When Millis Public Schools opened its doors for the start of the 2021-22 school year, teachers and staff were impatiently waiting to see their students again in real classrooms.
“We were so excited to have everyone come back to start the school year,” said Bob Mullaney, the superintendent of the Boston suburban school district.
But the transition was more difficult than expected.
“From the start, we’ve seen high levels of stress, anxiety, and various behavioral issues among the students,” says Mullaney.
Schools across the country are inundated with K-12 students struggling with mental health issues, according to school staff, pediatricians and mental health workers. Not only has this increase made it harder for educators to return to the classroom, it is also straining an already strained healthcare system.
Of course, the increase in mental health symptoms in children did not start with this school year. Recent studies show that the pandemic has exacerbated an already growing crisis in youth mental health. CDC data shows that the proportion of emergency mental health visits for children started to increase at the start of the pandemic. In the fall of 2020, the American Academy of Pediatrics, the Children’s Hospital Association, and the American Academy of Child & Adolescent Psychiatry reported a child and adolescent mental health emergency.
The US Surgeon General also drew attention to the crisis in an advisory on youth mental health released in December 2020.
The increase in symptoms continued until 2021. According to data from the Children’s Hospital Association, there were more than 47,000 mental health visits to emergency departments at 38 children’s hospitals across the country in the first three quarters of 2021 – almost 40% more than in the same period in 2020 .
And the situation has worsened in recent months.
Stressed students hurt others – and themselves
Schools See Many Children Acting Younger Than Their Age, Says Dr Vera Feuer, associate vice president of school mental health at Cohen Children’s Medical Center on Long Island. For example, high school kids behave more like college kids, often jostling and pushing each other in hallways, she says. Some troubled children often show their emotions more aggressively and violently.
“In some districts, they’re seeing a really alarming number of student fights,” says Mullaney.
Additionally, Mullaney says there have been recent reports of violence against authorities: A school principal in Massachusetts was assaulted by a student, he says, and other schools have seen staff members assaulted by students.
And a lot of students hurt themselves. There has been an increase in the number of students reporting self-harm, suicidal thoughts and attempted suicide in his district, Mullaney says. His school district has referred more children for mental health treatment than ever before, he adds.
Based on data from nearly 40 children’s hospitals across the country, there were 14,630 emergency room visits for children aged 5 to 18 between January and September last year.
“And sadly, young children are experiencing higher rates than in the past,” said Amy Knight, president of the Association of Children’s Hospitals (CHA), who hosted a congressional briefing on the crisis in youth mental health.
Indeed, healthcare providers across the country are seeing more referrals with cases that are beyond the capacity of schools.
“Certainly, we are seeing schools addressing children with more behavioral and aggression issues,” Feuer said. She and her colleagues also see children with depressive symptoms and those who refuse to go to school and need to be assessed for their risk of suicide. According to CDC data, the number of emergency room visits due to suspected suicide attempts by people aged 12 to 25 began to increase in May 2020, and the number of children hospitals across the country have seen those numbers continue to rise.
The psychological cost of a year away from school in person
Much of it increased reports of mental health problems stems from the stress of going back to school, says Dr Tami Benton, chief psychiatrist at Philadelphia Children’s Hospital, referring to his observations and those of his colleagues working with patients and schools.
“The year they weren’t in school was a year when they didn’t have the opportunity to develop the social skills that normally occur during their developmental period,” she says. “And you’re sort of catching up with all of this under extraordinary circumstances.”
Junior high school Francesca henderson from Atlanta says many of her friends have felt anxious about navigating the social landscape after a year of isolation. While Henderson herself was able to maintain her friendships during the pandemic, she says she initially struggled to interact with people up close again.
“The biggest problem I’ve had was adjusting to life in person,” says the 17-year-old.
Academics have also been stressful. “They made a lot of things a lot easier [last year]”says Henderson.” We didn’t have exams; we had projects and almost all of our evaluations were open. So you didn’t have to study so much. ”
Henderson and his peers have had to relearn skills like time management and focus to make up for the tougher academic pressures of this year.
This catching up has been especially difficult for some children, says Benton.
Children with special needs who relied on in-person support at school fell far behind their peers, both academically and developmentally, last year, as did children who were diagnosed with mental health before the pandemic.
“A lot of people have had services delayed, so by the time they sought mental health treatment their condition was actually worse,” Benton said. “For some of these kids, who actually had pretty strong peer support groups before the pandemic, [they] had to restore these [relationships] when they returned to school.
Henderson saw this in some of his friends, whose emotional well-being benefited greatly from social interactions at school before the pandemic. “So you take that cold turkey off, that was pretty damaging.”
Then there are the children who mourn the loss of loved ones to COVID-19. About 175,000 have lost a parent or caregiver, according to a CDC study. Children of color have been disproportionately affected by these losses because long-standing inequalities have caused higher death rates in their communities. CDC study showed that compared to white children, Asian children were 4.5 times more likely to have lost a parent or other caregiver to COVID-19, black children were 2.4 times more likely susceptible and Hispanic children twice as likely.
“And this trauma alone is very important,” said Dr. Nicole Christian-Brathwaite, a child and adolescent psychiatrist and chief medical officer at Array Behavioral Health, a telepsychiatry company. This is particularly strong “when there are children who have lost generations of family members and then go to school and have to deal with this stress without necessarily having a therapist available, a school counselor or a nurse”.
There is also not always adequate help for these children. Schools in many underserved communities have no mental health support, she adds. “Some schools have a counselor spread across an entire district.”
And many children who developed symptoms of mental health issues in the first year of the pandemic did not receive help right away because they were away from school staff who could have detected symptoms early on.
Before the pandemic, schools were “like the first responders” to student mental health issues, says Mullaney, the Massachusetts superintendent. Teachers and other school staff would spot changes in behavior or symptoms of mental illness and put these children in touch to help them. But it turned out to be more difficult in a virtual learning environment.
A perfect storm: no more help, harder to get
With an already overstretched health care system, children and families are struggling to get help in a timely manner.
“You see this perfect storm of mere increased need [and] difficulty in accessing care, ”explains psychiatrist Feuer, referring to the request of mental health professionals. “Not everyone has booked or taken new patients or is really planning very far in advance. But in many cases, not even planning, just saying “right now we can’t take anybody new,” because they’re so full. ”
As a result, families have no choice but to take their child to a hospital emergency room for diagnosis and treatment of mental health problems, especially if the child is in crisis.
Emergency room visits at the Colorado Children’s Hospital for Child and Youth Mental Health have increased 75% in recent months, said Heidi baskfield, vice president of population health and advocacy at Colorado Children’s Hospital, speaking at a virtual congressional briefing last month. She called the situation “untenable” for providers and communities.
“Every day in our emergency departments, between 15 and 40 children with mental health needs seek care,” she says. “We are constantly full with all of our mental health units. Our outpatient visits have gone from a wait of three weeks to sometimes over nine months. Imagine you are the parent of a child in crisis who calls for help and is told, “Call us back in a year. ”
The sharp increase in needs has led schools and healthcare providers to come up with solutions on the fly. Overwhelmed school staff in many places have sought advice from mental health providers to better spot symptoms of mental and behavioral problems so they can help children sooner. In some resource-rich communities, schools and providers work together to connect children to care before things get out of hand.
There has been some recognition of the problem at the federal level, and some resources to remedy it. The CARES Act and the American Rescue Act have helped many schools add more counselors and social workers to meet growing demand.
But Mullaney is still concerned about what will happen when the money for the COVID relief plans runs out.
“We have to find a way to continue these services,” he said. “The need will still exist for years to come.”
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