Children's mental health is national emergency in pandemic. What's being done in Idaho?

Oct. 25—In Dr. David Peterman's 40 years as a pediatrician in Idaho, he has never seen so many children younger than 12 coming in with anxiety.

"And the anxiety isn't just the fear for myself," said Peterman, the CEO of Primary Health Medical Group. "It's the fear for those around them — that is, 'If my dad goes to work, will he be OK? If my mom goes to the grocery store, is she going to get sick?'"

During the coronavirus pandemic, the answer to those questions has not been a sure thing.

Kids in Idaho and across the country are experiencing anxiety, depression, stress, and suicidal ideations and attempts, experts say. Some are continuing to struggle with a lack of consistency. Others remain in isolation, and many are grieving the loss of a primary caregiver or a loved one.

It's a problem so severe that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association last week declared an emergency in children's mental health.

The groups urged policymakers to increase federal funding for mental health providers, improve telemedicine and take steps to reduce the risk of suicide among children, among other recommendations.

In Idaho, school districts are making some changes to help students who are struggling, and are working to give children the tools they need to handle difficult situations.

There might still be obstacles, such as a lack of resources causing long waits to see mental health providers, but school counselors are optimistic that things are headed in the right direction — especially with students back in classrooms and not learning remotely.

"I think we've come a long way," said Jason Shanks, a counselor at Riverside Elementary School in the Boise School District. "During the pandemic (last year) we were dealing with very different things than we're dealing with now."

What national data show on suicide

A study from the Centers for Disease Control and Prevention found a significant increase in the number of children ages 12 to 17 who went to the emergency room for suspected suicide attempts during the pandemic.

The study looked at the period from February to March of this year and found that those visits were about 51% higher among girls ages 12 to 17 than at the same time in 2019. Among boys ages 12 to 17, the number was up only slightly, about 3.7%.

"We see kids who are really struggling, who are wondering if life is worth it, or who are trying to end their lives at a higher rate than we did before the pandemic," said Paula Griffith, a child and adolescent psychiatrist with St. Luke's Magic Valley. "And those rates were already high."

Idaho is regularly near the top of state rankings in terms of its suicide rate, Griffith said.

Even before the pandemic, the suicide rates for those age 10 to 24 were increasing nationally. Between 2007 and 2018, the rates among that age group went up by more than 50%, according to a study in National Vital Statistics Reports.

Fear, isolation, loss of loved ones

At different stages of the pandemic, kids in Idaho have had different experiences, doctors and school counselors said.

When the pandemic first started, little was known about the coronavirus and COVID-19, aside from its potential to be very serious. That's frightening to children, Peterman said.

"And particularly if you're younger, and you can't have a full understanding, then it's not unusual for a younger child to turn to a parent and say, 'Am I safe?'" he said. "'Are you, mom or dad, going to be OK?'"

As the pandemic continued, children then had to worry about the virus affecting the older, more vulnerable adults they loved. For many, that became an unfortunate reality. Children lost parents, grandparents and other relatives.

According to a study published by the medical journal Pediatrics, more than 140,000 U.S. children have lost a parent or caregiver during the pandemic. In Idaho, nearly 500 children have.

On top of that, many children were learning virtually for months — largely in isolation — making it difficult for them to get social interaction and also making it hard for school counselors to connect.

"All of us began to see a huge increase in mental health problems of children at all ages," Peterman said.

Corrie Anderson, a school counselor at Sherman Elementary School and the elementary counselor coordinator in the Nampa School District, said there has been so much shift and change over the past year-and-a-half.

"Just not knowing, not being able to control the uncontrollable variables," she said. "Are we on campus? Are we not on campus? Are we wearing masks? Are we not wearing masks? So that's been challenging for some of our kids — just the unknown piece of that."

What's the impact of being back at school?

Being back on campus and following a more consistent schedule has been really helpful for kids, Anderson said. They have been able to socialize, get back to some sense of normalcy and start to make up some of what they missed when learning virtually.

Being in person also means school counselors can get a better assessment of children, she said.

But even though most children are back in school full time, things haven't exactly returned to normal.

For those children who were anxious before, being back at school as the virus continues to be a crisis in Idaho can make them anxious and frightened, Peterman said. A number of children have had to work through certain issues just to get them comfortable in the classroom, he said.

"We have a handful of students that are still kind of wary of getting into large groups," Shanks said. "You see the anxiety just in their eyes."

Some students who learned primarily online over the past year could be experiencing anxiety over in-person learning and social interactions. Kids with learning disabilities or special needs also might have fallen more behind and now may be experiencing stress over needing to make up what they missed.

"It's a mixed bag, and it depends on, in some ways, what they were struggling with before," Griffith said. "If you're a kid with social anxiety, going to school is really hard. And if you're a kid who has depression that's worsened by social isolation, going back to school is really nice."

Children also are dealing with anxiety over the uncontrollable variables, including the big question of when the pandemic will end, Anderson said. They're experiencing fear over having to go back into isolation, concerns over loss of income or housing, and grief over the loss of loved ones.

