Why the Children’s Mental Health Crisis Predates COVID-19

CHRISTIANE AMANPOUR: For more than two years, the pandemic has placed great stresses on families around the world, especially on children. But our next guest, journalist Judith Warner writes that children have been suffering with increased feelings of anxiety and depression for years. She sat down with Michel Martin to discuss how COVID simply put a spotlight on that issue.

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MICHEL MARTIN, CONTRIBUTOR: Thanks, Christiane. Judith Warner, thank you so much for talking with us.

JUDITH WARHostsNER, MENTAL HEALTH JOURNALIST: I’m so glad to be here. Thank you, Michel.

MARTIN: So, you’ve been writing about mental health and wellness among children and adolescents for some time now. You wrote a piece recently for the “Washington Post” magazine where you talked about how it’s tempting to think that the challenges that we’re seeing, in fact, what some people call a crisis of mental health among children and adolescents is due to the pandemic. But you make the argument that this actually goes well before that. Why do you say that?

WARNER: Absolutely. Yes. As you say, I’ve been covering this for a long time. And the surgeon general in 1999 warned of a mental health crisis among American kids. And since that time, the numbers have just gotten worse, rising levels of depression and anxiety, rising rates of suicide, you know, this absolutely did not begin with the pandemic in 2020.

MARTIN: Just some of the numbers that cite that, I mean, you said, according to the CDC, the Centers for Disease Control, in 2019, one out of three high school students, and about half of all high school girls, reported persistent feelings of sadness or hopelessness. And also, according to the CDC in 2019, which is, again, before the pandemic, one out of six high school students reveal that they have crafted a suicide plan the previous year. That is really disturbing. I mean, I’m guessing that this is the kind of thing that perhaps parents and maybe educators had seen, but perhaps, couldn’t — maybe didn’t put it altogether. But why do you think that is and why do health professionals think that is? What’s at the root of this?

WARNER: Well, in just sense of — I mean, just raising the issue of parents and teachers, it’s very hard to recognize the signs of mental illness in kids if you don’t have the eyes to see it, because it looks so different from one kid to another or from adults and kids. A lot of parents whose kids go onto develop anxiety and depression had it themselves or have it for themselves, but it looks so different. And kids hide what’s going on with them. And teachers, of course, have the same issue. They can sense something isn’t right. But unless they have been specifically trained in how to spot serious problems, you just don’t see them, and kids really do their best to not worry the adults around them.

MARTIN: Do — why do you think it is that people are so quick to blame the pandemic? It’s it, in part, maybe because the kids were right in front of their faces, or are kids — were kids manifesting their distress in a more visible way during the pandemic? What do you think?

WARNER: All of that. And, you know, experts say that what the pandemic did was basically add gasoline to a fire that had been burning for a very long time. I mean, the pandemic was hard for everybody. Everybody. Adults and kids were stressed, not sleeping well, anxious, worried. And, of course, you know, 2020 also included all of the civil rights protests, you know, the Black Lives Matter protests, and the police response to those protests, the very militarized response. And there was really a big feeling of unsafety in that period, that then was heightens after January 6th as well. So, there were all kinds of different things going on, and kids were seeing that adults were fighting amongst themselves about what the right thing was to do about COVID. There was so much rage in the air, there still is. You know, these are toxic elements for a kid to be plunged into, just as it’s toxic for all of us, these are really tough times. So, parents definitely we’re seeing this, it was in front of their noses. And then, of course, the social isolation on top of all of that anxiety and stress just heightened whatever was going on beforehand. And there was a lot that was going on beforehand.

MARTIN: You know, you tell some really disturbing stories in your piece about some things going on beforehand. For example, you tell the story about a Northern Virginia child psychiatrist who would set up complicated medication regimen for a 14-year-old boy with a diagnosis. He had bipolar disorder, but the — but he had retired. And when the boy’s parents couldn’t find a replacement, his physicians didn’t feel comfortable continuing his medication regimen because they didn’t really understand why it was all about. So, his medication lapses. And they, you know, were trying to find somebody else to keep monitoring him, but it was, what was it, months before they could find somebody in that time? His medication lapses. He gets into a disagreement with someone. He picks up a gun and he shoot somebody. And then, he’s now — so, you know, somebody — and he’s locked up. And I also have to say, you know, more recently in the news, we are seeing some very disturbing stories involving kids. Like you’re seeing, on one hand, criminal justice implicated stories like a kid whose parents were actually called to school because he was showing some disturbing behavior. And in the very afternoon, after they refused to really engage with it, he shot people at school. And also, in the last couple of weeks, after your piece has aired, there’s been a number of stories of students, young women student athletes taking their own lives. And I’m just wondering, do you see this all as a piece? Because we tend to talk about this in different ways, and I’m wondering if you see this differently.

