Student Well-Being

Children’s Mental Health Emergencies Skyrocketed After COVID-19 Hit. What Schools Can Do

By Sarah D. Sparks — November 12, 2020 5 min read
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New federal data confirms what teachers and parents have been worrying about for months: The pandemic is taking a striking toll on children’s mental health.

New data from the Centers for Disease Control show the proportion of emergency department visits related to mental health crises has increased dramatically for young children and adolescents since the pandemic started.

From this March through October, the share of mental health-related hospital emergency department visits rose 24 percent for children ages 5 to 11 and 31 percent among adolescents ages 12 to 17, when compared to the same period in 2019, the CDC reported based on a federal health surveillance program. While the CDC does not record whether a patient reported a mental health emergency as a result of a disaster, all of the mental health emergencies included stress, anxiety, acute posttraumatic stress disorder, or panic. As the chart below shows, the share of mental health visits for every 100,000 pediatric hospital emergency visits each week rose steadily beginning about three months into the pandemic:

While the rising proportion of mental health visits may stem in part because parents tended to avoid taking their children to hospitals more generally during the pandemic, CDC analysts noted they think the findings “likely underestimate the total number of mental health-related health-care visits,” because they did not include urgent mental health visits in schools or non-emergency department settings. Federal researchers also noted that girls were significantly more likely to have mental health emergencies than boys, though the number of mental health emergency visits increased for both boys and girls.

The combination of disrupted routines, fear of sickness or family loss, and economic and housing mobility all have proven to be significant stressors for adults as well as children. But developmentally, the social isolation caused by repeated and sudden quarantines and widespread social inequities may prove the heaviest burdens for young and older adolescents, who are going through a period of growth in social learning now thought to be as intense as the cognitive growth seen in toddlers.

“We don’t know exactly what this pandemic is going to do to kids because it’s unprecedented,” said Deanna Barch, a professor and chair of the department of psychological and brain sciences at Washington University. “But I think the things that are emerging are mostly around social isolation, and that contributing to kids feeling depression and anxiety. ... People are social in general, but kids are particularly susceptible, because this is an important time for developing peer relationships. Kids who have not been able to return to school or been able to socialize, a lot of them are feeling pretty isolated and very sad and upset about that.”

While prior studies have found mixed benefits from social media on students’ mental health, it’s not yet clear whether building students’ online support systems can effectively buffer their social isolation during quarantine.

Signs of ‘Hopelessness’

Even before the pandemic, educators reported rising concern about students’ mental health. At schools that provided mental health services in 2019, school leaders reported more than half of their students required them. Suicide among young people reached a 30-year high as of 2017, with rates for young adolescents ages 10-14 more than tripling since 2007, to 2.5 deaths per 100,000.

It’s not clear yet what portion of the emergencies this spring and fall came from panic attacks, attempted suicides, or other mental health emergencies, but Barch, who is part of an ongoing federal study of adolescent development, said adults often underestimate the severity of children’s mental health problems. Children as young as 9 report thinking of killing themselves, she found, and 1 in 10 said they purposely cut, pinched, or burned themselves even when they weren’t suicidal. Overwhelmingly, the parents and teachers around them didn’t know about their suicidal ideas or self-harm.

“It’s obviously normal for kids to be upset ... but I think this is such an unusual situation that we don’t have any really clear way to distinguish between what is a ‘normal reaction’ to this situation,” Barch said. “In the range of upsetedness, this is just such a weird situation that, you know, you could argue every kid and every adult needs some help right now.”

“Kids may not necessarily spontaneously self-report that they’re feeling an increase in depression or anxiety,” she said. “It certainly can sound similar to what adults articulate—I wish I’d never been born, people are better off without them, feelings of hopelessness, like there’s nothing to look forward to—but parents and teachers are also going to need to look out for behavior changes, like becoming quiet or withdrawn ... that may show a trigger.”

Distanced Supports

Nisha Sachdev, an adjunct professor in public health at the George Washington University and senior associate at the Center for Health and Health Care in Schools, advised schools to think about how their approaches to mental health supports will work in the current remote learning and socially distanced in-person classes.

For example, trauma-informed instruction strategies, such as setting up clear structure and routines, helping students develop emotional resilience, and conducting emotional check-ins, can be more difficult to do when classes by necessity change from in-person to virtual and back again with swells in the rates of coronavirus infections. But Sachdev and center director Olga Price advised schools to focus on maintaining and strengthening connections among students and their peers and supportive adults, from telehealth counseling services to phone-buddy networks among students.

For more on how districts can recognize and respond to stress, trauma, and mental health problems in students in the wake of COVID-19, please see our special report and downloadable guide for teachers during remote learning.

Chart Source: National Syndromic Surveillence Program, CDC

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A version of this news article first appeared in the Inside School Research blog.

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