The latest COVID-19 wave may be waning, but the morass of mental health conditions the pandemic has left in its wake continues to strain resources and overwhelm physicians in Kansas and beyond – especially when it comes to children.
Experts say mental health concerns among children have escalated across the country, a virulent and sometimes deadly recipe of anxiety, depression and grief that is as potent as the virus exacerbating it.
Emergency department visits across the country for mental health emergencies rose by 24% for children ages 5-11 years and 31% for children ages 12-17 years in 2020, the Centers for Disease Control and Prevention reported. In addition, emergency department visits for suspected suicide attempts increased nearly 51% among girls ages 12-17 in early 2021, while ED visits for specific conditions such as anxiety, trauma, stress, eating disorders and tics continued to increase through 2021 and early 2022 compared with 2019.
“At COMCARE we have noted similar increases in mental health symptoms with new onset or exacerbation of depression, anxiety and ADHD in local youth during the pandemic,” said Rex Lear, MD, medical director of COMCARE of Sedgwick County. His quotes in this article are a collaboration of thoughts from him, child and adolescent psychiatrist DeAnn Jenkins, MD, and Shantel Westbrook, LMLP, LCP, director of Rehab Services for COMCARE.
“Our staff have recognized the negative impact of social isolation during the lockdown, grief with the hospitalization or death of caregivers (both parents and grandparents) and the ongoing fear/unrest in our community during the last two years,” Lear said.
The grief and anxiety expressed by students is immense. Children and teens who lost a parent or grandparent to COVID have not only been traumatized by their loss but were often not able to grieve with their families in a traditional supportive manner due to restrictions, Lear said. More than 140,000 children in the United States have lost a primary and/or secondary caregiver, with youth of color disproportionately impacted, the American Academy of Child and Adolescent Psychiatry (AACAP) reported.
“This amplified symptoms of depression in youth and their affected families,” he said. “The fear and uneasiness in our community has fed the anxiety symptoms many of our youth experienced returning to school and activities. Students with social anxiety disorder have painfully struggled to return to the classroom or large group settings.”
The soaring rates of mental health challenges among children, adolescents and their families prompted the AACAP, the American Academy of Pediatrics and the Children’s Hospital Association to jointly declare a National State of Emergency in Children’s Mental Health last October.
The pandemic has chipped away at the safety and stability of families, and the mental health problems it created continue to haunt people today.
“People lost their jobs. There was probably more substance- or alcohol-related situations in families, potentially more physical abuse,” noted Rachel Brown, MBBS, a child and adolescent psychiatrist and professor with the University of Kansas School of Medicine-Wichita. “There were lots of factors triggered by COVID, and even though COVID is much improved locally, those things have not gone away.”
Brown said mental health professionals have not seen drops in the numbers of children and adolescents seeking services that would indicate the crisis is easing. To complicate matters, there is a “huge need” for mental health care across Kansas that wasn’t met prior to the pandemic.
“According to SAMHSA (the Substance Abuse and Mental Health Services Administration), we should have somewhere in the region of 500-600 child psychiatrists,” Brown said. “We have 60.” Only five are in Wichita.
The dearth of master’s-level therapists, PhD-quality psychologists and medical-trained psychiatrists has fueled creative collaborations among mental health specialists in Wichita and across the state to meet sustained demand for services.
Last fall, COMCARE launched #ZeroReasonsWhy, a teen suicide prevention campaign, across eight school districts in the region. The teen-led storytelling and community mobilization campaign is focused on teen suicide prevention and mental health. It seeks to engage peer-to-peer conversations among key audiences of teens, parents, educators and health professionals to reduce the stigma of mental health, build community support and commit to education.
Last month, KUSM-Wichita and community partners increased the availability to mental health services for Haysville students. The idea is to provide evidence-based treatment for children and adolescents with mental illness. The model includes an onsite primary care physician and a child and adolescent psychologist who see patients in the school-based health clinic.
Then there’s the continued advocacy for primary care physicians – often the first to see and respond to a child in need of mental health services – to step up and help address some of the unmet need. One way to do that is through KSKidsMAP. The program, a partnership between the Kansas Department of Health and Environment and KUSM-Wichita, supports PCPs in treating kids with mental health issues.
The program provides case consultations, didactic sessions and a variety of other things to support the ability of primary care doctors to do evidence-based treatment for patients and families they are seeing, Brown said.
Some 99 out of 105 counties are designated as mental health professional shortage (MHPS) areas, leaving 70% of Kansas children and adolescents with unmet mental health needs, KSKidsMAP officials said. Medical providers around the state who recognize the increased mental health needs of our Kansas youth are encouraged to participate, Lear said.
“Primary care physicians can assist with early identification so as to treat early, therefore preventing the need for higher levels of care,” Lear said. “Any screening practices for anxiety and depression are helpful.”
Physicians interested in more information on KSKidsMAP can visit tinyurl.com/KSKidsMAP.