Addressing the Mental Health Crisis Among Kids and Teens

Welcome, everyone. I'm Doctor John Whyte, Chief Medical Officer at WebMD. And you're watching Coronavirus in Context. The United States surgeon general says we have a mental health crisis of kids and teens. Helping me unpack the scope of this crisis, as well as what we need to do, is Dr. Adelaide Robb. Dr. Robb is distinguished, endowed professor and chair of psychiatry and Behavioral Sciences at Children's National Hospital. Dr. Robb, thanks for joining me.

Dr. Whyte, thanks for having me on the program. I think over the last almost two years now we've been helping the children and teenagers in our area, and actually across the country, cope with the many struggles they've had due to the isolation, missed friendships and difficulty with loss of family and friends that we've all been struggling with.

I want to put it in perspective for folks with a couple of facts. According to the Substance Abuse and Mental Health Administration, major depression in adolescents 12 through 17 went from 8% to 15.7%. Percentage of high school students who contemplated suicide, increased from 13.8% to 18.8%. I mean, I could go on and on. The number of kids who have lost their caregiver in terms of a parent or grandparent. What do we need to do, Doctor Robb, to fix this and provide support? This is not a six month endeavor, right? This is a multi-year, multi strategy platform.

I think you're exactly right. I think what we need to do first, is deal with the acute trauma and crisis as it presents to us. Whether you're a primary care doctor or a parent, a child psychiatrist. As people walk in the office where they have a conversation with you, ask how they're coping. Ask what helps them feel centered and cared for. And try and make some changes. The schools have done amazing jobs getting kids back in the classroom, that structure, that routine, that normal day to day activity is very helpful in bringing kids back into their safe place. But we still have to make up for everything they've lost and the struggles they've had.

I'm gonna ask you a tough question, but if you don't mind, was it wrong to close the schools last year?

I do not think it was wrong to close the schools. But I think that many school systems struggled with online schooling. And because an important part of children and teens mental health is the interactions with their peers in the routine, being disembodied on a television screen is not the best way to have friendships. And it's not the best way to have an education. But it's what we had to do at the time. We need to move past that and get back to our normal activities so that we can bring back in that structure and support that school and friendships provide.

Even now while we're in a surge, should the priority be to keep the schools open as best as we can?

I'm afraid I'm a child psychiatrist and not an infectious disease doctor. And I think you go for the test and stay. So you get tested once or twice a week, as people are sick they move out. But for the people that have already had an episode over winter break, and people who are boosted and vaccinated, they still need that structure. And we need to keep them with their friends.

I want to ask you what you're seeing in your practice, and to help guide parents and caregivers what to look out for. And I want to start it off with, is it different when we're talking about kids in elementary school versus say kids in high school. How they manifest mental health issues. Does it present differently?

I think in elementary school, parents are an incredibly important part of the support system. So helping parents feel in control, and that their lives are organized and that they feel safe and able to provide for things, gives that framework, if you will, for the kid to feel safe. So if mom and dad are in control or grandmother or whoever, that helps provide that safety and security.

But what you're looking for in a younger child is changes in sleep pattern, changes in appetite, crying, irritability, tantruming, things that they've grown out of that are reappearing. And then you might reach out to your primary care provider or a mental health care practitioner if you're already in treatment. And say, I'm concerned because my child is not eating anymore. Or they're not sleeping through the night or they're waking up screaming. We need help. And then you can come in and get an assessment, get some next steps.

Teenagers who always reach out to their friends can't always do that if we're virtual and they're not able to interact with people. We need to check in with our teens and say, you haven't been to school in 12 months, how are things going? Or are you able to keep up with your friends? You might look to see is homework going undone or grades dropping? Are they hiding in their room all day long and not coming out to do things?

I'm fine. I'm fine. Everything's fine Dr. Robb. Right that's we're going to hear.

You've been a parent of a teenager. I have, as well.

What's the next thing you say? I'm fine. Don't bother me. I'm fine.

I think you say, when you're a teenager tells you they're fine, say, well you know what? It's been really hard for me feeling stuck at home and not being able to see my friends at work. And I know, I've been worried about everybody else in the family. Is there anything that you're worried about or any of your friends that you're concerned about? I'm glad you're doing well.

And sometimes, taking a step to the side and asking them to talk about a friend who may be struggling, then allows them to express some of the worries about themselves by talking about their friend. And then you can look back and say, well, it sounds like your friend, you know, Jaquan is having a tough time. Have you ever felt the way he did? Or have you been able to help him with his struggles? And you might get an answer back that is then, oh yeah, well, you know I'm not sleeping well. And I'm waking up with bad dreams.

And you have to keep at it, don't you. You can't be like, oh, I asked on Thursday and they said they were fine. So it's done. You keep at it with these open ended questions, as well some targeted questions. But Dr. Robb, what about the fact that a lot of parents are suffering from mental health right now. So how do they address the issues in their kids when they're having challenges addressing it for themselves?

