By Anne Blythe
More than $110 billion has been awarded to North Carolina in federal aid to help battle COVID-19 as wave after wave of variants spread illness and disruption — even for President Joe Biden, who now has to isolate at the White House after testing positive for the virus.
As North Carolina elevates its battle against the highly transmissible BA.5 variant with 44 counties labeled by the Centers For Disease Control and Prevention as having high community spread, a Duke physician would like to see a similar commitment to confronting the teen mental health crisis.
The CDC issued a report in April outlining how the pandemic has only worsened what already was a growing concern about the mental health of children and adolescents.
The universal mental health crisis hotline is 988, where trained crisis counselors will be available. To connect with a crisis counselor over chat, text HOME to 741741.
Last week, Gary Maslow, an associate professor in the Duke Department of Psychiatry & Behavioral Sciences and co-director of the Division of Child & Family Mental Health & Community Psychiatry, described the heightened concerns about the mental well-being of youth “the next wave of the pandemic.”
“The amount of resources we put into fighting COVID, a fraction of that would make a huge difference in making treatment available for those who are symptomatic, and supporting parents and families so they can care for their children,” Maslow said during a briefing with reporters with two of his colleagues at Duke who also work in behavioral health. “There is beginning to be momentum at the federal and state level to do that and hopefully at the local and community level we can sustain that and really have a robust response to say every child who has a mental health condition needs support.”
The CDC survey that was the basis for the April report found that 44 percent of high school students who responded said they experienced “persistent feelings of sadness or hopelessness.” Reports of such feelings were more prevalent among females than males. LGBTQ teens reported higher levels of poor mental health.
National and local trends
Nathan Copeland, an assistant professor in the Duke Department of Psychiatry and Behavioral Sciences and a child and adolescent psychiatrist at the Duke Center for Autism and Brain Development, said the past several years have been stressful for everyone, but especially for children.
“We saw increased loneliness. Increased isolation. Increased parental distress. Increased substance abuse disorders across the entire population,” Copeland said at the briefing with reporters and others last week. “The murder of George Floyd exacerbating racial trauma and highlighting the systemic racism that so many individuals experience. And we’ve just seen that temperature rise.
“We have seen a nearly two-fold increase in depressive symptoms and anxiety symptoms among children and adolescents,” Copeland added. “Nearly 20 percent of kids experiencing depression that’s impairing them, nearly 25 percent of kids experiencing anxiety that’s impairing them.”
Copeland said he is seeing behavior changes, too, at Duke. “One of the most common things that we see among kids is increased irritability, increased anger,” he said.
“But we already had a pediatric population that was in crisis for mental health reasons, then we had this event that raised the temperature,” Copeland added.
The CDC survey polled high school students online between January and June of 2021. Through the voluntary questionnaire the CDC was trying to get a snapshot of seven measures:
- Poor mental health during the pandemic;
- Poor mental health over the prior 30 days;
- Persistent feelings of sadness or hopelessness over the previous year;
- Serious consideration of attempting suicide during that time;
- Attempted suicides;
- Finding out from the teens whether they felt close to someone at school; and
- How virtual connection with others during the pandemic played into their lives and overall mental health.
The survey found that more than half of the respondents, 55 percent, experienced emotional abuse by a parent or other adult in their home with incidents of being sworn at, insulted or put down.
LGBTQ youth reported higher levels of attempted suicide and Asian and Black students said they had experienced racism before or during the pandemic, encounters that often are linked to poor mental health.
“These data echo a cry for help,” Debra Houry, acting principal deputy director of the CDC, said in a statement released in March. “The COVID-19 pandemic has created traumatic stressors that have the potential to further erode students’ mental wellbeing. Our research shows that surrounding youth with the proper support can reverse these trends and help our youth now and in the future.”
Sharper focus on behavioral health
Kody Kinsley, secretary of the state Department of Health and Human Services, told NC Health News shortly after taking office that as the state moves out of the pandemic and into recovery mode it will force a new focus on behavioral health.
Other health care organizations are taking note of the problems and planning for the future.
This week, ECU Health announced it would be partnering with Acadia, a provider of behavioral health resources, to build and operate a 144-bed facility in Greenville that is scheduled to open in 2025. The facility, for which ECU Health and Acadia say they are making a $65 million investment, will include 24 inpatient beds specifically for children and adolescents with mental health needs.
“As a clinician, seeing this type of investment and understanding the significant impact it will have on patients is exciting,” Syed A. Saeed, an ECU Health psychiatrist with more than 40 years of experience, said. “The needs of behavioral health patients differ from other patients and vary widely even within the same diagnosis. This state-of-the-art hospital will allow us to fully meet our patients’ unique needs in a safe, patient-centered environment and ensure clinicians have the resources and training needed to deliver excellent care.”
Another sign of increased attention to behavioral health needs happened in Greensboro this week when the UNC Greensboro Center for Youth, Family, and Community Partnerships and NC Youth and Family Voices Amplified Program announced they had joined forces. UNCG will house the program to help train and build a broader workforce of family and peer support providers who can guide people in crisis and their families to needed aid close to their communities.
Davis Regional Medical Center in Statesville also announced this week that the 146-bed hospital will cease delivering general patient care and become a “specialty hospital providing inpatient behavioral health services,” the Iredell Free News reported.
“The need for behavioral health services in North Carolina and across the country is at an all-time high, and Davis will support access for the people who need this specialized care,” a press release about the change said.
‘Unlike anything I’ve experienced’
The pandemic, according to the CDC survey and mental health care providers, showed just how important it is to keep children connected to schools, peers and other community organizations.
Maslow, the Duke child and adolescent psychiatrist who spoke with reporters last week, said this wave of children in distress is very troubling.
“It’s unlike anything I’ve experienced in doing this for 20 years, and that’s the tip of the iceberg,” Maslow said. “The worst outcome is children dying by suicide. That is happening but that is the tip of the iceberg. There’s a large amount of distress that’s happening that doesn’t rise to the level of that.
“The experience of seeing different marginalized groups having a disproportionate negative effect – LGBTQ+ children, young adults coming in – we’re certainly seeing that group having more vulnerability to these serious outcomes,” he added. “In Durham, we’ve actually seen Black youth but also Latinx, Hispanic youth presenting at much higher rates that we’ve seen before.”
Maslow also pointed out that more than 3,000 children in North Carolina lost a caregiver during the pandemic, adding to anxieties and other stressors that are harbingers of poor mental health. They also are dealing with parents and caregivers who have lost jobs or experienced financial stress, which can affect their sense of stability.
“Ultimately, I think we have an opportunity to look at places like schools, community connections in other ways, and find ways to support children and families,” Maslow said.