North Carolina’s Youth Mental Health Crisis: “We need to take action”

The pandemic has damaged our mental health. The CDC reports a significant increase in the number of people reporting symptoms of anxiety and depression nationwide, but the effects of COVID-19 on mental health are perhaps most profound in young people.

North Carolina psychiatrists agree that the youth mental health crisis is the latest wave of the pandemic.

Late last year – and nearly two years after the pandemic began – US surgeon general Dr. Vivek H. Murthy said the country was having a juvenile mental health crisis. Dr. Gary Maslow, a Duke University child psychiatrist, agreed, but a few months later it hit him.

“In March, I was shooting in the hospital – I’ve been at Duke for a decade – and I’ve never experienced the number of children or young adults that came with serious suicide attempts,” Maslow said. “What we could see in three months or a year we have seen in a week”.

Dr. Gary Maslow, Duke University child psychiatrist

The most recent numbers from the CDC show the first effects of the pandemic on young Americans. In 2020, the overall suicide rate declined, but it increased among people aged 10 to 34.

And for every teenager who committed suicide that year, more than 200 others attempted to do so.

Meanwhile, the share of high school students who reported persistent feelings of sadness or hopelessness was already increasing significantly in early 2020.

Maslow and other doctors agree that COVID-19 outages have exacerbated this trend. This was especially true of the most vulnerable children.

“Children who have developmental conditions like autism or an intellectual disability, when they were in school, had a whole matrix of support. And the loss of that was profound,” Maslow said.

So, the parents or guardians of the young people started dying from COVID-19. A report released by the COVID Collaborative states that more than 3,600 children in North Carolina had lost caregivers to the pandemic by the end of last year.

“Then they have depression or anxiety and some of the natural supports that they might mitigate that they are missing,” Maslow said.

‘Lost all patience’

Dr. Samantha Meltzer-Brody walks and speaks urgently. As chair of the UNC-Chapel Hill Department of Psychiatry, she works in the center of the campus, surrounded by UNC’s extensive system of hospitals and clinics.

“I lost all patience to talk about it,” Meltzer-Brody said shortly after sitting in her office. “There is a crisis and we must take action”.

Over the past two and a half years, new variants of COVID-19 have periodically overwhelmed hospitals with sick patients. Now, says Meltzer-Brody, it’s the mental health care system that’s being overwhelmed.

“You try to find a mental health doctor, but you can’t find him, because they are all booked. Our emergency wards are now full of patients with mental health problems, who have not been able to receive treatment, and they” in the emergency room in a sort of crisis, “he explains.

Dr. Samantha Melter-Brody

Dr. Samantha Meltzer-Brody, chair of the UNC-Chapel Hill Department of Psychiatry

“And there aren’t enough places to take care of them, including those who need hospital beds.”

Then there is the discrepancy between how much is spent on mental versus physical health care. In general, insurance companies don’t cover behavioral health as solidly as primary care.

“The decisions that are made in terms of what is appreciated and what is not, what is reimbursed and what is not, and what we will fund and what is not fundamentally have to do with stigma,” said Meltzer-Brody. . “Do we see it as a real disease? Or do we see it as a character defect?”

Treat the young

Nonprofit group Mental Health America ranks North Carolina 21st in the country for adult mental health care, but 42nd in the country for youth mental health care. The group’s rankings rely heavily on access to care, which includes the availability of beds or programs for young people.

“It’s really hard to analyze children’s health outside of the context of their family’s health,” said Kody Kinsley, secretary of the North Carolina Department of Health and Human Services.

Studies from the CDC show that children often suffer both mentally and physically if their parents do too, especially if they don’t have health insurance.

Kinsley’s position is appointed by Governor Roy Cooper, whose administrations pushed North Carolina to expand Medicaid under the Affordable Care Act, a move that would cover about half a million North Carolina who don’t have insurance.

“And nominally, most of those expansion beneficiaries would be adults,” Kinsley said. “However, we know that in the way that cost-shifting works in the healthcare system and how the money flows to the different hospitals and providers, it will go beyond just the beneficiaries themselves.”

Republican leaders in the North Carolina legislature were historically opposed to the expansion of Medicaid until this year. Senate President Phil Berger told WUNC in September that he supports it, but remains concerned about its launch.

“We need to find a way to increase the health system’s ability to treat people if we expect 500,000 to 600,000 people with an insurance card to be in the system,” Berger said.

There are state laws that control where, when and how many beds healthcare professionals can add to their systems. It would be up to the legislator to relax these rules.

‘What do you need?’

“The thing that keeps me awake at night is that we can identify that someone needs something, and therefore we can’t give them what they need,” said Dr. Gary Maslow, Duke’s child psychiatrist.

Maslow says the expansion of Medicaid and the addition of psychiatric beds would be only part of an effective overhaul; that there must be more ways to intervene before a child attempts suicide and gets to the emergency room.

“If I have a child in the clinic, I diagnosed this child with depression and they don’t commit suicide today, what they could really benefit from is like a two or three week treatment program,” Maslow explained. “This doesn’t exist. We just don’t have it.”

Maslow is also in a constant fight against the stigma of mental illness, both as a doctor and as a parent.

“Our job is to be there for them, try to communicate that we care for them, communicate hope and communicate safety,” he said. “… That idea of ​​arriving in a quiet space and saying, ‘What do you need?’

If you, your child, or someone you know is going through a mental health crisis, call 988 for the National Suicide and Crisis Lifeline.

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