I think many parents are struggling, because they're worried about the economics, their job, everybody's safety and health. And I think for parents, they have the experience of having had other struggles in their lives and come back from it. So they have lived experience that lets them know that eventually things will get better. I think that using community and extended family is often very helpful. Parents may be involved in religious organizations or groups or even a book club.

Whatever it is where they can reach out and get some support. And again, interacting with people. I think what we loved about the summer was everybody could go outside and do activities and eat and interact. And then it came back again. And I think that's one of the hardest things for everybody is we thought we had turned the corner and we were just in the eye of the hurricane, as it was.

Sometimes hope plays a role, in the fact that there is a lot of parents, a fair percentage, that don't seek help for their children. Because oh, it's going to get better. Oh, it's natural. Oh I don't want the stigma of my child going to see a psychiatrist or mental health professional. That's still exists, doesn't it? How do we get beyond that?

I think one of the ways we get beyond that is by partnering with the primary care doctor. So we work here in DC--

Pediatrician or a family physician, right, or a [INAUDIBLE].

We work here in DC and in Virginia with mental health access programs. And so pediatricians actually screen for anxiety and depression by asking questions on the PHQ 9 or the scared, which is an anxiety screener, as part of a regular checkup. And if it is elevated, then they can open the conversation, oh it looks like you're having issues with depression. Or it looks like you're having a lot of anxiety.

Would you like to talk about it? If they do some counseling and things are better, that's fine. If they need to start medication or move further, they actually reach out to the doctors at Children's, because we're part of the program. And we can do a live consultation with the pediatrician about next steps in terms of treatment, as well as offering referrals in the community where the family lives to get counseling or to get medication management. So we partner with the pediatricians, because I think sometimes asking the question of the doctor that's been giving you your booster shots and your checkups since you were six months old is easier than coming to see mental health care practitioner. It's more palatable, it feels familiar and it feels safe.

A lot of parents don't take their kids except once a year for the annual checkup. And you can't necessarily wait a long time when people are starting to have challenges. You mentioned the PHQ 9, that's a survey instrument we also use for adults. I'm an internist. You mentioned scare. We can put those resources available. Is there any role for parents to use those questions to talk to their kids rather than wait for it to be done by a physician or health professional?

I think you can certainly do that as a parent, especially if you are worried or concerned. They're all available on Google. And they are free screening instruments, just the way you might screen if you were at risk for lung cancer or something. This is an important health care issue. And I think the earlier somebody can get evaluated and treated, the less likely it's going to impact the child longer term. So if counseling can help turn the corner on the anxiety you have around the pandemic, then you don't have six months or 12 months of untreated anxiety, which starts to impact friendships and school performance.

Do we have enough resources, enough health care professionals that specialize in adolescent mental health issues in kids? It's a challenge on the adult side. Or are you seeing challenges in parents when they want to get help for their children? It's hard. It's frustrating.

We're seeing a lot of challenges around that. I think one of the boos of the pandemic has been the ability to use telemedicine. So that when people couldn't leave the house, or they live farther away, let's say you live all the way in Southern Maryland or rural Virginia and you can't make a 2 and 1/2 hour drive to the nearest children's satellite.

Because we're licensed in all those jurisdictions, I can just have a Zoom video evaluation or a Zoom follow up and we can help you in your home and move mental health care out to families. I think that's been great. The laws are going back to it being more difficult to do that with the end of the pandemic. And I think we need to rethink that as a country, because we're not in all parts of Virginia. There are not psychiatrists in all parts of Illinois or Indiana or Utah or Montana. It's hard to get to certain places. But if we can be made available using technology, then I think that's part of what we need to do.

How long do you think we're going to see the mental health consequences in kids as a result of the social isolation that kids have been experiencing? The stress, the anxiety, the PTSD for some folks.

One of the difficulties here, is it's not a natural disaster like a hurricane, even Hurricane Katrina--

This was just a couple of days. These are just, this is for two years. This hasn't stopped.

For two years. And so it's like a chronic trauma. And I think it's going to take longer for people to get past that. And I think we may continue to see things showing up over the next several years as we move forward.

So your message to parents who are concerned about mental health issues anxiety, depression, chronic stress in their kids. What should they do today after watching this video?

You know your child better than almost anyone else. If you, as a parent are concerned, don't be afraid to ask those hard questions. And if you have answers that make you more worried about your child, please ask for help. If the first place you ask can't help you, escalate to the local Medical Center. Reach out to any of your chapters of Pediatrics.

Every major city has pediatricians. They are being trained to help. And there are child psychiatrists out there. And even adult psychiatrists, psychologists, social workers. There are a number of people who can help. It's not wrong to ask for help. And you can change your child's life. And I want you to remember that. And don't give up. Your child is worth asking for help.

Doctor Robb, I want to thank you for those words, that advice, for all that you're doing to help kids, not just in the DC, Maryland, Virginia area, but all across the country. If you have questions for Doctor Robb or myself, shoot me an email. You can send it to [email protected]. Thanks for watching.