Mayday!

By Stephen Gray Wallace.

Just last month, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in children’s mental health, reminding us of the “serious toll of the COVID-19 pandemic on top of existing challenges” (AAP, 2021).

Placing an urgent call to policymakers, AAP president Lee Savio Beers, M.D., FAAP, said, “Young people have endured so much throughout this pandemic and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients.” Specifically, all three organizations are suggesting the following actions by policymakers.

• Increase federal funding to ensure all families can access mental health services.
• Improve access to telemedicine.
• Support effective models of school-based mental health care.
• Accelerate integration of mental health care in primary care pediatrics.
• Strengthen efforts to reduce the risk of suicide in children and adolescents.
• Address ongoing challenges of the acute care needs of children and adolescents.
• Fully fund community-based systems of care that connect families to evidence-based interventions.
• Promote and pay for trauma-informed care services.
• Address workforce challenges and shortages so that children can access mental health services no matter where they live.
• Advance policies that ensure compliance with mental health parity laws.

While youth mental health has been deteriorating for more than a decade, there is no denying the impact of COVID-19.

A paper published in The Lancet, “The Effects of Social Deprivation on Adolescent Development and Mental Health,” reports, “Adolescence (the stage between 10 and 24 years) is a period of life [characterized] by heightened sensitivity to social stimuli and the increased need for peer interaction. The physical distancing measures mandated globally to contain the spread of COVID-19 are radically reducing adolescents’ opportunities to engage in face-to-face social contact outside their household … Human studies have shown the importance of peer acceptance and peer influence in adolescence. Animal research has shown that social deprivation and isolation have unique effects on brain and [behavior] in adolescence compared with other stages of life” (Orben et al, 2020).

More recently, it has been suggested that three habits are “wrecking” teens (Diehl, 2021).

1. Sleeping with a phone
2. Staying up late
3. Withdrawing

Sound familiar?

While the youth mental health crisis is real, a radically different view emerged just over a year ago. In her Forbes article, Alison Escalante examines the question that some researchers are asking: “What if mental disorders like anxiety, depression or post-traumatic stress disorder aren’t mental disorders at all?” (Escalante, 2020).

Mental disorders are routinely treated by medication under the medical model. So why are the anthropologists who wrote this study claiming that these disorders might not be medical at all? They point to a few key points. First, that medical science has never been able to prove that anxiety, depression or post-traumatic stress disorder (PTSD) are inherited conditions.

Second, the study authors note that despite widespread and increasing use of antidepressants, rates of anxiety and depression do not seem to be improving. From 1990-2010 the global prevalence of major depressive disorder and anxiety disorders held at 4.4% and 4%. At the same time, evidence has continued to show that antidepressants perform no better than placebo.

Intellectual arguments aside, surging suicide rates among America’s youth suggest that, indeed, more action by elected and appointed officials is the right path to follow. According to the National Center for Health Statistics at the Centers for Disease Control and Prevention, “The suicide rate for persons aged 10–14 declined from 2000 (1.5) to 2007 (0.9), and then nearly tripled from 2007 to 2017 (2.5) (Figure 2). The suicide rate for persons aged 10–14 was higher than the homicide rate from 2000 to 2005, not significantly different from 2006 to 2008, and higher again from 2009 to 2017. By 2017, the suicide rate was more than twice the homicide rate (2.5 compared with 0.9)” (Curtin and Heron, 2019).

Groundbreaking data from the Center for Adolescent Research and Education (CARE) and Total Brain reveal that the COVID pandemic is having a dramatic impact on U.S. students’ mental health, which in turn is affecting precious cognitive capacities like memory, focus and planning. A neuroscientific study conducted by Total Brain and CARE revealed the following.

• 48% of high school and college students are at risk of general anxiety
• 45% are at risk of social anxiety
• 39% are at risk of PTSD
• Risk of common mental health conditions is 19% to 41% higher for females than males

The National Alliance on Mental Illness reports, “Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn’t always easy. There’s no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness” (NAMI, 2021).

NAMI says that while each mental disorder has its own symptoms, there are common signs of mental illness in adults and adolescents.

• Excessive worrying or fear
• Feeling excessively sad or low
• Confused thinking or problems concentrating and learning
• Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
• Prolonged or strong feelings of irritability or anger
• Avoiding friends and social activities
• Difficulties understanding or relating to other people
• Changes in sleeping habits or feeling tired and low energy
• Changes in eating habits such as increased hunger or lack of appetite
• Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
• Inability to perceive changes in one’s own feelings, behavior or personality (“lack of insight” or anosognosia)
• Overuse of substances like alcohol or drugs
• Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
• Thinking about suicide
• Inability to carry out daily activities or handle daily problems and stress
• An intense fear of weight gain or concern with appearance

Because children’s brains are still developing, their obvious symptoms are behavioral. NAMI lists some specific symptoms.

• Changes in school performance
• Excessive worry or anxiety, for instance fighting to avoid bed or school
• Hyperactive behavior
• Frequent nightmares
• Frequent disobedience or aggression
• Frequent temper tantrums

When parents and other caring adults are aware and on alert, they become an integral part of a youth mental health safety net that can help to avoid Mayday moments and protect kids.

 

References

AAP News. (2021). AAP, AACAP, CHA declare national emergency in children’s mental health. American Academy of Pediatrics. October 19, 2021. https://www.aappublications.org/news/2021/10/19/children-mental-health-national-emergency-101921 (7 Nov. 2021).

Curtin, S. and M. Heron. (2019). Death rates due to suicide and homicide among persons aged 10-24: United States, 2000-2017. NCHS Data Brief. No. 352. October 2019. National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf (7 Nov. 2021).

Diehl, T. (2021). Three habits that are wrecking your teen. All Pro Dad. https://www.allprodad.com/3-teenage-habits-wrecking-teen/?fbclid=IwAR0fHGVcCQRpJkf8YgR8XOzoMjBvqxnGQsfTbSh8HoKfpaPFFfYwyyAGGqw (7 Nov. 2021).

Escalante, A. (2020). Researchers doubt that certain mental disorders are disorders at all. Forbes. August 11, 2020. https://www.forbes.com/sites/alisonescalante/2020/08/11/researchers-doubt-that-certain-mental-disorders-are-disorders-at-all/?sh=679795fe15a6 (7 Nov. 2021).

NAMI. (2021). Warning signs and symptoms. National Alliance on Mental Health. https://www.nami.org/About-Mental-Illness/Warning-Signs-and-Symptoms (7 Nov. 2021).

Orben, A., Tomova, L. and S-J Blakemore. (2020). The effects of social deprivation on adolescent development and mental health. The Lancet. August 1, 2020. Volume 4, Issue 8. https://doi.org/10.1016/S2352-4642(20)30186-3 (7 Nov. 2021).

Total Brain. (2021). High prevalence of mental health risk amid COVID pandemic taking a serious toll on U.S. students’ cognition. February 24, 2021. https://www.totalbrain.com/high-prevalence-of-mental-health-risk-amid-covid-pandemic-taking-a-serious-toll-on-us-students-cognition/(7 Nov. 2021).