Subjected to screens in a year of mostly remote learning, children’s mental health has suffered.
Physically distanced from many of the supports and connections that define childhood and school in a year of unprecedented stressors, “the kids are not OK,” as Vermont Gov. Phill Scottsaid in February.
It’s a sentiment that’s been echoed repeatedly, by governors all throughout New England, fromMassachusetts to New Hampshire to Rhode Island, as well as the Centers for Disease Control, which reported that nationwide the proportion of children’s mental health-related emergency department visits, among all pediatric emergency department visits, rose from mid-March through October 2020, with increases of 24% among children aged five to 11 years and 31% among adolescents aged 12 to 17 years, compared with the same period in 2019.
'Massive pandemic of mentally ill adolescents'
And it’s been seen with alarming clarity by mental health professionals on the front lines.
The director of the Division of Pediatric Hospital Medicine at Hasbro Children's Hospital in Providence told The Providence Journal they have seen a "massive pandemic of mentally ill adolescents," to the point where three-quarters of the patients in the hospital were adolescents who wanted to hurt themselves because of mental illness.
“When I say it’s massive, I don’t want to understate this,” said Dr. Brian Alverson, the director of the Division of Pediatric Hospital Medicine at Hasbro Children's Hospital, in an interview with the Providence Journal in February. At that time, “when I looked at the census of the hospital. Three-quarters of the hospital was adolescents who wanted to hurt themselves because of mental illness.”
But getting mental health services to children in a world that has been largely remote has been a challenge, though not a new one.
How has the pandemic affected children’s mental health?
“Pre-COVID, there had already been an increase in mental health issues for kids and teens, an increase in anxiety and depression,” said Marcia Tryon, school-based therapist for Newport Mental Health, a Middletown, Rhode Island-based nonprofit. “The pandemic certainly increased peoples’ feelings of anxiety and depression, especially when it comes to isolation.”
At Seacoast Mental Health Center in Portsmouth, New Hampshire, “we have certainly seen a higher rate of need” during the pandemic, said Jodie Lubarsky, child, adolescent and family services director at Seacoast.
Lubarsky, who’s also a licensed clinical mental health counselor in New Hampshire, said she’s not aware of an increase in youth suicide rates in that state during the pandemic. “But the severity of symptoms, the number of youth expressing thoughts of suicide without a plan and feelings of (hopelessness) seem to have increased. We have seen a higher volume of youth and families reporting increased symptoms to their treatment providers or to staff at schools,” she said.
Teen suicide and depression
Teen suicide, most often associated with depression, was the second leading cause of death for adolescents aged 15 to 19 years, according to the CDC, pulling from data spanning the years 1999 to 2019.
Despite this,new research out of the University of New Hampshire reports that more than half of children in high-risk populations in the U.S. are not receiving behavioral health services that could help them. Researchers used data that was collected pre-pandemic.
The author of the study, David Finkelhor, presents a silver lining.
“Childhood mental illness is fairly amenable to solutions,” said Finkelhor, professor of sociology at UNH and director of UNH’s Crimes against Children Research Center, in an email. “The main problems are not enough providers, not enough providers trained in evidence-based practices, and big obstacles identifying those in need and getting them linked with providers,” he said.
Lubarsky pointed to the issues of lingering stigma and limited access to the proper levels of care.
“I think it’s (also) a little bit of having families know what’s available to them,” Tryon said, speaking on barriers, pandemic or not, to youth mental health care.
Potential solutions to these problems – training on, access to, and finding mental health help — are coming from the same computers that children have been stuck behind all year. A crisis intervention and suicide prevention organization for LGBTQ youth leveraged technology to train more volunteer counselors. Virtual therapy has become more popular, allowing children to get help where ever they are. A Connecticut-based nonprofit found a way to combat parental isolation via support groups, helping families to have a better idea of what’s available to them.
The technological solutions crafted by such organizations allow for some of the traditional barriers to youth mental health support and care- stigma, a dearth of providers and limited accessibility- to be squashed, while simultaneously skirting the unique barriers brought by COVID.
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A mental health training program
Studies by the U.S. Department of Health and Human Services projected a shortage of mental health providers, even before a pandemic radically increased demand.
Organizations such as The Trevor Project, the world’s largest suicide prevention and crisis intervention organization for LGBTQ youth, have found themselves needing to enhance and scale their counselor training programs.
