Abstract
Our nation is facing a public health crisis that affects the mental health of every one of us, but particularly our children. This unprecedented crisis calls for a response that highlights their unique vulnerabilities to traumatic stress and the behavioral and emotional impacts of isolation and disruption. Unfortunately, children and teens with a mental health disorder are even more at risk.
I call on my colleagues to champion the following message about our youth in this time: Child and adolescent mental health impacts will be a long-lasting outcome of COVID-19. Our nation's young population can be placed into four categories when thinking about mental health and wellness: mentally healthy, subclinical, clinical, and severely mentally ill (SMI). Using these risk categories can help us to assess who will need the most help during COVID-19. Here are the four mental health categories, in ascending order of risk:
Mentally healthy: Most young people (>50%) are in good mental health. For these young people, the crisis causes stress, worry, and numerous challenges related to the particular life circumstances of the family. If a child's family is financially fragile before this event, if parents are separated, if school is overburdened, then this crisis can be more demoralizing and anxiety provoking. It can affect a child's sleep, mood, appetite, and attention span. But most young people will weather this crisis without lasting effects.
Subclinical: The second category is smaller and consists of youth who have subclinical mental health disorder symptoms. They worry more than average. They are more inattentive or more somber than the average child. However, these symptoms do not normally cause distress or dysfunction. For these children, the crisis may increase symptom severity so that they cross the clinical threshold.
Diagnosable mental health disorders: The third category is the 20% of youth who have a psychiatric disorder—approximately 17 million children and adolescents in the United States. Although they meet the criteria for impairing diagnoses such as anxiety, depression, and attention deficit/hyperactivity disorder, two thirds of them are unidentified and untreated. That makes this group the most vulnerable group. The COVID-19 crisis has forced a rapid transition to closed schools, unstructured days, financial insecurity, and the overwhelming specter of the health risk to their parents and loved ones, and these young people will need support and care in the months and perhaps years to come.
Severely mentally ill: These are youth with SMI such as schizophrenia and other psychotic disorders. This group suffers because of the closure of treatment programs such as day hospitals and the disruption of the supply chain for needed medications.
On a good day, the mental health system is not adequate to meet the needs of our children. During a crisis such as COVID-19, it becomes truly stretched and overburdened. Across this nation (and indeed across the world), an immediate transformation is needed. When resources are limited, emergency rooms are high risk, and families are urged to shelter in place, our families must play a vital part in evaluating the mental health needs of youth. Indeed, they must be a part of providing prevention. And to do that, we must commit to improving the kinds of resources that are sorely lacking in this crisis:
Every parent needs new tools and information to parent during the time of the coronavirus, including skills to manage their children's anxiety (as well as their own).
Parents of at-risk youth should be more aware of signs and symptoms and have access to resources helping them to identify emergent mental health disorders.
Parents with children with mental health disorders need special tools and telemedicine options to get them the evidence-based treatment they need.
Teens with very severe psychiatric disorders need their parents to provide the extra structure they are missing from day programs.
This crisis is truly unprecedented. In the last few weeks, the Child Mind Institute has transformed from a bustling nonprofit with multiple physical locations and clinical and research centers into an all-online, borderless organization. Much the same has happened for families and doctors across the country and the world. A few weeks ago, we were deeply skeptical of screen time; now, we remain skeptical but are also deeply grateful for the connection that our technology allows us to maintain.
My point here is that the underlying issues—that many of our young people are at risk for mental health disorders, and that crises elevate this risk—are not new. But the ways in which we come together to address this risk and keep our children healthy in the era of coronavirus must be innovative and iterative and must put children and teens first.