Mental health officials struggle with an increase in pediatric patients

Area mental health professionals are seeing an alarming increase in pediatric patients with mental health issues and suicidal thoughts, even as their caregivers deal with the loss of colleagues, fatigue and mental health concerns.

Dr. Jennifer Katzenstein is the director of psychology, neuropsychology and social work at St. Petersburg’s Johns Hopkins All Children’s Hospital. She said All Children’s witnessed a 30% increase in outpatient referrals and children admitted to the hospital with thoughts of self-harm, suicide attempts, overdoses and suffering from child abuse through the first year of the pandemic. Now it appears the situation is getting worse.

While Katzenstein thought the number of pediatric patients with mental health concerns had peaked and plateaued, the last two months have proven otherwise.

“Even in the past six weeks or so, we’ve seen another increase in kids attempting suicide,” she said. “Definitely in the last month or two, I’ve seen an uptick again.”

Katzenstein said the increase is due to several factors, including a constant feeling of uncertainty, isolation, grief, political tensions and greater social responsibility among adolescents – all of which amplify feelings of distress. Furthermore, medical professionals realized they were amid a mental health epidemic even before Covid swept over the country. Katzenstein said the workforce was insufficient to meet the needs of children and families, and the pandemic exacerbated the problem.

Before the pandemic, Katzenstein said one in five children experienced depression, and doctors could diagnose about 75% of kids with a mental health condition before they reach 17. She added that children waited an average of 10 years for appropriate diagnosis and treatment before the pandemic increased caseloads and reduced the number of qualified professionals.

“And since that time, we’ve seen the increase in uncertainty causing more anxiety and depression,” Katzenstein said. “And now there’s interesting data that’s been released showing that over 140,000 kids have lost their primary caregiver to Covid as well.”

She added that questions surrounding a return to a sense of normalcy compounded the stress compiled through two years of disruptions, isolation for children – and patients are not the only ones struggling.

“Our helpers, who have been helping throughout the pandemic, need help too now,” said Katzenstein. “They’re exhausted and burned out, and the demand for mental health services continues to increase … ”

Katzenstein noted that 140,000 kids have lost their primary caregivers to Covid, and medical professionals are exhausted and burned out amid increasing caseloads. Pictured: Johns Hopkins All Children’s Hospital.

Katzenstein said she is unaware of data specifically comparing the increase in pediatric mental health issues with adults. However, researchers project 25-30% of children are affected by anxiety and depression, and she said recent papers suggest 40% of adults have experienced significant anxiety and distress over the last year.

The most common diagnoses among adolescents are anxiety and depression, said Katzenstein, with many experiencing loss and grief that results in PTSD or acute stress. She sees more disruptive behavior and sleep disorders in younger children and toddlers.

Katzenstein said health professionals are also noticing varying types of stressors among different groups in the community. She noted that underserved populations already encounter barriers to access health care, and the pandemic led to even more financial burdens on those groups.

“We have seen a greater impact on those populations,” said Katzenstein. “In addition, we know that if we have a kid who had mental health concerns before the pandemic, they are more likely to have increased mental health concerns during the pandemic, as well.”

Katzenstein said treatment depends on the severity of the condition. If a child shows significant suicidal thoughts or has attempted suicide, health professionals connect them to services through a Baker Act receiving facility. The hospital provides less severe cases with therapy, either in an individual or family setting.

The pandemic has also pushed caregivers to reevaluate their delivery of treatments, including virtual individual and group therapy sessions.

“So, we’re trying to accommodate our families to give them the best care that we can,” said Katzenstein. “While also increasing our volumes as much as we can, as well.”

Katzenstein encourages parents to set time aside with no distractions to check on their children every day. She said it is critical to monitor who kids are talking to, who they are friends with and what activities they enjoy. If there are any changes to those patterns, or if the child becomes more anxious, sad or depressed, then parents should know something is amiss.

Most importantly, Katzenstein stressed taking the time to just listen to children. If a child shares something they find distressing, she said to take it seriously and seek care.

Katzenstein relayed one aspect of the pandemic that she called amazing – the attention it brought to mental health. The Surgeon General issued a report calling for more attention and advocacy for children’s mental health, and the Children’s Hospital Association recently issued a call to action through classifying children’s mental health as an emergency.

“So, we’ve brought a lot of attention to it,” said Katzenstein. “We have certainly in our community, and others in the area continue to focus on what we can do.

“I feel optimistic moving forward that we could not only return to where we were, but we could also provide way better care and way better early recognition so our kids and families can get what they need.”

For guidance on supporting the emotional and behavioral health needs of children, adolescents, and families, visit the American Academy of Pediatrics website here.

If you or someone you know is struggling with suicidal thoughts, the U.S. National Suicide Prevention Lifeline is available any time day or night at 800-273-TALK (8255). The Crisis Text Line also provides confidential support for those in crisis by texting 741741.