“We know that nearly 70% of our digital crisis counselors volunteer on nights and weekends, indicating a need for more training options outside of typical business hours,” said Dan Fichter, head of AI & engineering at The Trevor Project, in an email.
One way to make it available whenever someone is ready to train – artificial intelligence. In March, the Trevor Project launched its Crisis Contact Simulator, an AI tool designed in partnership with Google.org.
“(This) first-of-its-kind model simulates the youth side of digital conversations with LGBTQ youth in crisis,” Fichter said. “This allows aspiring counselors to experience realistic practice conversations representing a range of life situations, identities, and backgrounds of youth in crisis before participating in instructor-led roleplays and monitored counselor shifts with trainers. The Crisis Contact Simulator will increase trainee confidence and competency.”
The Trevor Project uses AI to train counselors for LGBTQ youth in crisis
The Trevor Project’s use of AI to increase its counselor base plays into the call from experts for more mental health care providers. Though a provider is considered a different caliber of professional compared to a volunteer counselor, The Trevor Project’s program still contributes to a greater number of trained individuals available to help youth in crisis.
The organization anticipates that the Crisis Contact Simulator- coupled with other developments within its counselor training program- will enable a tripling of its digital counselor base this year.
“(We) will not ever replace a counselor with AI technology when serving youth in crisis,” Fichter said. “The wonderful thing about the Crisis Contact Simulator is that it’s not compromising the human touch of our training program – it simply increases scheduling flexibility for our volunteers.”
It’s an idea that could be taken to other organizations. But Fitcher cautioned, they should consider “lower-tech but reliable and effective alternative approaches first, as we do constantly at The Trevor Project, before reaching for AI.”
Does online therapy work?
While counselors are not likely to be replaced with AI anytime soon, as Fitcher noted, virtual therapy – seeing a therapist online – has become much more popular. During the last week of March 2020, when pandemic-related restrictions were largely in effect, teletherapy saw an uptick of 154%, according to the CDC. As social distancing continued, it became more prevalent.
TheAmerican Psychiatric Society surveyed their members at the end of 2020 and found that 85% of the people they surveyed said they were either somewhat satisfied or satisfied with their virtual therapy and that no-shows were reduced.
Jill Stanzler-Katz, a clinical social worker and psychotherapist self-employed in private practice in Massachusetts, said she’s found virtual therapy to be “very effective.”
“It’s accessible to anyone with a computer, tablet or smart phone,” though she noted the potential for technological glitches, which is a drawback. “People don’t have to take extra time to drive to an in-person office visit.”
It also helps for people that are concerned about stigma, said Tyron, noting that it eliminates concerns such as waiting room anxieties.
With the pandemic, access to virtual platforms that protect patient privacy became more accessible, regulatory burdens lessened and circumstances forced practitioners to learn the technology, according to APA. In their end of year letter to the Department of Human Services, they touted the push into telehealth as a step forward for access to care, declaring “the house call is back.”
How can a parent help a mentally ill child? There are support groups for that
To find the best summer camp, or a sterling orthodontist, parents turn to the advice and recommendations of their fellow parents, said Randi Silverman, founder and executive director of The Youth Mental Health Project, a Connecticut-based nonprofit.
But when it comes to the mental health of their children, parents are often isolated, silenced or shamed.
The Youth Mental Health Project launched The Parent Support Network in Oct. 2018- with one location- after recognizing that “parents are very much isolated and alone” when their children experience mental health problems and challenges, Silverman said in a recent phone interview.
The Parent Support Network switched to an entirely virtual platform when COVID hit, which enabled an extension of its reach to every state in the country, and to parents who became further isolated.
At the end of 2020, there were 150 meetings, compared to 88 meetings in 2019. 800 parents were supported via the meetings in 2020, compared to the roughly 700 parents in 2019.
Going virtual allowed the group to connect to more parents, but it also created challenges. Privacy was a concern, Silverman said, though many parents have found loopholes like shutting off their cameras, using headphones or typing if they can’t talk.
Also, “it’s not the same as a personal connection,” Silverman said.
When it comes to advice for other organizations looking to create a program like The Parent Support Network, “I would advise them to work with us,” Silverman said. “We’ve done all the work…we’ve created a turnkey program (and) we’re willing to share and collaborate…we don’t need to reinvent the wheel.”
© 2021 Newport Daily News, R.I. Distributed by Tribune Content Agency, LLC.
