The kids are back in school – and struggling with mental health issues
When Millis Public Schools opened its doors for the 2021-22 school year, teachers and staff were eager to see their students back in real classrooms.
“We were so excited to have everyone back to start the school year,” said Bob Mullaney, the suburban Boston school district superintendent.
But the transition was more difficult than expected.
“From the beginning, we saw high levels of stress, anxiety, different behavioral issues among students,” says Mullaney.
Schools across the country are overwhelmed with K-12 students struggling with mental health issues, according to school staff, pediatricians and mental health workers. Not only has this surge 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 didn’t start with this school year. Recent studies show that the pandemic has exacerbated an already growing youth mental health crisis. CDC data shows that the proportion of emergency mental health visits for children began to increase at the start of the pandemic. In fall 2020, the American Academy of Pediatrics, Association of Children’s Hospitals, and American Academy of Child & Adolescent Psychiatry stated a child and adolescent mental health emergency.
The United States Surgeon General also drew attention to the crisis in a youth mental health advisory released in December 2020.
The increase in symptoms continued through 2021. According to data from the Association of Children’s Hospitalsthere 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, nearly 40% more than the same period in 2020.
And the situation has worsened in recent months.
Stressed Students Harm 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’s Children’s Medical Center on Long Island. For example, high school kids behave more like middle school kids, often jostling and jostling in the hallways, she says. Some children in difficulty often show their emotions more aggressively and violently.
“In some districts, you’re seeing a really alarming number of student fights,” Mullaney says.
In addition, Mullaney says there have been recent reports of violence against authorities: a Massachusetts school principal 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 acts of self-harm, suicidal thoughts and attempts 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 unfortunately, young children are experiencing higher rates than in the past,” said Amy Knight, president of the Association of Children’s Hospitals (CHA), who moderated a congressional briefing on the crisis in youth mental health.
Indeed, health care providers across the country are seeing more referrals with cases that are beyond the capacity of schools.
“Certainly we see schools referring kids with more behavior and aggression issues,” Feuer says. She and her colleagues also see children with depressive symptoms and those who refuse to attend school and need to be assessed for suicide risk. According to data from the CDC, the number of emergency room visits due to suspected suicide attempts by people aged 12 to 25 began to increase in May 2020, and children country hospitals have seen these numbers continue to rise.
The psychological cost of a year away from in-person school
A lot of that increase in reports of mental health problems stems from the stress of returning to school, says Dr. Tami Bentonchief psychiatrist at Philadelphia Children’s Hospitalreferring to his observations and those of his colleagues working with patients and schools.
“The year they weren’t in school was a year where they didn’t have the opportunity to develop the social skills that normally occur during their developmental period,” she says. “And you are making up for all of this under extraordinary circumstances.”
junior high school Francesca Henderson from Atlanta says many of his 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 had was adjusting to life in person,” the 17-year-old explains.
Academics were also stressed. “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 assessments were open. So you didn’t have to study so much.”
Henderson and his peers have had to relearn skills such as time management and focus to catch up with the tougher academic pressures this year.
This catch-up has been especially difficult for some children, Benton says.
Children with special needs who relied on in-person support at school lagged far behind their peers both academically and developmentally last year, as did children who had a mental health diagnosis before. the pandemic.
“A lot of people had delayed services, so by the time they sought mental health treatment, they were actually getting worse,” Benton says. “For some of these kids, who actually had pretty strong peer support groups before the pandemic, [they] had to restore them [relationships] when they went back to school.”
Henderson saw this among some of his friends, whose emotional well-being greatly benefited from social interactions at school before the pandemic. “So you take that cold turkey out, it was kind of detrimental.”
Then there are children mourning 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 longstanding inequalities have caused higher death rates in their communities. The 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 and Hispanic children twice as likely.
“And that trauma alone is very significant,” says Dr. Nicole Christian-Brathwaite, a child and adolescent psychiatrist and chief medical officer at Array Behavioral Health, a telepsychiatry society. 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 or a school counselor or a nurse” .
Nor is there 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 the symptoms very early.
Before the pandemic, schools were “kind of like first responders” when it came to student mental health issues, says Mullaney, the Massachusetts superintendent. Teachers and other school staff would identify changes in behavior or symptoms of mental illness and put these children in contact for support. But it proved more difficult in a virtual learning environment.
A perfect storm: more help needed, harder to get
With an already overstretched healthcare system, children and families struggle to get timely help.
“You see this perfect storm of just the increased need [and] difficulty in accessing care,” explains psychiatrist Feuer, referring to the demand from mental health professionals. “Everyone is either taking or not taking new patients or really making appointments way in advance. But in many cases not even planning, just saying ‘right now we can’t take anyone new’ because they are 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 issues, especially if the child is in crisis.
Visits to the Colorado Children’s Hospital ER for child and adolescent mental health have increased 75% in recent months, said Heidi BaskfieldVice 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, there are between 15 and 40 children with mental health needs who seek care,” she says. “We are always full with all of our mental health units. Our outpatient visits have gone from a three week wait to sometimes more than nine months. Imagine you are the parent of a child in crisis calling for help and let us tell you, ‘call us back in a year.’
The surge in need has led schools and healthcare providers to come up with solutions on the fly. In many places, overwhelmed school staff have reached out to mental health providers for advice on how to better spot symptoms of mental and behavioral problems so they can help children earlier. In some well-resourced communities, schools and providers work together to connect kids to care before things get out of hand.
There has been some recognition of the problem at the federal level, and some resources to fix it. The CARES Act and the American Rescue Act have helped many schools add more counselors and social workers to meet increased demand.
But Mullaney is still concerned about what will happen when the money for COVID relief plans runs out.
“We have to find a way to continue these services,” he says. “The need will still exist for years to come.”