UK psychologist discusses the mental health crisis impacting kids

In December 2021, the U.S. Surgeon General issued an advisory regarding the mental health crisis in children brought on by the COVID-19 pandemic. In response, Kentucky Children's Hospital (KCH) signed on to the Sound the Alarm For Kids campaign dedicated to raising awareness and allocating resources to address this crisis.

"Providers everywhere are calling for change in regard to access to mental health services for children, said Scottie B. Day, M.D., physician-in-chief at Kentucky Children's Hospital. "But first we need to work together to reduce the stigma and have conversations about mental health."

UK HealthCare pediatric psychologist Alissa Briggs, Ph.D., answers frequently asked questions regarding the unprecedented crisis children and adolescents face today. 

What are providers seeing in KCH and the pediatric clinics right now?

Briggs: As an adolescent mental health provider, I am seeing the same mental health concerns that I saw before the pandemic. However, several patients’ new mental health concerns are directly linked to the pandemic. In addition, many patients who struggled with mental health before the pandemic are either doing worse or having difficulty healing. Most adolescents cite prolonged isolation from peers, fraying peer relationships, and lack of organized activities outside of the home as contributing factors to their worsening mental health. We have definitely seen an increase in eating disorders and self-injury, and unstructured time at home is likely a factor in this increase. When school and activities resumed, mental health improved for some, but some remained stuck in depression, anxiety and self-harm behaviors.

What has contributed to the increase in suicide attempts and suicide ideation?

Briggs: Hopelessness, financial stress, feeling like a burden and loss of relationships are all driving factors for suicide. The pandemic certainly increased feelings of hopeless, financial stress and changes in relationships for many. In addition, as many parents struggled to juggle remote school, quarantines and work, it is reasonable to assume that this could create some feeling of burdensome in some children and adolescents.

How do issues such as socioeconomic status, race, sexual orientation and gender identity factor into this increase?

Briggs: Many adolescents who fall outside of the cisgender and straight category rely on their peer group for support. They may be out at school and not at home. For these adolescents, lack of access to affirming peers and/or an affirming environment could contribute to stress and suicidal behavior. On the other hand, adolescents who were experiencing discrimination and harassment at school due to their sexual orientation and/or gender identity may have found it to be a relief to be at home with affirming parents. Having at least one parent who is affirming of the adolescent’s gender identity and sexual orientation reduces the adolescent’s risk of suicide significantly.

We also know that BIPOC youth are disproportionately affected by social determinants of health, meaning that race intersects with health outcomes and healthcare. In addition, lower socioeconomic status negatively affects access to healthcare and is often associated with being placed in customer facing, service positions. BIPOC adolescents and adolescents whose family have limited resources were more likely to be directly impacted by COVID from loss of income to loss of life of an immediate family member.

We can expect that these adolescents will be more likely to experience mental health challenges moving forward given the disproportionate experience of adverse life events over the past two years. 

Do you think the social stigma surrounding mental health is what keeps parents from talking to their children or even taking their child’s mental health concerns seriously?

Briggs: Actually, I think an inability to recognize the signs that an adolescent is struggling with mental health and limited emotion-based communication skills are what prevent parents from addressing their adolescent’s mental health. When people are in a stress response, they may respond with fighting (an increase in arguments, outbursts and irritability), flight (avoidance of people and situations) or freeze (shutting down, crying and not communicating). These may be interpreted as behavioral problems and addressed in a more punitive approach rather than as signs that an adolescent is struggling. Adolescents can demonstrate their need for support in ways that serve to push away the very people they need.

In addition, many parents have not learned how to truly listen. Listening involves much more than hearing. It involves eye contact, positioning your body toward someone, a supportive expression, reflecting emotions you perceive in the other person, and paraphrasing what you are hearing them say. Looking at a phone is a huge barrier to beginning communication due to the nonverbal behavior required. Have phone-free time at home. In addition, many parents jump into trying to solve problems rather than first focusing on the emotions and concerns the adolescent is trying to express. Many adolescents I see for therapy indicate they do not feel their parents truly understand how they feel or what they are trying to tell them. I highly recommend the "How To Talk So Kids Will Listen and Listen So Kids Will Talk" series by Adele Faber and Elaine Mazlish for all parents.

How has the pandemic affected the mental health of children and teens?

Briggs: It has made things worse for adolescents who were already struggling and made it difficult for adolescents who were doing fine.

In addition, many adolescents have experienced trauma associated with family members’ infections. Trauma activates the stress response system, and if this system is activated frequently or continuously, it becomes difficult to turn off. When the stress response system is stuck on, we end up with depression, anxiety, and symptoms of post-traumatic stress.

What are the signs that a child may be struggling with their mental health?

Briggs: Remember "Fight, Flight, or Freeze" — our automatic responses to activation of our stress response system.

• Fight: Is your adolescent more argumentative? Irritable? Aggressive?
• Flight: Are they avoiding situations or interactions?
• Freeze: Do they seem shutdown and withdrawn? Are they more tearful?

I think it is also important to keep in mind that we don’t get to choose our stress response style. Adolescents can learn strategies to counteract and prevent the stress response, but the overall reaction is not controlled. There was a time when a quick, automatic reaction was adaptive (i.e., when faced with the threat of death from a tiger or a member of another tribe). Our society has evolved more quickly than our stress response system, and the ways in which we automatically react don’t always make sense.

An adolescent who gets irritable and argumentative is no more in control of that response than an adolescent who becomes tearful and withdrawn. Unfortunately, adolescents who tend to “fight” receive more punitive reactions and more blame for their behavior, which makes their overall mental health worse.

What can parents, caregivers and teachers do if they are concerned about a child’s mental health?

Briggs: Reach out to your pediatrician, who can help provide referrals and resources. Also, reach out to a supportive teacher, guidance counselor or administrator at school. Most schools have increased the availability of mental health professionals at school, and your adolescent may be able to access therapy during the school day. If the school does not have resources, they may be aware of resources available in the community.

What resources are available for parents and caregivers? How can we further support them?

Briggs: There are many parenting books to chose from, which can be overwhelming. However, there are some gems out there. Anything by Ross Greene is a worthwhile read, and he has a website with a treasure trove of resources, including ways to connect with other parents. As I mentioned earlier, the "How to Talk" series can improve your relationship and communication with your adolescent.

Employers can do a lot to support parents and caregivers. In our culture, we focus a lot on what the individual can do, but sometimes the individual needs the systems in which they participate to change. Parents, especially parents of elementary school aged children and younger, have been burning the candle at both ends for two years trying to care for their families and maintain their employment. Employers can provide leave time for parents to access therapy and take their kids to therapy.

Employers can provide increased flexibility so that parents can work remotely our outside of normal business hours if needed in order to balance work and family obligations. In addition, employers can find ways to increase pay to attract and retain workers so that this flexibility is possible. Given the challenges many industries are facing with staffing, employees are in a position to bargain. I think these are reasonable requests parents can make that may lead to some helpful changes.

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For more information about child and adolescent mental health including available resources and making an appointment with one of our providers, contact KCH's Division of Adolescent Medicine.