YOUNGSTOWN, Ohio – The mental health challenges that confront many children and adolescents nationwide are no less evident locally.
Nationally, conditions are so worrisome that last fall the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association issued a joint declaration of a national emergency in child and adolescent mental health.
“This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020,” said the declaration.
“Rates of childhood mental health concerns and suicide rose steadily between 2010 and 2020 and by 2018 suicide was the second leading cause of death for youth ages 10-24,” the statement continues. “The pandemic has intensified this crisis: across the country we have witnessed dramatic increases in emergency department visits for all mental health emergencies, including suspected suicide attempts.”
Mahoning Valley mental health professionals who deal with teenagers and those younger similarly report increased demand for their services. They say the COVID-19 pandemic put new pressures on them and exacerbated existing issues. Compounding the demand is sometimes-limited access to resources that could help them.
“Mental health issues that are here on an ongoing basis don’t go away with COVID. If anything, some of these stressors can exacerbate these,” Christine LePosa says. LePosa is director of clinical services at Belmont Pines Hospital, which provides behavioral health services for those ages 6 though 18.
“From the time that the pandemic emerged through the present, we have seen an increased demand for services,” she says. “There’s been an increase in mental health challenges. And those that already existed have been exacerbated, increasing the need to access higher levels of care.”
Patients are presenting with anxiety-related challenges, LePosa says. Many stressors accompanied the pandemic. Among them are the individual’s health and the health of their loved ones, changes in routine such as schooling, family work situations, child care, financial challenges and even access to basic needs such as food, clothing and shelter.
“These are additional sources of stress that can result in enhanced anxiety,” LePosa says. “In addition to that, we’re seeing increases in depression … that is largely related to social isolation and lack of human contact, as well as not having set, structured routines.”
Belmont Pines also is seeing increases in what mental health professionals refer to as trauma, from traumatic events such as the death of a loved one because of COVID-19 or related issues or ongoing, chronic trauma, referred to as “little T” as opposed to the “big T” events.
Joe Caruso, president and CEO of Compass Family and Community Services, which operates facilities in Mahoning and Trumbull counties, estimates his agency has seen a 20% increase in youth cases.
The children are experiencing depression and anxiety, he says. In some cases, they were concerned about interacting with their peers out of concern they might bring home an illness that would harm a parent, grandparent, aunt or uncle.
“We’ve had an incredible amount of volume and there’s such a shortage in counselors,” Caruso says, noting that demand for help among adults has increased about 40%, he adds.
At some point, the young people seem “a little bit paralyzed because so much of what they’re hearing and seeing is uncertain,” he says. What they experience also depends on the anxiety and stress they see in their parents or caregivers.
Children are “very resilient” but at the same time also are “sponges,” soaking in everything around them from family, friends and others. So it can’t be taken for granted that they are going to be OK, Caruso says.
Coleman Health Services also is seeing more presentations in children and adolescents, reports Carmella Hill, director of behavioral health for its Trumbull/Mahoning county office.
“Many are fearful of the pandemic,” she says. “Maybe they’ve had loved ones who passed away from the illness or other illnesses.”
Coleman provides behavioral health services primarily for adults but addresses youth under its crisis services, Hill says. The agency recently started a mobile response stabilization team that works with families who have children and adolescents.
Counselors are reporting increased expressions of suicidal thoughts and other forms of self-harm, such as cutting or burning oneself, as well as increased anxiety, worry or fear, according to Hill. Other young people present with mood or behavioral issues including depression or bipolar type symptoms such as mania or hyperactivity
In some cases, children and adolescents are being referred by the schools because of behaviors they’re demonstrating. These include negative interactions with their peers, withdrawing or not engaging in school work as they had before, says Meg Harris, clinical supervisor and coordinator of trauma services for Alta Behavioral Healthcare in Youngstown.
Alta focuses on patients up to age 21.
“We’re seeing quite an increase in the demand for counseling,” Harris says.
Young people have struggled during the pandemic with not knowing what to expect day to day and watching family members cope with financial or employment concerns, she says.
When students were permitted to return to their schools, there was anxiety over whether to wear a mask or if they would choose to continue to participate virtually, whether they would be judged, Harris says. In addition to conditions such as anxiety and eating disorders that were frequent in the past, young patients also are increasingly reporting issues related to gender identity.
Some of the issues with which youths are coming to counseling for relate directly to the measures taken to help keep people safe during the pandemic, such as social distancing and masking.
Socialization is “certainly impacted” because children and adolescents weren’t with their peers as they normally would have been, Coleman’s Hill says.
Being masked meant both children and adults were often unable to tell whether a person was smiling or frowning, for example, or other visual cues.
“That’s very difficult,” says Caruso from Compass Family and Community Services.
There also has been confusion over physical contact because of social distancing recommendations. Some children haven’t learned how to share or to collaborate to solve problems because for two years of their educational lives they had to sit six feet away from others.
“They were not working in groups the way they would normally work in groups,” Harris says. For children who entered kindergarten at the start of the pandemic, they did not have normal classroom experience until second or third grade.
Additionally, the pandemic complicated the transition from middle school to high school. A teenager just entering the dating scene “may not even know how to do that. … They’ve been so isolated that they really don’t know how to develop a social relationship with someone,” Harris says.
“Another challenge we’re seeing is more limited access to support services,” says Belmont Pines’ LePosa. “It can be hard for kids to access outpatient support service. There was a period of time where these services were either decreased – not as many providers were available in the area – or they had transitioned to telehealth, which can be helpful to some folks. But for other folks that in-person interaction with a support is more beneficial.”
“Sometimes what happens is that parent doesn’t want to allow their children – or their parents – to see how they’re feeling,” Caruso says. “So they shove it in and hold it in and that makes it worse on them.”
Many don’t want to reach for help because of the perceived stigma. But more are recognizing that help is available for them and they can take advantage of it to move themselves and their families forward.
“We’ve seen some youth and some adults with great success,” Caruso says. For those who hadn’t engaged counseling services earlier, feelings are “more deeply ingrained” so it might take longer for them to break out of their conditions.
Some schools have employed strategies such as having students meet in groups to discuss how they feel.
“The thinking behind that is if they’re together and maybe they see that their peers are having the same kinds of struggles that they’re having, that they might be more open. Or, at the very least, open to acknowledging their own feelings within themselves,” Alta’s Harris says.
Counselors are working with both adults and children to assure them that their feelings are understandable and to help them with strategies to cope with their anxiety and stress.
In her department, Alta has a “transition to independence” group who meets every Tuesday in person, although participants can also connect virtually, Harris says.
“They cook a meal together and they talk about life. They talk about what you need to know and skills that you need to have as you transition to adulthood,” she says. “It’s really a nice way for kids to connect with one another or reconnect with one another.”
Alta also has case management services in schools to help identify factors that might be impeding students’ progress and help them to learn how to reintegrate into social situations.
In addition, Alta offers art therapy, which is useful for patients who have difficulty expressing themselves verbally.
“We have a lot of anxiety reduction techniques that we use, like deep breathing types of exercises,” Harrs says.
Previously, counselors at Belmont Pines weren’t asking pointed questions related to COVID involving patients or their loved ones. Now, however, those questions are being included to determine whether it could be a contributing factor, LePosa says.
“Sometimes it is; sometimes it isn’t. But we’re staying curious and asking those questions in a more pointed way,” she says. “We are looking at the why behind the what as we see kids come in with anxiety, with depression, with trauma, with behaviors that pose a risk to themselves or others, such as suicidal ideas or gestures such as self-injury behaviors, such as aggressive behavior.”