The COVID-19 pandemic has spurred tremendous momentum for the development and implementation of novel strategies for behavioral health care. This panel will discuss the innovations made amid COVID-19 that specifically address the nation’s lingering challenges with timely, equitable treatment for behavioral health conditions and the need for more integrated, whole person care.
What issues has it exacerbated? Are there any new challenges that have been created?
What are the potential short- and long-term effects of the pandemic on their overall mental health and wellbeing?
Early on, children and families struggled with the acute emotional stresses of the pandemic. While children may not have understood all of the public health complexities of the pandemic, they picked up on family and community concerns for their health. They missed being at school. They saw their parents struggling with work or finances. Too many children and families grieved the loss of a loved one or the trauma of seeing someone become gravely ill. These stresses will have ongoing impacts (e.g. post-traumatic sequelae, mood and/or anxiety problems, disruptive behaviors) for many children and families, although, thankfully, many will also find ways to heal and recover.
But as the pandemic has gone on, we have also witnessed a broad spectrum of chronic challenges develop and/or worsen. Families with children already struggling with mood, anxiety, or behavioral challenges or with developmental and/or intellectual disabilities lost access to critical educational and emotional support services. Many children struggled or failed to progress academically. Many parents found their own mental health worsening while balancing increasing demands on their time and energy. Abuse and neglect issues may have gone unnoticed without direct contact with caring school staff. And fueling all of these underlying challenges are so many critical social determinants of health, from financial challenges to parental job loss to housing and food insecurity to loss of child care or health insurance.
And now, as children and families are slowly emerging into the new reality of what the world may look like after the worst of the pandemic, it may feel like a shared graduated exposure exercise for many. Many will embrace and thrive with new freedoms. Others may struggle to reintegrate into pre-existing social patterns and systems. We will need to increase broad-spectrum emotional support across child- and family-serving systems, while also increasing access to quality MH treatment.
ER visits for mental health issues have increased 20% in the past year in our local Children's Hospital...and we are expecting these numbers to rise without significant prevention and intervention efforts. For example, many children have likely been struggling under the radar as they have predominantly been at home. Many children who have experienced and been exposed to the increased interpersonal violence at home noted during the pandemic - we will see the impact of this soon. We also expect that with children back in school and activities, they will cycle through systems that typically identify and refer to behavioral health services and demand on already overloaded behavioral health resources. As a community we are preparing for a "mental health tsunami" in the fall when children return to school. They will face social pressures after a year+ of virtual learning and navigate a new paradigm of learning. We need a swift ramp-up of resources, community and clinical collaboration networks, and prevention/at-risk intervention efforts. COVID has been a disruptor but we can make it a catalyst for change to support the well-being and health of children.
In June of 2020, a national survey re the well-being of parents and children during COVID (pre and post March 2020), and results were published in PEDIATRICS. 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children. Families reported an increase in severe food insecurity, and a decrease in employer-sponsored insurance coverage for their children. Significant even early in the pandemic
Pending
The COVID pandemic has increased depression and anxiety in the general population. Many people have used alcohol or drugs to cope, and unfortunately we are seeing increased alcohol abuse and increased overdoses.
Some people have described the pandemic as a "shared trauma", and health care workers have felt particularly traumatized by the prolonged state of crisis.
Interestingly, people with social anxiety disorder may be doing BETTER doing the pandemic because they do not have to socialize and therefore can avoid their symptoms. I have also heard from patients with panic disorder and agorophobia that they feel better because they feel "normal" by staying at home all the time.
Pending
Covid-19 has affected every aspect of our lives and caused fear, anxiety, and complicated grief. Covid-19 disrupted an already ailing mental health system. The impact of isolation due to quarantine and social distancing, economic downturn, racial tension among others has led to influx of mental health needs. Research has shown that patients who had mental health problems who were already established in care do better than the general population during the early stages of epidemics and natural disasters. There is a honeymoon stage and heroism in the early stages. However, more than a year into the pandemic, we are noticing higher acuity of symptoms, increased substance use, health anxiety and trauma among patients presenting in both primary care and behavioral health clinics. In addition, patients who previously did not have mental health problems are now presenting with neurological, cognitive, emotional, and behavioral effects of COVID 19 infection which has added a new layer to the demand of mental health access. While this presents a bleak picture, it hopefully inspires everyone to look at innovative ways on how we can better deliver mental health. We can all weather this crisis together as a community!
Pending
So true! For behavioral health, we are seeing third waves and likely fourth waves of mental health issues. It is not a sprint, not a marathon, more like a triathalon!
Connect
During this pandemic families are having an array of experiences, some that are positive (more family time, learning together, physical activities), and some that are highly stressful (working from home or loss of job and of income, food insecurity, housing insecurity, loss of a family member or friend, assuring online school for one or more children, supervising schooling while working from home, …). We know that family stress can have an impact on children’s social-emotional development and behavior. Very young children cannot verbalize their experiences; children 3 and older may. It is important to recognize the signs of anxiety in young children, remembering that trauma often presents with anxiety.
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We are also seeing a significant increase in substance use disorders. Many people who had maintained sobriety relapsed during the pandemic as their support structures and sober living practices were adversely impacted by restrictions and isolation - people experienced a crumbling of a carefully constructed infrastructure of treatment and community support. We have also observed an increase in overdoses over the past year.
Pending
Access to BH services has been a challenge and given the increased need as well described in prior responses, there is even more difficulty in accessing those services.