WARNER: It is all of a piece in that. You know, the common thread in the stories that you just talked about is lack of access to care, right? Kids not getting care. About half of kids with diagnosed mental disorders actually get specialized care. You know, actually, see somebody, like a child psychiatrist, a child psychologist, a child, you know, counselor who is specifically trained in addressing these sorts of issues. And there are lots of reasons for that, just coming back to the story that you told about the person in Northern Virginia. I mean, that was — it was actually a pediatrician who told me that story. The psychiatrist — and this is all too typical how fragmented care is, and how difficult the responsibilities are that then fall on parents. The psychiatrist didn’t give the family any referrals. The family then goes to the pediatric practice saying, can you help with the medication? The pediatricians, because the child is on this very complicated cocktail of meds, as so many are, especially those who are diagnosed with bipolar disorder, they didn’t do the diagnosis, they didn’t write prescriptions, and they didn’t feel comfortable renewing them. But they felt like the family needed help and the kids had to get care. So, they actually put their whole nursing staff on the job of finding a psychiatrist for this kid, and they called around for days and days and finally found one who didn’t have too much of a weight, meaning it was just a month as opposed to three months or six months. And as you say — and you know, you told how that story ended. And this doctor also told me the story because afterwards, she was so horrified that she really set out to do something about it. And she went around the state and then, around the country to hear what was going on. Also, in Northern Virginia, at around that time, there had been a kid was on a waiting list for one of the few hospitals that actually had a pediatric psych unit. There were 1,000 kids on that list. And, you know, while he was on it, he died by suicide. So, this is just — this is huge, huge problem.

MARTIN: Why do you think it is that, you know, on the one hand, yes, people have been talking a very great deal about the impact of COVID on children and adolescents, and also, frankly, on adults who are clearly have been in distress. But the broader picture of some of the mental health challenges doesn’t seem to — I don’t know if you share — my observation just doesn’t seem to have kind of risen to the level of a coherent national conversation. Why do you think that is? Is it just — it is stigma that people — when people — as families that they’re dealing with this, they don’t talk about it with other families? What’s your take on them?

WARNER: A large part of it is stigma. Although, the stigma side of it, I really do think has decreased in recent years. But with the examples you just gave of the athletes, they must have been suffering, versus the kids were “acting out,” you know, there’s a big race component to that. I mean, you know, very often, the cases of the kids who (INAUDIBLE) tragedy are white kids and the kids who were said to be acting out are black kids, you know, who are really viewed differently in school. I mean, I’m not telling you anything you don’t know or that hasn’t been reported already elsewhere, that you do have a school to prison pipeline, basically, of black boys, and increasingly, girls, who are viewed as behavior problems, you know, who’s difficulties are seen as a conduct disorder, who, in fact, are suffering from depression or undiagnosed learning issues, and who don’t get treatment as a result and who are just vilified over and over again. And that is a very long-standing problem, and it’s one that continues to this day.

MARTIN: How does the profession itself of, let’s say, psychiatry, address this? Is — Does this address this in any — does the profession address this in anyway?

WARNER: I think that there is increasingly plenty of goodwill, but there – – you are up against a structural situation where you have 4 percent of psychiatrists, all psychiatrist, not just child psychiatrists, who are black. And you have, of course, you know, a patient population which represents every group across the socioeconomic spectrum, but who in — you know, as part of which, you have kids who have been subjected to racism all their lives and who, in more recent years, have been living at a time when more and more groups are being singled out in very dangerous ways. So, the stress has risen. I mean, you know, experiencing racism is now widely recognized as a form of trauma in and of itself. So, you have a really big population of traumatized kids, kids living in poverty who are traumatized by so many aspects of their living situation. And this, of course, is a long, ongoing problem that has only really gotten a lot of attention in recent years. And that attention, I think, is slowly trickling out into the mainstream, sort of beyond professionals. But it’s still not something that kind of drips off the tongue. So, I think that we tend to be, we journalists and, you know, the social conversation of (INAUDIBLE) tend to be a lot more narrow in what and who we focused on than we readily admit or we even realize.

