Mental Health is written across a chalkboard.

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Courtesy Edgar Languren

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COVID-19 continues to impact the mental health of children and youth. The American Academy of Child and Adolescent Psychiatry has declared a “national emergency” on children’s mental health, with the pandemic exacerbating many pre-existing challenges. American Public Media’s mental health correspondent Alisa Roth joins us to tell us more about what that declaration means for youth, their families and hwhat the alarming statistics mean.

OPB is presenting a free live Zoom event hosted by Dave Miller at 4:30 p.m. Thursday: “Call to Mind Live: How Youth Are Coping with Anxiety & Stress.” There will be opportunities for audience participation, and you can register for that free event here.


The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Since the beginning of the pandemic parents, teachers, mental health professionals and kids themselves have been telling us that young people in this country are in a mental health crisis. Now some of the biggest professional organizations are adding their voices to the chorus of alarm. Last month, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association all declared a national emergency in child and adolescent mental health. Then again we’ve been hearing about a crisis for years now, well before the pandemic. Alisa Roth has been reporting on this issue as a mental health correspondent for American Public Media and she joins us now.  Alisa, welcome to Think Out Loud.

Alisa Roth: Thank you.

Miller: How bad was the situation for young people’s mental health before the pandemic?

Roth: It was pretty bad. In 2018 the CDC reported that 7% of kids between the ages of 3 and 17 had an anxiety disorder. More than 3% of them had a depressive disorder and 9% had ADD or ADHD. And it starts early. So one in six kids between the ages of two and eight, little kids, had a diagnosed mental behavioral or developmental disorder and this is all pre pandemic. The other thing though is that it was getting worse. So the CDC does a survey every other year looking at adolescent health. And in 2009, one quarter of high school students reported having persistent feelings of sadness or hopelessness. Ten years later, 2019, so it’s still pre-pandemic, more than a third of them reported feeling that way. And if we look at other metrics from that survey, so seriously considering a suicide attempt, making a suicide plan, attempted suicide, all those things high schoolers reported had gone up in those in those ten years. So it was bad.

Miller: Why was youth mental health at such a crisis point and getting worse even before the pandemic?

Roth: The short answer is that we don’t really know. Academic pressure seemed to be a big one. Pew Research did a survey and found that 60% of teenagers reported that they had real pressure or they felt real pressure to get good grades, in something that I think all of us who have been in high school can relate to. They said they felt real pressure to look good and to fit in socially, and they also felt pressure to be involved in a lot of extracurriculars and to be good at sports. So this go-getter society that we live in, I think it is challenging. Social media is a big one that I’m sure you’ve heard people talk about. There was a study by, there’s been a number of studies on this, but there was a study by some psychology professors who actually found a connection between having a smartphone, so, easy access to social media, and depression. And then the other piece is that we talk about it more. It’s okay to talk about mental health, it’s okay to talk about our feelings. So there is some question, is some of it that we’re just reporting it? It’s always been bad and we’re just reporting it more. But when we talk about younger kids, it’s a little bit harder to tell what’s going on. Having a family history of mental health issues can play into it, if a kid has been sick, if they’re living in stressful circumstances, whether that’s the family circumstances or the neighborhood circumstances, that can also play into it. But as I started with, we really don’t know exactly why it was so bad.

Miller: How much of all this has to do with a lack of access to adequate care?

Roth: It’s a really interesting question. Not having care isn’t the cause per se, on the other hand, we know that mental health, like physical health, can get worse if it’s not treated and if it’s not treated in a timely fashion. So what starts out as a very manageable, very treatable problem can quickly spiral into something that’s unmanageable, right? And that’s where not having access to care can be the problem. Of course there are a lot of reasons why somebody might not have access to care. It could be that the family doesn’t have the right kind of insurance coverage or the parents can’t find a provider who works for them, who’s in the right area, who accepts the insurance. Or it could be that the parents aren’t seeking the care. So it’s all tied in together.

Miller: So let’s fast forward to the last 20 months. Last month, when these big deal associations of pediatric groups or psychiatrists or children’s hospitals, they declared a national emergency in child and adolescent mental health. What are some of the numbers that went into those announcements?

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Roth: Those numbers are pretty alarming. One in four kids reported increased signs of depression. One in five have more signs of anxiety than they had before. And it’s important to note that these numbers aren’t just in the US, it’s kids all over the world who are having these problems, right? There was one study where researchers compared studies, so they looked across all these studies, accounted for 80,000 young people around the world and they found that depression and anxiety in kids has gone up and has stayed up all over the place. Another worrying metric are emergency room visits. It’s the place of last resort, but it’s a place that parents will take kids if they are truly in a mental health crisis. And if we go back to last year, between April and October of 2020, the number of little kids, so 5 to 11 year olds, who ended up in the ER because of a crisis went up by a quarter. And it’s even worse when we start talking about the teenagers, the kids between 12 and 17, that number went up by a third who were ending up in the ER, so it’s bad.

