The COVID-19 pandemic unleashed, but didn’t spark a relative tidal wave of demand for counseling services for children and teens.
“It had been brewing long before the pandemic,” said Catherine Mok, M.A., L.M.S.W., a clinical social worker for Austin Family Counseling, during the “Mental health for kids is falling short. What can fix it?” panel at Health Journalism 2022.
“What I’m seeing on the ground is anxiety, depression [and] suicidal ideation. Our practice has [never] seen so many parents calling in and looking for help for their children,” Mok said.
That’s because the field of pediatric and adolescent counseling, like that of adult counseling, has endured a years-long shortage of clinicians. Depending on the state, there is an average of four to 65 pediatric and family psychiatrists per 100,000 youth.
The national average is 14 psychiatrists per 100,000 young people, according to the American Association of Child & Adolescent Psychiatry’s (AACAP) most recent workforce map. The association has estimated there should be 47 psychiatrists per 100,000 youth. Also, roughly half of children and teens with diagnosable mental health disorders are getting necessary treatment, according to the AACAP.
“This is a national calling,” Mok said of the urgency to reverse a crisis that finds 70% of U.S. counties without psychiatrists who specialize in treating teens and children, according to the AACAP. The ranks of pediatric clinical social workers and psychologists are also lacking.
The pandemic worsened mental health conditions for many children, panelists explained. “We literally have had a child say, ‘I killed my mommy,’” said panelist Julie Kaplow, Ph.D., A.B.P.P, executive vice president for trauma and grief programs and policy at Meadows Mental Health Policy Institute.
Accompanying the pandemic, is “a silent epidemic of childhood trauma and grief. Not being able to say ‘goodbye.’ There is a lot of shame and guilt associated with that,” Kaplow said. “Childhood grief is not just a mini-me version of adult grief. Kids can be high or low in different dimensions of grief.”
While trauma, as one disorder, looks different in children and teens, the mental conditions of people in those age groups have long been poorly gauged and, at times, dismissed as not quite legitimate, researchers and clinicians have argued. To help hedge against that tendency, the National Institute of Mental Health offers parents, educators and others its “Children and Mental Health: Is This Just a Stage?” guidance.
Working with families to tackle mental health concerns
Leading up to and compounding traumas associated with the pandemic are related to income, region, race and other social determinants of health, Mok said.
“It occurs in context of a family unit and the stressors within it,” said Roshni Koli, M.D., a psychiatrist and medical director of pediatric mental health at the University of Texas’ Dell Children’s Medical Center and Dell Medical School.
“It’s important to recognize that their mental health and mental illness doesn’t occur in a silo.”
When entire families are involved in mental health treatment for youth, “that’s when we see the best results,” Mok said.
During the tumult of recent years, young people, Mok said, have been “grieving the loss of safety and connection; the loss of just being a child; the freedom of walking into school without worry abought their safety; and from bringing home COVID. I’ve had kids ask me, ‘Am I going to die? Am I going to kill my family?’ These are things we may not see from the outside. Parents, when they call for help [it’s often because] they don’t know what to do.”
The pandemic spotlighted the glaring insufficiencies of the nation’s infrastructure of child and adolescent clinicians.
Building and better training a mental health workforce is key to addressing the mental health needs of the nation’s young people, panelists concluded.