LACONIA — New Hampshire struck a somber first on Valentine’s Day, Feb. 14: 51 children waited in emergency rooms statewide for hospitalization because of mental health crises – the highest recorded on any single day, according to hospital counts.

“That was the highest we ever saw in all the years I’ve been here,” said Maggie Pritchard, executive director of Lakes Region Mental Health Center in Laconia and Plymouth. “And that number doesn’t count for the kids waiting at home,” for inpatient care. On Wednesday, 15 children in emergency rooms statewide were waiting for hospital treatment for serious depression, self-harm or suicide risk, according to reports to the state’s Department of Health and Human Services.

It’s not a statistic that speaks well for the state of children’s mental health. “These are kids that are in crisis and needing an inpatient level of care,” said Ken Norton, director of NAMI NH, the state chapter of the National Alliance on Mental Illness. “The tip of the iceberg is that outpatient appointments are also up.” Families and individuals call multiple providers and get placed on waiting lists because they can’t get help, Norton said.

The data collected over months and years represents a sobering trend, including in the number of people younger than 18 waiting for beds at New Hampshire Hospital, which seeks to stabilize those with life-threatening mental illness or safety concerns. Before the pandemic, the highest quarterly average of children waiting for beds on a given day was seven in 2017 – an average that repeated from April to June last year. By September the average jumped to 10, then hit 16 in December.

“That’s a pretty dramatic increase” and one that should sound alarms, Norton said.

Predating COVID

Even before COVID, this generation of young people has shown to be more at risk than others for depression, anxiety and the cumulative effects of stress, according to local mental health and social service providers. For kids, the social isolation of COVID has made things worse.

“A lot of studies and reports are showing there’s been increased stress, anxiety and depression across the lifespan, hitting the young and older ends of the spectrum especially hard,” Norton said.

Symptoms of stress and mental illness have ballooned with schools converting to full or part-time remote learning from home. At the same time, wait times for mental health counseling have increased. Mental health counselors are in shorter supply as staffing levels have plummeted during COVID, including at residential treatment centers, which routinely accept young patients sent from emergency rooms. There are fewer eyes on kids with mental health challenges, and more are living without necessary help.

“With staff shortages and a high demand, it’s a perfect storm,” Pritchard said. Last month, a study of community needs in the greater Winnipesaukee region found that access to mental health care was a top priority cited by survey participants, and three out of four said they had experienced increased stress and anxiety because of COVID.

At Lakes Region Mental Health Center, children are now waiting until early May for a new patient appointment, and 20 are on the wait list for the first available opening. Children who can travel to LRMHC in Plymouth can be quickly seen, Pritchard said. Over the course of the pandemic, LRMHC emergency services has fielded an increase in calls related to children in crisis.

Child and adolescent counselors at Health First clinics in Laconia and Tilton can see first-time patients in person or by telehealth within two to three weeks of calling, said Ashley Douhart, the clinic’s director of behavioral health.

But the dearth of timely care continues system-wide, and the numbers of kids in crisis aren’t decreasing.

Between July 2019 and June 2020, LRMHC emergency services staff treated 88 children in the emergency room at Lakes Region General Hospital.  Between June 2020 and December 2020, that number almost doubled in half the time, to 154 children during that period.

“When we started off, we all had hopes (that the cornonavirus) would end quickly. The longer that COVID goes on, the less hope we have,” Pritchard said, citing the increase in depression, fear and despair for adults as well as children. “People have come to terms with the fact that they can’t predict, and it’s very stressful and anxiety provoking.”

COVID fallout filters down. Young people miss important social outlets that contribute to wellness, from sports and in-person clubs, to homeroom, the school bus rides and lunch line jokes.

“There's definitely a rise in childhood depression and anxiety. For children, that social connection is so important. COVID has removed most of that from their lives,” Douhart said.

Haves and have-nots

COVID appears to have spiked a trend that was building long before – a sea change in society and the culture of growing up. Adolescent teens and – increasingly – younger children are exposed to information and social media around the clock. This translates to instant peer influence and instantaneous judgement by others. It breeds nagging and depressing comparisons, and a sense of entitlement or loss, Douhart said.

“If you don’t have a Snapchat account or the latest iPhone, that’s grounds for kids who aren’t nice to each other,” Douhart said. The pandemic has virtually sifted kids further into highly-exposed categories of haves and have nots, especially as life increasingly relies on technology, and having dependable internet and WiFi. In rural and lower-income homes in the Lakes Region and elsewhere, guaranteed internet and computer access is not a given.

With in-person interaction shrinking in COVID’s virtual world, online life offers constant reminders of childhood’s winners and losers.

“Frankly it’s tough to be a kid today,” said Kelley Caravona, suicide prevention coordinator at NAMI NH. While social media has increased connectedness and online chat rooms and groups have united many isolated kids into like-minded tribes – which can be new and comforting connections – there’s a sinister side. “Kids are forced to relive their mistakes a lot through social media and news travels really quickly,” Caravona said, and it can be difficult to undo assaults to self-esteem and emotional harm.

