Referring kids for mental health care as pandemic persists

Persistent or moderate-to-severe distress requires consulting with a mental health provider about whether psychological or pharmacological intervention is warranted.

The COVID-19 pandemic created not only a physical health crisis, but a mental health crisis that will likely outlast the virus, according to Kristie V. Schultz, Ph.D., a pediatric psychologist with Norton Children’s Behavioral & Mental Health, affiliated with the UofL School of Medicine.

“While life-threatening physical health effects may impact some personally, the mental health consequences will impact everyone,” Dr. Schultz said.

With the pandemic, children are showing difficulties functioning in a number of areas, according to Dr. Schultz. These include difficulty with concentration, irritability, restlessness, nervousness and feelings of loneliness. Children also might experience sleeping disorders, fatigue or nightmares, as well as poor appetite.

Persistent or moderate-to-severe distress requires consulting with a mental health provider about whether psychological or pharmacological intervention is warranted. Oftentimes, a combination can be most beneficial, according to Dr. Schultz.

“It’s critical pediatricians refer for further mental health support, if necessary,” she said. “The impact on mental health can occur immediately, but also last over long periods of time. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatments adding to the cost burden of managing the illness.”

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Four-question screening tools for depression and anxiety

Even with pediatricians’ time-limited sessions, screening for mental health concerns can be immensely important, according to Dr. Schultz. The PHQ-2 and the GAD-2 are four questions to determine whether further exploration of symptoms is warranted. Monitoring symptoms of anxiety and depression especially during the pandemic is crucial.

Worries and anxiety related to COVID-19 might present as adjustment disorders, acute stress disorder or post-traumatic stress disorder. Depression likely will increase for children and teens as a result of the pandemic.

Younger children are at greater risk because high levels of stress and isolation can affect their brain development, sometimes with irreparable long-term consequences.

Children thrive when they’re safe and protected, when community and family connections are safe and stable, and when their basic needs are met, but the pandemic has disrupted some or all aspects of a child’s life.

What families can do

Dr. Schultz’s first recommendation is to create and enforce a schedule. This can include things like regular sleep and wake times, regular mealtimes and schooling hours. Youth also need time for social engagement and exercise or enjoyable activities. It’s also important to ask how children and adolescents are feeling, according to Dr. Schultz.

Parents also may want to limit exposure to media coverage about the pandemic. Dr. Schultz recommends that parents explain the pandemic to children in an age-appropriate manner and answer their questions in a way that is transparent and supportive.

“Fostering resilience and providing support is immensely important. It’s important for adults and families to model a positive psychological attitude. Children observe adults and families, and that is how they are learning to cope,” Dr. Schultz said.

It’s important to encourage physical distance rather than “social” distance, according to Dr. Schultz. Children should continue to have social interactions, either in a safe in-person way or virtually. Social isolation can be a precursor to a number of mental health conditions, including depression, anxiety and suicidal behavior.

The suicide rate, already the second leading cause death for ages 10 through 34, is likely to go up for months or even years to come as a result of the pandemic, according to Dr. Schultz. Experiences associated with higher depressive symptoms can include quarantining, witnessing traumatic events and fear of risk.

Asking families about safety at home

It’s also imperative to ask about safety at home, as well as any indications of self-harm or suicidality. If a patient reports thoughts of self-harm or suicide, but their safety can be maintained at home, a safety plan is immensely important, according to Dr. Schultz.

A safety plan would include identifying warning signs that the child needs help, coping skills that they could use, adults in which they could confide, and things that are important to them and worth living for.

If children report any indication of harming themselves with a specific plan, the family needs to limit access to those means. If safety cannot be maintained at home or suicidal ideation is persistent, the family needs to get the child to the nearest emergency department or call 911.

In addition, child abuse and neglect likely have increased during COVID-19, according to Dr. Schultz.

“Historically, we’ve seen an increase in child abuse and neglect in similar situations, such as the Great Recession in 2008,” Dr. Schultz said. “It’s important to report concerns of abuse or neglect to the child abuse hotline.”

In Kentucky, the number is (877) 597-2331 (877-KYSAFE1). In Indiana, call (800) 800-5556.

National Suicide Prevention Lifeline

(800) 273-8255

Crisis Text Line

Text HOME to 741741

Seven Counties Services

24/7 Child Crisis Line

(502) 589-8070

LGBT Youth

(866) 4-U-TREVOR (488-7386)

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