By Carmen Heredia Rodriguez, Kaiser Health News
Krissy Williams, 15, had previously attempted suicide, but never with pills.
The teenager was diagnosed with schizophrenia at age 9. People with this chronic mental health condition perceive reality differently and often experience hallucinations and delusions. She learned to deal with these symptoms using a variety of services available at home and at school.
But the pandemic has disrupted these lifelines. She lost much of the support that was offered at school. She also lost regular contact with her peers. Her mother lost access to care – which allowed her to take a break.
On a Thursday in October, isolation and sadness came to a head. When Krissy’s mother, Patricia Williams, called a mental health helpline for help, Krissy was standing on the deck of her home in Maryland with a bottle of pain reliever in one hand and water in the other.
Before Patricia could react, Krissy put the pills in her mouth and swallowed.
Efforts to contain the spread of the novel coronavirus in the United States have resulted in drastic changes in the way children and teens learn, play, and socialize. Tens of millions of students attend school through distance learning. Many extracurricular activities have been canceled. Playgrounds, zoos and other recreational areas are closed. Kids like Krissy struggle with this and the toll becomes obvious.
Government figures show that the proportion of children who came to emergency rooms with mental health problems increased by 24% from mid-March to mid-October, compared to the same period in 2019. Among adolescents, it increased by 31%. Anecdotally, some hospitals said they are seeing more cases of major depression and suicidal thoughts in children, especially attempts at overdose.
The increased demand for intensive psychiatric care that accompanied the pandemic has exacerbated the problems that have long plagued the system. In some hospitals, the number of children who could not immediately get a bed in the psychiatric ward increased. Others reduced the number of beds or closed psychiatric units overall to reduce the spread of Covid-19.
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“It is only a matter of time before a tsunami hits the coast of our service system and it will be overwhelmed with the mental health needs of children,” said Jason Williams, psychologist and director of operations for the Pediatric Mental Health Institute at Colorado Children’s Hospital.
“I think we’re just seeing the tip of the iceberg to be honest.”
Prior to the Covid, more than 8 million children between the ages of 3 and 17 were diagnosed with mental or behavioral health status, according to the latest National Child Health Survey. A separate survey by the Centers for Disease Control and Prevention found that one in three students in 2019 felt persistently sad and hopeless in 2019 – a 40% increase from 2009.
The coronavirus pandemic appears to be adding to these difficulties. A review of 80 studies found that forced isolation and loneliness in children were correlated with an increased risk of depression.
“We are all social beings, but they are [teenagers] at the point in their development where their peers are their reality, ”said Terrie Andrews, psychologist and behavioral health administrator at Wolfson Children’s Hospital in Florida. “Your colleagues are your grounding mechanism.”
Children’s hospitals in New York, Colorado, and Missouri reported an increase in the number of patients who contemplated or attempted suicide. Clinicians also mentioned spikes in children with major depression and those with autism who are behaving.
The number of overdose attempts in children has drawn the attention of doctors in two facilities. Andrews of Wolfson Children’s said the facility is distributing lockers for guns and medicines to the public – including parents who walk in after children try to kill themselves with medicine.
Children’s National Hospital in Washington, DC, also saw an increase, said Dr. Colby Tyson, assistant director of inpatient psychiatry. She has seen children’s mental health deteriorate due to a likely increase in family conflict – often a consequence of the chaos caused by the pandemic. Without school, peer connections, or work, families do not have the opportunity to spend time apart and regroup, which can create an already tense situation.
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“That break is gone,” she said.
The increased demand for children’s psychiatric services caused by the pandemic has made it more difficult to find a bed in an inpatient facility.
Some hospitals report that they are at full capacity and that more children are “getting on” or sleeping in emergency rooms before being admitted to the mental health department. Among them is the Pediatric Mental Health Institute at Colorado Children’s Hospital. Williams said the inpatient unit has been full since March. Some children now wait almost two days for bed, from eight to ten hours before the pandemic.
The Cincinnati Children’s Hospital Medical Center in Ohio is also at full capacity, according to clinicians, having had several days of overloading the unit and instead taking children to the emergency room waiting to be admitted. In Florida, Andrews said, up to 25 children were held on surgical floors at Wolfson Children’s while they waited for a place in the inpatient mental health department to open. Your wait could be up to five days, she said.
Several hospitals said the usual summer onset of psychiatric admissions for children was absent over the past year. “We never saw that during the pandemic,” said Andrews. “We were very busy the whole time.”
Some facilities have decided to reduce the number of beds available in order to maintain physical distance and further limit care. Children’s National in DC cut five beds out of its unit to maintain single occupancy in each room, said Dr. Adelaide Robb, director of psychiatry and behavioral science.
The measures taken to contain the spread of Covid have also had an impact on the way children in the hospital receive psychiatric benefits. In addition to vendors wearing protective gear, some hospitals like Cincinnati Children’s have rearranged furniture and put notices on the floor to remind reminders to stay 6 feet apart. The UPMC Western Psychiatric Hospital in Pittsburgh and other institutions encourage children to save their masks by offering rewards such as extra computer time. Patients at Children’s National are now eating in their rooms, a change from when they ate together.
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Despite the need for distance, social interaction is still an important part of children’s psychiatric care, the doctors said. Facilities have developed several ways to do this safely, including creating smaller pods for group therapy. Children at Cincinnati Children’s can play with toys, but only with toys that can then be wiped clean. No cards or board games, said Dr. Suzanne Sampang, clinical-medical director for child and adolescent psychiatry in the hospital.
“I think what’s different about psychiatric treatment is that interaction is really the treatment,” she said, “just like a drug.”
The added precautions to control infection present challenges in making therapeutic compounds. Masks can make it difficult to read a person’s face. Online meetings make it difficult to build trust between a patient and a therapist.
“There’s something about the real relationship in person that the best technology can’t give you,” said Robb.
Currently, Krissy is relying on virtual platforms for some of her psychiatric benefits. Although she was hospitalized and has brain damage from the overdose, she is now home and in good spirits. She likes geometry, dances on TikTok, and tries to beat her mom on Super Mario Bros. on the Wii. But being away from her friends, she said, was a difficult adjustment.
“When you are used to something,” she said, “it is not easy to change everything.”
If you’ve been contemplating suicide or if someone you know has spoken about it, call the National Suicide Prevention Lifeline at 1-800-273-8255 or use the online Lifeline Crisis Chat, which is open 24 hours a day , available seven days a week.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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