release said. “We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness and suicidality that will have lasting impacts on them, their families and their communities.”
Between March and October 2020, emergency department visits for children with mental health emergencies rose by 24% among kids age 5-11 and 31% for kids age 12-17, compared with 2019 levels, according to CHA. There was more than a 50 percent increase in suspected suicide attempts among girls age 12-17 who made emergency department visits in early 2021, compared with the same period in 2019.
Many young people have experienced the loss of a loved one from the coronavirus during the pandemic. Recent AAP data shows more than 140,000 children in the U.S. experienced the death of a primary or secondary caregiver during the pandemic, with children of color disproportionately impacted.
The children’s health groups released a long list of recommendations to address the crisis, including increased federal funding for access to mental health resources, more access to telemedicine, and the expansion of short-stay units to ease a shortage of beds for children and adolescents experiencing mental health issues.
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‘Salt in the wound’
As the delta variant drove the latest COVID-19 surge, along with a record number of cases and hospitalizations among children, Dr. Meg Rush called it a “parallel epidemic” to the youth mental health crisis.
Rush, who leads Monroe Carrell Jr. Children’s Hospital at Vanderbilt, testified before Congress in September about the effects of COVID-19 on children.
“Children and families across the country face substantial disruptions to their daily lives due to COVID-19,” Rush said. “I have consistently had equally, if not more, numbers of children admitted to my hospital in the last six weeks with a behavioral health primary diagnosis as I have (for) COVID.”
Dr. Heather Kreth, a psychologist who helps lead pediatric behavioral health at Vanderbilt, cares for patients at the children’s hospital awaiting beds in the psychiatric hospital.
She said while the uptick in mental health crises among youth is recent, the shortage of beds for them and the lack of access to proper care was decades in the making.
“On any given day, I can have between five and 35 children and adolescents who are here waiting for psychiatric treatment,” she said. “At Vanderbilt and at hospitals across the country, this has been a growing problem year-over-year.”
She said they are on track this year to have the most behavioral health admissions at the children’s hospital than ever before. She said that is consistent with what other hospitals are experiencing.
While she fully supports COVID-19 mitigation strategies including lockdowns, virtual schooling, masks and vaccinations, she is concerned about isolation and disruption during the pandemic especially for at-risk youth.
“The pandemic poured salt in the wound, but the wound was already gushing blood,” Kreth said.
Family adjusts course as normalcy slowly returns
Even as COVID-19 cases decline, restrictions ease and vaccines are made available for more children, the wide-ranging mental health effects of the pandemic could last for years.
For the Dembowczyk family, navigating the needs of their three school-age children brought mental health to the forefront of their conversations. Their oldest two are 16 and 13 and attend school in person in Murfreesboro. But their youngest, who is 9, has a weakened immune system. They ultimately decided to homeschool him full-time during the pandemic to keep him safe.
As mask mandates and COVID-19 safety measures became topics of national debate and the virus surged repeatedly, the Dembowczyks said their older children were anxious about catching COVID-19 or spreading it to others — especially their younger brother.
Brian Dembowczyk said their youngest has struggled with loneliness and missing out on school and social events. He also watched his son grow frustrated when others around them didn’t take COVID-19 seriously.
Tara Dembowczyk said they check in with their kids during family dinners, making space to discuss everything from their experiences at school to the larger issues driven by the pandemic worldwide. She and her husband also take to time to ask each kid privately to rate their anxiety on a scale of one to 10, with 10 being the most intense.
“These questions spur deeper conversations and provide opportunities to discuss coping techniques,” Tara Dembowczyk said. “Having those check-ins is vital to loving them through their difficult times.”
The Dembowczyks said their family has adapted well. More than anything, they hope heightened mental health awareness inspires others to seek help when they need it.
“They have to bear such weight on their minds and hearts,” Brian Dembowczyk said. “We’re in a community, and you can’t shield yourself entirely. What we do affects others, and we need to remember that.”
Study reveals neurological effects of COVID-19
Experts have learned that the virus itself can have wide-ranging physical, neurological and mental health effects on people.
The long-term effects of COVID-19 on adults and children can include physical symptoms including fatigue, chronic pain, inflammation and heart palpitations. Some struggle with depression and difficulty concentrating. Multisystem inflammatory syndrome, known in children as MIS-C, also is linked to COVID-19.
A study published in March spanning 61 hospitals and 31 states delved deeper into the neurological effects of COVID-19 in young people.
The study, funded by the Centers for Disease Control and Prevention, included 1,695 patients under age 21 who were hospitalized with acute COVID-19 or multisystem inflammatory syndrome between March and December 2020. It found hundreds experienced neurological symptoms ranging from altered awareness, seizures and difficulty walking or crawling to anxiety, depression and psychosis.
“Of the patients, 22% had neurologic involvement, which I think surprised us all quite a bit,” said Dr. Elizabeth Mack, who contributed to the study and oversees critical pediatric care at the Medical University of South Carolina. “Of those cases, 88% experienced only temporary symptoms, which is certainly reassuring, but the other 12% did not bounce back and some did not survive, which are big numbers when you’re looking at over 1,000 patients.”
One 10-year-old boy in Middle Tennessee, who The Tennessean has chosen not to name to protect his identity, developed severe anxiety, depression and frequent seizures after having COVID-19 in September 2020.
Some days, the seizures come four at a time. They usually last for about a minute and leave him exhausted and confused. It takes him an hour or two to recover.
After a slew of hospital stays, appointments and tests, doctors diagnosed with the boy with nonepileptic seizures, generalized anxiety disorder and major depressive disorder. Nonepileptic seizures are often associated with psychological issues, according to the National Institute of Health.
He’s now on medications to help regulate his mood, sleep, depression and anxiety and is in special education at his school. Sometimes he goes days without seizures, but his mental health is faltering.
While his case is still a mystery, his mom is convinced it’s linked to COVID-19.
Though he was not hospitalized and did not develop MIS-C, his mom said the findings of the study echo what has happened to her son after the virus ran its course.
Mack said there is much to learn when it comes to how COVID-19 affects children long-term, both physically and neurologically. While the study focused on children who were hospitalized, Mack hopes to see more research on the long-term effects of the virus on children in both inpatient and outpatient settings.
“We’re on the cusp of figuring out what all can happen,” she said.
Where to find mental health support for your child
Is your child struggling, or do you know one who may need help? Here are a few resources for mental health in Tennessee.
Tennessee Behavior Health Services
Tennessee offers a wide range of behavioral health services, including support for children and families. Find out more at tn.gov/behavioral-health.
Tennessee Statewide Crisis Line
Tennessee offers a free crisis hotline that is available 24 hours a day for anyone experiencing a mental health crisis. All calls are directed to a trained counselor in the caller’s area. Call or text 855-CRISIS-1 (855-274-7471).
Behavioral Health Safety Net
The Behavioral Health Safety Net provides free, essential outpatient mental health services to Tennesseans who lack insurance coverage, including children. More information is available at tn.gov/bhsn or at 800-560-5767.
Non-profit mental health providers
Tennessee has several non-profit providers for mental health, including Centerstone (centerstone.org), TN Voices (tnvoices.org), Mental Health Cooperative (mhc-tn.org) and the National Alliance of Mental Illness Tennessee (namitn.org). You can also reach out to your primary care provider or your child’s school counselor to ask for mental health resources.