Social media is the communication du jour of people trying to stay in touch during the pandemic. “These devices in our hands make it so we have access to information in a moment. If you’re young and already experiencing anxiety and depression and have a hard time getting through the day, you’re reminded of things,” that make you perceive your life as not so good – and yourself as chronically deficient, Caravona said. “You’re scrolling through Facebook and seeing wonderful photos of other people hiking, biking and winning awards,” and that can make you feel like a loser and more alone.

School wellness programs try to help kids see through the photo-enhancements, exaggerations and fictions posted on social media, and concentrate on the things that really matter to them. But it’s hard to ignore the swamp where you’re expected to swim, school and mental health counselors warn. Someone doesn’t have to insult you or exclude you. The self-aggrandizing statements of others can make you feel like you’re in a black hole by comparison, especially when there isn’t much or any meaningful in-person social interaction to counteract it.

According to Caravona, there has been no reported increase in youth suicide deaths in New Hampshire during COVID, which is good news. Schools on hybrid schedules, including teachers leading classes on Zoom, are trying to keep tabs on students who seem silent or disenchanted or periodically absent. The state recently received a grant to improve early identification of children at risk of suicide and self harm in Coos and Carroll counties and in the Capital region, where suicide rates and signs of risk have been higher than the state average.

Because of the historic high levels of children waiting for psychiatric inpatient care, DHHS Commissioner Lori Shibinette last week commissioned NH Hospital to dedicate 10 beds for children, and said Hampstead Hospital is working to increase its capacity over the next few months. New Hampshire is currently accepting proposals to create a residential treatment facility that will include children, said NAMI NH's Norton.
 
Parents on the front lines

For young people, anxiety and depression continue to flourish day to day.  This puts parents on the front lines, in charge of rescuing foundering children as the coronavirus continues to mean working, learning and playing at home. Many at-risk children have depended on school for peer and adult support, positive role modeling and mental health counseling  – which doesn’t always translate well via teleconferencing.

Remote learning isn’t for everyone. Some prefer it, but many formerly solid, motivated students are becoming derailed, complaining that they can’t focus, are constantly distracted, and can’t seem to get their work done, Douhart said. Some are failing or dropping classes for the first time. School used to provide structure and reinforcement, and help ward off destructive thoughts. For kids who live in the shadow of family substance misuse and are spending more time at home, that takes a heavy toll on mental health, Douhart said. Teenagers and adolescents who grappled with depression before COVID are sinking to deeper and longer-lasting lows, she added. A phone call or text may crack the isolation, but it doesn’t substitute for the deeper human satisfaction of meeting, talking and doing things together, mental health workers and educators warn.

To combat stress and isolation, and to prevent serious mental illness from taking root, Douhart tells parents to listen to their children and to ask about their feelings, and to consciously fill them with encouragement, optimism and hope.

“All the adolescents I’ve seen pre-COVID have struggled with a greater depth of depression,” as the pandemic wears on. “A lot of my patients have made trips to the ER,” Douhart said. “So many kids don’t get enough encouragement. Depending on what their trauma is, some depend on that face-to-face, and need that human connection.”

Parents should watch for warning signs, and get their children mental health help, Douhart said. Alarm bells include grief and sadness that lasts beyond an upsetting or disappointing event, disinterest in family time or activities that used to be fun or important, and a decline in grades, changes in sleep, appetite or typical mood, higher levels of irritability or angry outbursts, isolation and any level of self-harm.

Make sure they’re actively participating in family life – especially since more is happening at home, Douhart said. Research has shown that eating family dinner together creates positive outcomes for adolescents as they grow into adults. Simple activities like family board games and movie nights also help combat silence, withdrawal, and depression for kids at any age.

“It’s important to give kids hope so they have something to look forward to,” Pritchard said. Help them to keep their eyes on a prize, such as, “On this date I’ll be able to go outside without a mask and play basketball with my friends.” Being around their families all the time may not be ideal, Pritchard said. “Kids are very tired of it and they don’t have a future they can see clearly right now.”

It’s about sitting down with them, identifying what is bothering them, giving them skills and tactics to get through, Pritchard said. “It’s about playing to their strengths and understanding your children, and setting up the expectation of something that’s comforting to them.”

In the meantime, some things that make adults feel happy and relaxed may work for them, too – like playing cards together or doing a yoga class on YouTube. “We think we know our kids. But sometimes it’s not that easy. You have to work at it and explore it,” Pritchard said.

If someone you know may be at risk for suicide, call the NATIONAL SUICIDE PREVENTION LIFELINE at 1-800-273-8255.

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The Sunshine Project is underwritten by grants from the Endowment for Health, New Hampshire’s largest health foundation, and the New Hampshire Charitable Foundation. Roberta Baker can be reached by email at Roberta@laconiadailysun.com.

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