As pandemic wanes, children's mental health woes overwhelm system
Jun. 12—Lucie, a mother of four, was at her wits' end, the stress level in her Norwich home sky high.
For some time, her 9-year-old son had been having fits of rage. He was finding reasons to be angry and he was throwing things, at times targeting her and his three siblings, intending to harm them. By last weekend, the situation had gotten dire, with Lucie's son raging every day, sometimes numerous times a day.
Lucie, which is not her real name and whose identity The Day agreed to withhold, was convinced her son needed to be hospitalized. She called Dr. Richard Lavoie, her son's pediatrician.
Lavoie contacted the Connecticut Children's Medical Center in Hartford, a resource he often taps on behalf of parents. He did so knowing full well that the COVID-19 pandemic had overwhelmed therapists and other pediatric mental health providers.
He called anyway.
"I spoke to an APRN (Advanced Practice Registered Nurse) who was very helpful," Lavoie said. "But what I was hoping for didn't come to pass. She told me that right then there were 30 patients, ages 7 and up, who were waiting for inpatient care. They were staying in hallways, sitting on stretchers and in community rooms, waiting to be placed somewhere."
"She said if my patient showed up, he would just be No. 31," Lavoie said.
Though the pandemic may be in retreat, some of the inadequacies it exposed, such as those involving behavioral health care, particularly children's mental health care, are only now becoming stark, according to health providers.
"My (mental health) consults have tripled," said Lavoie, who has been in practice in Norwich for decades. "Every single day, we are dealing with crises of all sorts. My first calls today were from therapists, teachers, care providers. We're seeing a frightening explosion of kids needing outpatient care, medication management and inpatient care."
"It's scary," he said.
In early May, the American Psychiatric Association released a poll showing more people were reporting pandemic-related mental health issues than a year earlier and that parents were especially concerned about their children's well-being.
"More than half of adults (53%) with children under 18 in their household say they are concerned about the mental state of their children and almost half (48%) say the pandemic has caused mental health problems for one or more of their children, including minor problems for 29% and major problems for 19%," the AMA reported. "More than a quarter (26%) of parents say they have sought professional mental health help for their children because of the pandemic."
Nearly half (49%) of parents who have children under 18 said their child had received help from a mental health professional since the start of the pandemic. Among those whose children had received help, 23% said it came from a primary care professional, 18% from a psychiatrist, 15% from a psychologist, 13% from a therapist, 10% from a social worker and 10% from a school counselor or school psychologist.
A fifth of parents said they had trouble scheduling appointments with a pediatric mental health professional.
Anxiety, depression chief symptoms
Dr. Bonnie Mackenzie, medical director of pediatric emergency medicine at Lawrence + Memorial Hospital in New London, said pediatric cases in the hospital's emergency room decreased in 2020 but have returned to pre-pandemic levels. The median number of hours each patient spends in the ER has increased from eight to 14, she said, an indication that cases are more severe.
"The general feeling in our emergency department is that there has been an increase in acuity," Mackenzie said. "It feels like when children present for mental health treatment, their needs are increased. We're feeling it's because of the pandemic ... the stresses they're feeling in terms of (a lack of) normal social support."
Anxiety and depression are the symptoms that most commonly lead to pediatric mental health visits. L+M's emergency room has seen children because of suicidal ideation and even suicide attempts, Mackenzie said. Much less common, she said, are pediatric cases of homicidal ideation.
"Parents are looking for help with hard-to-manage behavior at home, verbal or physical outbursts," she said. Eating and sleep disorders and panic attacks also are associated with pediatric mental health problems.
Providers and parents agree on the cause.
"It's about being separated from their peers," said Carrie Pichie, a clinical psychologist and a regional director of ambulatory services for Hartford HealthCare's Behavioral Health Network. "Early in the pandemic, not being in school and not being able to participate in sports and other extracurriculars was devastating for many kids. Some find it difficult to reintegrate when schools are back in session."
Pichie said the number of pediatric cases she's seeing has increased over the last few months, even as the pandemic has waned. When schools first adopted virtual and hybrid learning schedules, children adjusted. But in time, she said, the lack of social interaction caught up with them.
"Kids left at home to do schoolwork without adult supervision may play video games instead," Pichie said. "Not being in school, they miss contact with teachers, guidance counselors and coaches — people who can recognize changes in their functioning."
Lavoie said the pandemic's toll on families is a factor in children's mental health.
"Job losses, relationships breaking apart ...," he said. "Kids see it, they hear it. There's no place for them to hide and there's no place for them to vent."
Lavoie said the amount of medications he prescribes has tripled, too, including the antipsychotics Abilify and Vraylar and the antidepressant Zoloft, all of which produce side effects. His office asks patients 12 and older to complete the PHQ-9, a questionnaire that screens for the presence and severity of depression.
The bulletin board in his office is covered with the business cards of therapists and social workers.
Lucie, the Norwich mother, said the impulse-control medication prescribed for her 9-year-old son hasn't worked. She found his remote sessions with a therapist to be ineffective but said he has benefited from some counseling at school and is now in a partial hospitalization program. She's still waiting to schedule a face-to-face appointment for a psychiatric evaluation.
"It's just not available," she said of the help she needs. "I know the system's overloaded. We need more beds (in pediatric mental health facilities), more therapists, more doctors — seasoned professionals. There's just not enough out there."
In the meantime, the resumption in the fall of full-time, in-person schooling and all the social interaction it affords children offers some promise.
"He seldom rages at school," Lucie said of her 9-year-old son.