MARTIN: You cite in your piece that it takes, on average, eight to 10 years from the time a child first starts having symptoms to actually started to receive treatment. Recently, there is a very disturbing, you know, piece in “The New York Times” about kids sleeping in emergency rooms around the country because there are no beds, inappropriate psychiatric placements for them, literally sleeping in emergency rooms because people don’t know what else to do until a place opens up So, do you at least feel encouraged that perhjaps people were paying more attention?

WARNER: I feel encouraged by the fact that it used to be, of course, that who had kids with mental health issues were sort of those people over there. Nobody wanted to identify with that group. There was a large part of denial that was mixed in with all of that. I think that that’s really been softened over the course of the pandemic, because life’s been hard for ones for just about everyone. Of course, not to the same degree, but there is something of a shared awareness, even if it hasn’t necessarily led to more compassion, it has, at least, led to a greater and more universal investment in the subject. And, you know, I really, really hope that people will tune into the fact that there are good solutions available right now that aren’t expensive and could be put into place very quickly and easily. I hope that that won’t end up getting so widely politicized that it becomes impossible. And I’m talking about things like training teachers and other school personnel to be able to recognize when kids are showing signs of emotional distress that, you know, maybe rises to the level of being mental illness, something that could be diagnosed. Or training parents in the skills to be able to teach their kids tools for dealing with their emotions. Training teachers to do that. And training pediatricians to be able to serve basically as first responders when it comes to kids’ mental health issues. And that’s all that is underway, all of that already is like — is ready to go. It’s just has to be more broadly put into place.

MARTIN: Can you give us an example of a place where this is working, where these kinds of strategies are being employed?

WARNER: There are a number of organizations that are very successfully training pediatricians, for example, in being able to diagnose the most entry, the most complemental health issues. There’s an organization called Reach that does this around the country, there’s something called Project Echo that’s being widely in Virginia to train pediatricians. And, you know, in this way, thousands of pediatricians have been trained in doing kind of basic psychiatric work. And what that means is that child psychiatrist, of which there are so few, about 8,000 for the entire country, are freed up. And if this became more widespread, they would be greatly freed up to be able to just treat kids who had the more complex and difficult problems like bipolar disorder. And the model is more or less the same when it comes to teachers or parents. You know, for parents, in the “Washington Post” piece with that like little box that says where they can go to pick up some of these skills, and there are people who have developed programs for school personnel, for teachers, that really short lesson plans accompanied sometimes by videos. I’ve seen some of them. That are really, really good. They’re simple. They’re sort of at the — for the — they’re made for kind of 10-year-olds more or less, but in fact, they are good enough to reach older kids and even slightly younger ones. And, you know, in five minutes, those videos can drive a point home that teachers can then address in a 15-minute lesson and then reinforce. And that is starting off in a couple of D.C. schools in order to, you know, get experience and data. It’s there. It’s doable.

MARTIN: So, before we let you go, Judith, what — people listening to our conversation, what would you — what should they do? I mean, what about parents who just want to support — or not even parents, people who are looking at this and they’re saying, you know what, I’m recognizing that this is a crisis for our community, and I want to be helpful. What could they do?

WARNER: There are things we could do to address what’s going on right now, and there are things that we could do to prevent kids from being so traumatized that, you know, trauma is driving a lot of the most serious mental health problems. And a lot of that trauma comes about because of poverty, because of racism, because of sexual abuse, you know, all of these things that seem like maybe, that seem like, you know, such large systemic problems that we throw up our hands, but there is so much good science, both about the effects that these kinds of social traumas have, and also, what to do about them, what kinds of interventions have an effect and can make things better. And we really need a lot more air time going to both, you know, the causes of trauma, the effect of trauma, but also, what we can do. Because it’s really not terribly complicated. And just add on and say, trauma isn’t just something also that affects low-income people. This is happening across the board. When you think about sexual violence, or the effect of living in a home with a parent with mental illness or somebody who is struggling with an addiction that isn’t being treated. This is all of our problem, and maybe it’s the last remaining stigma that we don’t want to talk about that, but we have to talk about it if we are going to do something for these kids.

MARTIN: Judith Warner, thank you so much for talking with us.

WARNER: Well, thank you so much for giving me the opportunity to be here.