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Part Two: Taking a closer look at mental health during the pandemic

Wicked Local Northwest - 2/18/2021

Feb. 12—Editor's note: In the second part of this series, we continue to take a closer look at how mental health issues have increased during the pandemic with a particular look at children and adolescents.

Although remote and hybrid learning among school-aged children has helped reduce the spread of COVID-19, it has come with an adverse effect.

According to the Massachusetts Department of Public Health (DPH), during the COVID-19 pandemic, Massachusetts has seen a significant increase in people — many of them children and adolescents — seeking emergency psychiatric care, including inpatient treatment.

Dr. Eric Meikle, head of pediatrics at Lowell General Hospital, said for children, the hybrid and remote schooling formats have reduced risk of coronavirus spread, but increased a sense of isolation.

"Social interactions provide models of behavior, and help children learn vital communication and behavioral skills," Meikle said. "It's a time when you need to get out, and experience other kids. It standardizes both your speech, and social skills ... I don't know how this is going to affect the kids long-term."

Meikle said children with special needs, including children on the autism spectrum, face particular challenges.

"They really don't get the concept of the teacher as a person on the other side of the screen," said Meikle.

According to Diane Bedell, McLean Hospital's director of ambulatory services, children/adolescents are feeling more isolated due to social distancing and remote learning, are restricted from age-appropriate efforts towards independence, and are experiencing Zoom fatigue.

A rise in numbers

The DPH says that after an initial drop in demand for inpatient psychiatric treatment early in the pandemic, Massachusetts has since June 2020 seen emergency department (ED) boarding — holding patients in the ER due to lack of beds — increase by 200-400% over the previous year. Often, those being boarded are moved to pediatric floors with consultant psychiatrists assisting.

According to Dr. Susan M. Szulewski, associate chief medical officer for McLean Hospital and the medical director of McLean's Clinical Evaluation Center, Feb. 5 statistics across the McLean's system showed 22 young people in emergency departments and another 13 boarding on medical floors.

"One reason could be that there are not enough inpatient beds, but also during the time of the pandemic we know patients are staying longer in the hospital due to inadequate outpatient services for them to step down to," said Szulewski.

Data provided by the state Department of Public Health showed over 66 children/adolescents boarding in emergency departments across Massachusetts for Feb. 5 alone. According to DPH records during the period of January to November 2019 there were a total of 374 referrals for Expedited Psychiatric Inpatient Admissions (EPIA) in the 0-17 age group. For that same period in 2020, during the pandemic, the total number of referrals for ages 0-17 was 1,075.

Since the pandemic began, McLean's programs are reporting an increase in referrals for all levels of care, which include residential, partial, outpatient, and inpatient, with a higher rate in the adolescent/transitional age youth.

According to Szulewski, most ambulatory and partial programs have converted to virtual during the pandemic and it's challenging to locate outpatient providers willing to take on new patients.

These increased numbers are reflected at Lowell General Hospital as well, where a rising number of children and adolescents are arriving at the emergency room seeking care for mental health issues.

Meikle said the pandemic has created mental health challenges for adults and children alike — but that children have unique needs.

"It's always hard to find a bed at any given time. The hospitals might have had [a waiting period] in the three-to-five-day range...they have a lot more people waiting for beds," said Meikle.

Lowell General opened an additional campus to better accommodate those waiting.

Because hospitals must maintain strict protocols due to the coronavirus, young people are often left on their own apart from family for stretches of time while there.

"You are not going to have mom come in for a while, or dad come in for a while," Meikle said.

He added that an ER's job is to keep the patient safe — usually providing a "sitter" while waiting for a bed.

"Typically, the role of the hospital is going to be making the patient safe, so someone watches them 24 hours a day. They just sit there — they get fed — they get fed three times a day, and they wait until a bed becomes available."

Difficulty finding help

Mike Lynch, a licensed mental health counselor in Concord, sees children, adolescents, and young adults at his practice Concord Youth Counseling. He has seen a significant increase in the number of people seeking help for themselves or their children during the pandemic.

"I have spoken to many people that are experiencing difficulties in getting help, finding that many therapists have little- to- no availability for new patients and have full waiting lists," said Lynch.

Before the pandemic, Meikle said he would get calls from worried parents a few times a week about a child.

"I get it a couple of times a day now," said Meikle. "They are despondent, worried about their futures, their grades have fallen apart."

Meikle can also attest to the difficulty in finding a counselor during this time.

"We hired a counselor in our office, on May 1," Meikle said. "We were concerned in the middle of the pandemic, she had over 40 people on her waiting list. She stopped adding them, because she couldn't add anymore."

Since many clinicians are now offering telehealth, location has become less of an issue when searching for a therapist. Lynch also suggests that if people are struggling to find an available clinician, they should look into online support groups to connect with others.

"If you are a parent, looking for a therapist for your child, the guidance counselors at your school can give you recommendations and provide you with support in the process for finding a good fit for your child," said Lynch.

According to Szulewski, McLean's outpatient service has transitioned to virtual, while residential and partial programs are hybrid, virtual and in-person.

"We do not have child/adolescent inpatient beds on our campus but work in collaboration with Franciscan Hospital- which is often at 99% capacity with wait lists of several days to weeks," she said.

Deputy Director of Multimedia Robert Fucci and multimedia journalist Margaret Smith contributed to this story. In the final installment of our series on mental health, we will look at how local police departments have responded to mental health calls during the pandemic.

Glossary

Expedited Psychiatric Inpatient Admissions (EPIA): Goal is to connect a patient with a psychiatric bed at a faster rate.

Inpatient: Health care treatment for someone who is admitted to a hospital (usually for acute mental illness, i.e. actively suicidal) and is monitored 24/7.

Outpatient: Health care treatment given to individuals not admitted to a hospital.

Partial hospitalization program (PHP): The patient being treated for mental illness resides at home but commutes to a treatment facility for care up to seven days a week. During the pandemic many of these types of programs have turned virtual.

Residential program: The patient receiving mental health treatment lives at the mental health facility. The setting is less "hospital ward like" and more "home like".

Warning Signs

Diane Bedell of McLean Hospital advises parents to watch for any marked changes in behavior in their children.

Signs to watch for include: Acting withdrawn, irritable, anxious, or expressing thoughts that they wish they could go to sleep and that they think the family would be better off without them. Falling school grades are also early signs of distress and should be red flags.

Bedell said parents should have a low threshold for seeking help and tap the resources they have close to them including pediatrician, teachers, and caregivers.

Resources

www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/parental-resource-kit/adolescence.html.

www.mcleanhospital.org/.

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