by Therese Horvat
Special to The Leaven
When they should be enjoying the times of their lives, growing numbers of children and adolescents across the United States are struggling with mental health issues.
These challenges were on the rise before COVID-19 and have only intensified over the course of the pandemic.
Experts believe it will take a community of support to alter this trajectory.
Pre-COVID, rates rising
Prior to COVID-19, mental health challenges affecting 3- to 17-year-olds were escalating at alarming rates.
• Up to 1 in 5 youth (ages 3 to 17) had a mental, emotional, developmental or behavioral disorder. (U.S. Surgeon General Advisory)
• In 2016, of the 7.7 million children with treatable mental health disorders, about half did not receive adequate treatment. (U.S. Surgeon General Advisory)
• More than 1 in 3 high school students experienced persistent feelings of sadness or hopelessness in 2019, a 40% increase since 2009. (CDC)
• In 2019, approximately 1 in 6 high school youth reported making a suicide plan in the past year, a 44% increase since 2009. (CDC)
Parents, youth, counselors, educators and health care providers agree that the pandemic exacerbated these issues. So much so that in October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a “National State of Emergency in Children’s Mental Health.”
Last December, the U.S. surgeon general followed with an advisory titled, “Protecting Youth Mental Health.” In that document, U.S. Surgeon General Vivek H. Murthy, MD, described the challenges as real and widespread.
But he ended on a hopeful note.
“But most importantly, they are treatable, and often preventable,” said Murthy.
Understanding the mental health of children, adolescents
The Centers for Disease Control and Prevention (CDC) defines the mental health of youth as reaching developmental and emotional milestones; learning healthy social skills and ways to cope with problems; and achieving positive quality of life.
Mental health encompasses the emotional, psychological and social well-being of children and adolescents. Mental health disorders are serious, and persistent changes in the ways youth typically learn, behave or handle their emotions cause distress and problems getting through the day.
Katie Stilwell, associate superintendent for student services of the archdiocesan Catholic schools office, explained that behavior changes are a big sign that something is going on with a child or adolescent. Stilwell, a licensed professional counselor and a national board-certified counselor, says children often do not have the words or self-awareness to recognize mental health problems, so adults need to look at their behaviors for clues that something bigger is going on. Warning signs could include withdrawal, conflict with friends, mood swings, changes in sleep and/or eating patterns, excessive worry, school avoidance or irritability.
The behavior of younger children may regress, such as returning to bed-wetting; they may be more aggressive or fussy or not socialize well.
Laura Oliva, school counselor at St. Thomas Aquinas High School in Overland Park, said that adolescents display anxiety and anger as cover for many underlying issues.
Attention deficit/hyperactivity disorder, behavior disorders, anxiety and depression are all among the leading mental health issues experienced by children. Common among adolescents are excessive anxiety about everyday matters; severe feelings of self-consciousness and insecurity; and depression.
Oliva, dual licensed as a school counselor and a professional counselor, believes today’s youth are growing up in a tougher world. They are overscheduled and focused on competition, grades and test scores; they struggle with their identity; their caregivers might have their own mental health issues and can’t always meet their children’s needs; and families are struggling with serious personal and financial factors.
Because their brains are still developing, youth are particularly vulnerable emotionally; they need guidance and healthy boundaries.
Maureen Huppe, archdiocesan associate superintendent for student services with a doctorate in administration and special education, identified social media pressures as having an intense influence, particularly on the mental health of middle schoolers.
“They think they need to look a certain way and be invited certain places; that people are watching them and judging them. They are insecure because of this,” she said.
Stilwell also correlated growing mental health concerns among youth with increased screen time and social media influence. She and Huppe see these habits developing at younger and younger ages.
That’s in addition, of course, to the trauma and adverse childhood events that some kids are experiencing. Their overall well-being can be negatively impacted by the social drivers of health.
Marian Earls, general pediatrician and developmental and behavioral pediatrician in Greensboro, North Carolina, said youth feel the effects of household income challenges, stress within the family, lack of access to health care, and job loss due to the pandemic.
She added that there is a shortage of mental health professionals to serve children and adolescents. Earls has been extensively involved with the American Academy of Pediatrics at the national and state levels with significant focus on mental health.
Pandemic magnifies the challenges
The uncertainties, anxiety, disruption and isolation associated with COVID-19 took a further toll on the mental health of youth.
Oliva recounted that the pandemic cut everyone off from the predictabilities of life and from loved ones. It disrupted traditions. Healthy outlets and familiar routines — including sports, playtime and gatherings — disappeared. These abrupt changes caused stress and pressure for children and adolescents.
Very young children and middle schoolers missed opportunities for social development. While archdiocesan schools were completely remote only from March through August 2020, Stilwell said six months is a large amount of time for 5-year-olds.
Additionally, youth felt the worry, stress and anxiety experienced by the adults in their lives. They lived with the fears and realities of the pandemic, and sometimes the grief.
Earls cited the report that, as of June 2021, 140,000 youth in the U.S. lost a parent or grandparent caregiver to COVID. That number was projected to increase in subsequent months.