There also are mixed messages. Rules over masks and COVID-19 mitigation measures vary across school districts in the Treasure Valley and are constantly changing. All of that creates insecurity, Peterman said.

"It's not the masks. It's not the separations. It's not the rules themselves that cause anxiety," he said. "It's when they're changing or they're getting mixed messages. That's when children are anxious.

"I can't emphasize enough the importance ... of consistency. Children respond to that and need that."

Lack of mental health care providers

Idaho already struggled with a lack of mental health resources for children before the pandemic.

"So to begin with, we're at a disadvantage in the sense that we don't have an adequate number of counselors, social workers and particularly child psychiatrists in Idaho," Peterman said. "So you begin with not having enough of what's really very, very important to address mental health problems with children."

A limited number of resources means children could have to wait weeks or months to see a provider.

Shanks said that from what he's seen, there has been a longer wait at more agencies. He said it's "really hard to get in anywhere right now," and noted that for many places, it was that way before COVID-19.

Normally, summer is a quieter time in child psychiatry, Griffith said. She didn't see that lull this year.

"It was just as busy as other times in the year," she said, "and I think part of that has to do with the unpredictability of the things ... we count on to help pace us through life."

Griffith said she thinks she's booked a couple of months out for her next new evaluation. Her clinic also has a crisis process in place that helps "triage patient referrals," she said.

"We try and walk the fine line between everyone appropriately waiting their turn, but also helping the people who are in the most need," she said.

More resources in schools

School districts across the Treasure Valley have been working to get more mental health resources for students.

In Nampa, Anderson said she's been spending more time in the classroom on coping mechanisms to help with strong emotions. This year, she's supplementing her program in K-5 classrooms with one called "The Zones of Regulation." That program helps kids with emotional regulation and finding tools they can use, she said.

When she's meeting kids in small groups, she said she also focuses a little more on coping, communication of feelings and relationship building with peers.

"We lost some time with socialization," she said. "Kids are very resilient and they bounce back and normally they do just fine. But there's the pocket of kids who still need support."

For elementary students in the Boise School District, Shanks said they are now teaching "Sources of Strength." That program, a youth suicide prevention project, teaches students how to find and rely on strengths within themselves, he said.

The West Ada School District is also working on expanding its social-emotional learning programs in middle and high schools by using some federal COVID-19 funds.

Those programs were already in place at the elementary level, said Jeanne Buschine, the district's supervisor of counseling. The district piloted a program in middle schools last year and has since expanded that, she said. At the high school level, the district is piloting a program this year at a few schools, but one of the biggest challenges is finding the time to reach the students, she said.

Those programs teach skills on how to self-regulate, manage stress, solve problems, ask for help and express their feelings, she said. Buschine said West Ada is also participating in a few surveys that will give the district a better idea of how many students are struggling and what they are dealing with.

Next semester, the district is planning to bring in some school counseling interns from universities in the area to a few high schools to pilot some group counseling programs. If those work well, the district plans to expand them next year, Buschine said.

"Our whole intervention is designed around keeping kids from having to leave class and to have skills right there with them on how to calm down (and) how to manage their stress," Buschine said.

Districts are also working to create or expand agreements with different agencies to bring mental health providers into schools to work with students. Those programs give kids the chance to meet with someone on a regular basis during school time — eliminating some of the barriers they might face to access those services after school.

Is it getting better?

School counselors said they think being back in school and having a more normal routine is helping kids. Isolation and a lack of a consistency were really difficult for everyone, not only children.

"I do think that it's getting better," Anderson said. "I think that having consistency and stability helps ease a lot of that anxiety for our kids, knowing what to expect."

Experts also said they believe the stigma associated with mental health and seeking care has improved. Buschine said the pandemic has helped to normalize that people do experience these challenges.

"I feel like as a culture, we're having more conversations around it, partially because it's blossoming even more as a problem," Griffith said. "And so I feel like I see less stigma from the people that come into my office, internalized stigma about seeking mental health treatment generally."

Over and over again, school counselors, teachers and doctors have said that children are resilient. And treatment works for those who access services.

"With children, if it's diagnosed, it's treatable," Peterman said.

But there has been a lot of trauma the past year and a half.

"How many of these children have had a parent or grandparent, a cousin, an uncle, who have died from COVID?" Peterman said. "And so that doesn't just go away."

Griffith also emphasized what an important role parents and adults can play in how children have responded and continue to respond to the pandemic.

"I think that sometimes adults underestimate children's ability, and perceptiveness to recognize the bigger conversations going on, and to take on whatever perspective the big people in their life that they love, and trust, have," she said. " ... So we have the chance to help help them survive and do well."

Griffith said the most important thing, to get started, is for children to talk to a trusted adult in their life, whether that's a school counselor, a family member, a friend or a doctor.

Resources

National Suicide Prevention Lifeline: 1-800-273-8255

Idaho Suicide Prevention Hotline: Call 800-273-8255 or text 208-398-4357

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