During the first year of the novel coronavirus epidemic in the United States, concerns about individuals’ mental health took a backseat to the initial plan of “two weeks to flatten the [epidemiological] curve” so as not to overwhelm hospitals with coronavirus patients, which shifted to a new goal of zero coronavirus.

Although daycare facilities serving the families of essential workers remained open throughout the pandemic, with very few cases of coronavirus, children were kept home from school and told to forgo spring sports and activities, as well as traditional activities like the prom and end-of-year class trips. Dramatic restrictions on interpersonal association and in-person education continued for the fall 2020 semester.

Social deprivation, schedule disruption, distance learning pose problems

With schools introducing little new material and treating the last quarter of the school year as a combination of review and enrichment, teens had less work to do. Interaction with fellow students and with teachers was limited to brief Zoom calls; districts scrambled to provide students with WiFi hotspots to facilitate a basic level of instruction.

Districts like the Bethlehem Area actively sought to provide behavioral and emotional supports through virtual check-ins with guidance counselors, to mitigate the challenges posed by the change from an all-day routine with trusted teachers and administrators trained in trauma-informed practices.

Psychological and sociological researchers sounded early warnings, and JAMA Pediatrics editor Dr. Dimitri Christakis called for children’s mental health concerns to be given significant weight in policy decisions (https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766113).

“To help inform states and counties that are struggling to make this enormously consequential and urgent decision regarding the fall semester, an expert task force focusing exclusively on school closure should be convened immediately,” Dr. Christakis wrote in May 2020. “They should review the state of the evidence regarding horizontal transmission among children and their families, as well as what is known about the feasibility of distance learning and the psychological implications of children continuing to stay at home.”

National media outlets and medical journals have documented the undeniable and dramatic increase in mental health issues among children. A meta-analysis published Aug. 9 in JAMA Pediatrics (https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapediatrics.2021.2482) found that “1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of pre-pandemic estimates.”

Specific stories from around the United States paint an even harder picture. Sixty percent of high school students in Washington state reported being depressed for the majority of 2020, with nearly 10 percent saying they had “little to no hope for the future.” Emergency rooms in Massachusetts had to “board” people – including teens – experiencing mental health crises at higher rates every month during 2020. Nationwide, 31 percent more children aged 12 through 17 went to the ER for mental health reasons in 2020 than in 2019, suicide attempts sent nearly 51 percent more teen girls to the ER in 2020 than in 2019.

Local mental health situation complex

In the Lehigh Valley, families experiencing mental health challenges have a several places to turn. One of them, Catholic Charities of the Diocese of Allentown, has provided services, including mental and behavioral health care, to people regardless of faith or income, in Berks, Carbon, Lehigh, Northampton, and Schuylkill counties for more than 50 years.

Professional counselors offer help in areas such as depression, anxiety and family issues. Although Catholic Charities accepts insurance for its services, uninsured individuals are also served using a sliding fee scale based on household net income. Families who receive counseling through Catholic Charities are not in an acute crisis situation, but have mental and behavioral health issues that can be treated on an outpatient basis.

In 2019, Catholic Charities provided counseling to 65 youths under age 18. In 2020, that number rose to 72, an increase of nearly 11 percent. All 72 children and teens were provided counseling free of charge.

Catholic Charities Executive Director Rob Nicolella tells the Press that in addition to youths with general issues of depression, there were some students whose families sought care because of new mental health issues specifically linked to pandemic mitigation measures. Those students were struggling with the transition to online learning and the uncertainty of how long it would last. Their difficulty in making academic progress brought on anxiety and fears that their new academic challenges would jeopardize their college plans.

Individuals in an acute crisis who need immediate help can find it through Crisis Intervention of Northampton County (610-252-9060) or Crisis Intervention of Lehigh County (610-782-3127). These agencies provide immediate intervention for suicidal and depressed individuals, including home visits and placement in treatment facilities like Horizon House Inc. on Cedar Crest Boulevard and Robbins Bower Crisis Residence on Emmaus Avenue.

In Northampton County, the number of children (people younger than 18) who prompted calls to Crisis Intervention increased nearly 10 percent, from 71 in 2019 to 78 in 2020. When all ages are considered, the increase from 2019 to 2020 is more significant: 12.6 percent (from 1,187 to 1,337).

One data point that appears to run counter to the national trend is the number of individuals served by Lehigh County Crisis Intervention. Lisa Cozzi, Crisis Intervention director, shares numbers from 2019 and 2020 indicating a decrease in the number of children and teens who had contact with the service. The number of “active cases” involving individuals aged 18 and younger went from 460 in 2019 to 389 in 2020.

With an increased focus on outreach by school districts, it is possible that children in need of extra support were caught by school safety nets. Another possibility is that parents, sharing working space with their children for a greater percentage of each day, saw developing problems and sought support from private counselors before their children’s mental health reached crisis level.

Mitigation plans still largely ignore mental and behavioral health

Although peer-reviewed studies amply document the short-term harms suffered by children and researchers speculate that damage may be long-term for many, policymakers in most areas have paid little more than lip service to children’s mental health when making and updating coronavirus mitigation plans. Policy choices around social distancing, mask-wearing and school closures are still based on changing models of virus transmission, rather than weighing costs and benefits of specific policy choices for the 75 million Americans under age 18.

The authors of a recent paper in the journal Neurobiology of Stress noted, “speculation is widespread that the adverse effects will be pervasive and lasting” (https://doi.org/10.1016/j.ynstr.2020.100291).

Physician and best-selling author Vinay Prasad, MD, MPH, wrote in February, “The Covid-19 pandemic has harmed children – not because they have fallen ill from the virus, for the most part, but by the choices societies have made to protect adults who are vastly more likely to suffer from the disease.”

As we face another school year, Dr. Prasad points out that “Here is the real answer to the question of whether it’s worth it to mask kids: No one has any clue […] When you combine tens of thousands of data sets with hundreds of researchers looking at the question, analytic flexibility and selective reporting results, meaning the resulting literature is little more than an opinion poll […] Large, empirical studies alone can answer this question, and we did literally zero of them.”

Dr. Vinay Prasad, an associate professor of medicine at the University of California-San Francisco, addresses the issue of masks on children, but could be talking about virtually every child-impacting policy since March 2020 when he says, “A thousand years from now, on this question, our society will look as primitive and ignorant as the people who survived the plagues of Europe in the Middle Ages. The only difference is that we could have done better.”

NEXT: Teen suicide attempts were already rising before coronavirus