How can we help improve children's mental health? Ask the kids

Welcome back to Path to Recovery, a newsletter that will bring you weekly conversations on how the health care profession will recover from one of the most significant crises of our time. Click "subscribe" above or follow along using #PathtoRecovery .

Here’s what we’re talking about this week.

The children’s mental health crisis didn’t start with COVID-19. But the pandemic served as an accelerant, exacerbating and exposing deep fissures in the pediatric mental health system.?

Not only did the early months of the pandemic create mass disruptions, but the extended social isolation took its toll on young people. Researchers found that rates of mental health conditions like anxiety and depression actually increased as the pandemic dragged on, according to a meta-analysis published last year in the journal JAMA Pediatrics. Older adolescents and girls were most likely to report mental health issues.?

Adding to the trouble has been a severe shortage of pediatric mental health providers, particularly those who take insurance. Only half of parents who sought mental health services for their children during the pandemic were able to access them, according to a survey last year from DotCom Therapy, which provides virtual behavioral health care to children. Employers, meanwhile, are trying to meet the demand, and have been rapidly expanding mental health benefits for dependents.?

As part of our coverage for Mental Health Awareness Month, I sat down with Dr. Rhonda Medows , who herself has been sitting down with children for her #KidsTalkCovid series. Medows is president of population health for hospital network Providence Health & Services, and has made children’s mental health a core focus.

Here we discuss what the pandemic has shown us about pediatric mental health care, what parents can do and how children have been showing their own ingenuity in taking care of each other.

(The following transcript has been edited for length and clarity.)?

LinkedIn News: Why are we seeing this mental health crisis in children?

Medows: We've always had difficulties with actually having the resources for children in general. This predates covid; it predates all the changes that we've gone through over the last two years now. We didn't have anywhere nearly enough [mental health services for children] or nearly enough that were convenient and easily accessed.

With covid, our children, just like adults, were faced with new fears. They went through the same things and probably a little bit more: they had their families disrupted; their school disrupted; their parents were suddenly home or they were working in these really odd jobs in the service industry. People were talking about scary things like getting sick from a virus.

And add to that all the things going on in the news around them. They were not immune, and they were perfectly aware of any social unrest. They were aware of protests and riots; they were aware of their parents’ responses to those stresses.

And then some of them were caught in the middle of some of our debates: should they go back to school, should they wear a mask? And then, just when they’d think that they could go to a party or a soccer game, or whatever, that was being pulled back and forth.

LinkedIn News: In some way, the pandemic lockdowns were a mass social experiment. Have we learned anything over the past two years?

Meadows: There are some things that we learned the hard way, and there are some things that we have apparently not learned well enough.

If nothing else, the pandemic was a trifecta of all the bad things that could happen, the perfect storm. The covid pandemic interfered with our health and our ability to get health care. There were also the economic challenges that occurred, and then lastly the social unrest. We had all three things happen at the same time, and I think what it did was it stressed every aspect of our health and home life.

It proved that we have nowhere near enough resources for mental health. We pretty much pressure tested the mental health system that we already knew was inadequate and had deficiencies.?

As health care professionals, we've learned to try to put in things like virtual digital health, but then there were other communities that took it upon themselves to create communities online. Some of the kids that I was interviewing for my Kids Talk series said they went into chat rooms, and it may have been gaming chat rooms, but there were kids helping other kids and they were just talking about their worries or concerns.?

I think we did learn that you don't have to have an MD degree or nursing degree to be able to help somebody through a difficult time, particularly when they're just starting to have anxiety and depression, and sometimes they just need that human contact.

LinkedIn News: How should we be addressing the children’s mental health crisis on a policy level?

Medows: On the policy side, I am still hearing things that are in pieces; I don't hear things that are connected. They're not looped.

I know that the Health and Human Service Secretary is going to be announcing in July that there will be a new 988 hotline if you're having a mental health crisis. But you can't just have the hotline; you also have to have the services to back it up, because once they get through with the phone call, there has to be follow-up.?

We have the emergency phone number, the digital tools, the group therapies and the individual therapies, but there's still this thing that we’re missing for maintenance and for more intensive care.?

We need the actual providers and access, and then for the health plans to actually help people reach them, they need to be in-network. Both sides need to invest in the pipeline, so we have sufficient mid-level and higher-level mental health professionals.

LinkedIn News: It’s been well-documented that psychiatrists accept insurance less frequently than other specialties, usually blaming low reimbursement rates, and the situation hasn’t gotten better .?

Meadows: Right, the demand exceeds supply. (It’s challenging) trying to convince them to change after they feel like they've been disenfranchised for decades, and I have never understood, as long as I've been doing medicine and health care, how people can possibly think that we can separate the head from the body.

If I had my wish as a policymaker with an ability to use my magic pen to fund things, I would fund that pipeline. I would actually make the requirement that the payers and providers have to sit down together and jointly do that work together, and I would expand permanently the digital health virtual world. And then I would invest in training the people who are hosting those services, laypeople, mid-levels, etc.

You know how we have social influencers? Why not find those people, train them appropriately, and give them the tools they need? Why not leverage a whole new way of communicating that we learned during the pandemic? I know it sounds a little bit radical, but they have huge followings.

LinkedIn News: What does this mean for parents?

Medows: We're going to need to recognize our own humanity as well as our own limitations, because our children mirror us. Number one, when we can deal with our own stresses (in a healthy way), we are exhibiting behaviors that they then copy; they're like little sponges. Number two is teaching them coping skills, teaching them how to do self care, inviting them to talk. And the older they get, the more they may respond with grunting, but you have to still try, no matter where they are.

When I’ve talked to children, I’ll ask them, Who helps you feel better? … And then I’ll ask them, Who do you help feel better? And, you know, that's when they light up. I don't know about you, but when I'm feeling down, nothing will distract me better than trying to help somebody else.

LinkedIn News: Is there anything else we didn’t cover?

Medows: I think one of the most important things is that in 2020, it wasn't just that a certain segment was impacted; it was many people of all ages. Some communities were impacted worse than others, but it was also very pervasive. The pandemic highlighted all the places where we did not have strength and where we need to build strength. And it also highlighted some of the places where the kids have led us in solutions.