Miller: What have you heard from individual clinicians or educators about what they’re seeing?

Roth: As with so many things, it depends who you talk to. I spoke to a pediatrician in Massachusetts named Michael Yogman. He told me he’s seen a real change in his patients: “I mean, I’m probably getting 3-4 calls a day from parents who say, either my child refuses to go to school because they’re so anxious and traumatized, they’re so anxious, they’re not sleeping, they’re weeping, they’re losing weight.”

Roth: He also told me that he hands out screening questionnaires to kids when they come to his office. And these questionnaires ask about the kids mental health and he said those numbers on those questionnaires are absolutely off the chart in what he sees as cries for mental help. I also talked to a counselor who oversees mental health care for a whole school district in Wisconsin and he told me he’s seen a real variation in kids. So the kids who were in the mainstream are actually doing okay. But he said that the kids who are marginalized, whether it’s because of their race or the family situation or their sexual orientation or anything else, that those kids are doing way, way worse than they have been.

Miller: In the Portland area, Reynolds Middle School announced just this week that they were closing down in person classes starting today for three weeks. Not because of a COVID outbreak, but to give the school time to develop safety protocols and social emotional supports. This is in response to fights and other really disruptive behaviors at the school in recent weeks. What have you heard about the return to in person classes after so long away?

Roth: I thought it was so fascinating when I heard about this, because I’ve been hearing about physical altercations a lot. I think we sometimes think about how mental health problems, whether it’s anxiety or depression manifests in grownups, but it’s so different in kids and it often manifests in anger or in physical outbursts. And a lot of people I talked to for this said that they’ve been seeing more and more fistfights. The return has been tough. There’s the academic side. So all these kids who are out of school or largely out of school last year, who are having to catch up and then the social stuff is just stressful, like having to remember how to socialize again and how to be around kids and how not to be able to turn off your Zoom camera and all these things has been really hard for kids.

Miller: When we talk about this crisis in youth mental health, are we really just talking about a subset of a broader mental health crisis in the American population as a whole? I guess I’m wondering what’s distinct about the youth piece here?

Roth: You’re right. We were all in bad shape before and we’re all in worse shape now. Even just the ups and downs of the pandemic have been shown to be stressful. Everything’s fine. We’re back in business and oh, wait a second, hold off we’re not. But the thing about being an adult is that it’s easier to understand what’s going on. It’s easier to identify those feelings. It’s easier to get help for ourselves or at least to know we need help. The other thing is that the kids look to us for regulation. This is something I heard again and again from the health professionals and teachers is when kids look to their parents or look to their teachers and see that their parents are stressed out or worried or having a hard time, they are also going to have a harder time and be more worried.

Miller: What have you heard from experts about the possible long term mental health effects of the last 20 months?

Roth: I think the biggest takeaway that I got is that we’re not done yet. I mean obviously the pandemic unfortunately is not over yet. And so that means that we’re in the very early days of understanding the full extent, the full effect of this pandemic on our mental health. I talked to a woman named Sharon Hoover, she co-directs the National Center for School Mental Health. And she said that part of the challenge in understanding what the mental health effects are is that we’re even just still collecting data: “And so one of the things that we need to be attuned to is the fact that there’s gonna be some long term impact that we can’t determine yet.”

Roth: And the other thing she pointed out is that PTSD and similar effects can take years to manifest. So it might be that everybody is fine right now or reasonably okay right now and that five,ten years from now we see effects that we didn’t even anticipate. So hold on, we’re not there yet.

Miller: So where do we go from here?

Roth: This is of course the multimillion dollar question. I think at a small scale what I’ve heard is that we need to be listening to our kids. We need to be reassuring them as best as we can in a situation where we are not reassured and we don’t really know what’s going on and we need to get them the help they need when they need it. Bigger picture, it comes back to some of what you talked about about mental health care. We need more mental health care. In order to get more mental health care, we need more money for it and experts are saying we need more of it in the schools because that’s where the kids are and we need more of it integrated into regular pediatric care. So when the kid goes to the doctor, the doctor can say you need some mental health care, let’s get you this or this is what we should do.

Miller: Alisa Roth, thanks very much.

Roth: You’re welcome.

Miller: Alisa Roth is a mental health correspondent for American Public Media. Here’s a quick reminder about an event we’re doing this afternoon. It’s called ‘Call to Mind Live: How Youth are Coping with Anxiety and Stress’. It is a free streaming video event, a series of conversations with young people and with mental health professionals. It starts at 4:30pm today. You can register for it right now on our website, OPB.org/thinkoutloud.

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