Huppe witnessed an escalation of behavior issues in her work for the archdiocese, especially among younger children. Having been away from school for a while, they needed to relearn routines and expectations. Returning to the classroom from the imposed isolation of the pandemic made it difficult for some high school students to reconnect; others dealt with depression.
Again, the nationwide stats are telling. In February and March 2021, the CDC reported a 51% increase in emergency department visits for suspected suicide attempts by adolescent girls (12- to 17-year-olds) compared to 2019. A Kaiser Family Foundation issue brief cited studies showing that only one-third of high school students felt they were able to cope with their sources of stress, and that 22% of parents of 5- to 12-year-olds reported overall worsened mental or emotional health for their children.
Further compounding these mental health concerns was the concurrent exposure of youth to the societal tensions associated with racism, political polarization, climate change and gun violence. Earls said that COVID shone the spotlight on disparities that result from structural racism. Children of color and from low-income families remained at higher risk of mental health issues and less likely to receive care.
Schools at the frontline
The challenge for teachers and counselors, Huppe believes, is to get to the reason behind behavior changes among children to help determine interventions. Teachers are in a unique position to do this.
Stilwell said they are with their students through much of the day and are often the first to notice when significant changes occur and persist — out-of-character responses or actions disproportionate for the situation, such as lashing out, withdrawal or declining school performance.
When they do, teachers and counselors first work to rule out an academic concern as the source of the behavior change. The school counselor or social worker will meet with the child to discuss the issue; triage in the moment; and provide social, emotional and academic support.
“Our counselors and social workers are here to help kids have good days at school. If we suspect something bigger is going on, we connect with parents,” said Stilwell.
Schools don’t provide ongoing therapy for students dealing with mental health issues. This requires referral to an outside counselor in private practice or at a community mental health center. Within the archdiocese, Catholic Charities offers a referral line (at (913) 433-2064) for families who may have financial concerns about counseling/therapy services.
Earls suggested that accessing a pediatrician is often a good place for parents to start. These physicians specialize in the health of children and adolescents, and they have the trust of parents. They are increasingly trained in psychosocial assessments.
In the home environment, parents can watch for warning signs or red flags signaling mental health concerns. When parents notice abnormal changes in behavior in their children, school counselors encourage them to approach the situation from a point of love rather than judging or reacting.
“The best thing parents can do,” said Oliva, “is to spend quality time with kids; be active and reflective listeners; accept their feelings; don’t judge their feelings.”
To help reduce the stress children and adolescents are experiencing, Earls prescribed common practices that support good health: adequate sleep, healthy diets, exercise, routines, one-on-ones with their parents, and breathing and meditation techniques. Children may still need professional counseling or therapy to help them address the mental health or behavioral issues they are facing — but these basic health strategies are a good place to start.
Beyond the pandemic
More funds, more time and more mental health professionals would go a long way toward addressing the emotional and behavioral concerns affecting children and adolescents.
Many schools in the archdiocese used federal funds available during the pandemic to add counselors or social workers to their staffs. Huppe hopes that when these three-year grant cycles end, alternate funding sources will allow continuation of the positions.
Stilwell’s dream would be the adoption and funding of one counselor for every 250 students, the ratio recommended by the American School Counselor Association. This would be a significant service enhancement for larger archdiocesan schools.
Huppe would like to offer ongoing faculty training in trauma-informed instruction. This instruction would specifically incorporate parental involvement in this approach and would take into account the ways trauma impacts learning and behavior.
Other items on Stilwell’s wish list are an evidence-based social/emotional curriculum for pre-K through 12th grades that aligns with the Catholic faith, and time to implement the curriculum. Likewise, Oliva advocates for more classroom time to teach about mental health and strategies to maintain and improve it.
Access to mental health services is critical to alleviate the current crisis. Earls believes telemedicine/telehealth, though having limitations for some children and adolescents, has served as a viable alternative during the pandemic and could be beneficial going forward, especially in underserved and under-resourced areas. Child Psychiatry Access Programs are available in many states and utilize telehealth to provide consultation and coordination of care.
Earls also envisions the integration of mental health professionals into teams of primary care doctors and widespread adoption of mental health competencies in pediatric practices that encompass prevention and promotion, assessment and intervention.
Parishes can support the mental health of youth by welcoming them and making them feel connected to the church. Stilwell said that youth crave love, acceptance and connection. Youth groups with young leaders can help adolescents feel this connection and know that they are loved, accepted, included and heard. Parishes can continue to support schools and youth ministries in their work with children and adolescents. They can help direct families to available community resources.
On a positive note
Oliva agreed with the U.S. surgeon general that the prognosis is not all gloom and doom. The pandemic helped dispel some of the stigma associated with mental health challenges.
Mental health concerns and disorders affecting children and adolescents can be treated and managed. Awareness of warning signs and early identification are important.
Youth are resilient. They can benefit from the understanding and assistance of adults, partnering to help them live their lives to the fullest — parents, teachers, counselors, social workers, pediatricians, child care providers, pastors, mental health professionals, youth ministers, peers, coaches and others.
Surgeon General Murthy writes that supporting the mental health of youth will require a whole-of-society effort.
“Our obligation to act is not just medical,” he concluded. “It’s moral.”