North Carolina’s Youth Mental Health Crisis: ‘We Must Take Action’

The pandemic has damaged our mental health. The CDC reports a significant increase in the number of people reporting symptoms of anxiety and depression nationwide, but the effects of COVID-19 on mental health are perhaps most profound among young people.

Psychiatrists in North Carolina agree that the youth mental health crisis is the latest wave of the pandemic.

Late last year—and nearly two years after the pandemic—U.S. Surgeon General Dr. Vivek H. Murthy declared that the country has a youth mental health crisis. Dr. Gary Maslow, a child psychiatrist at Duke University, agreed, but a few months later it happened for him.

“In March, I was in the hospital — I’ve been at Duke for a decade — and I’ve never had such a number of children or young adults come in with serious suicide attempts,” Maslow said. “What we could see in three months or a year, we saw in a week.”

Dr. Gary Maslow, a child psychiatrist at Duke University

The latest CDC data shows the early effects of the pandemic on young Americans. In 2020, the overall suicide rate decreased, but increased among people between the ages of 10 and 34.

And for every teenager who died by suicide this year, more than 200 others attempted it.

Meanwhile, the share of high school students reporting persistent feelings of sadness or hopelessness has already risen significantly in early 2020.

Maslow and other doctors agree that the disruptions of COVID-19 have exacerbated this trend. This is especially true for the most vulnerable children.

“Kids who have developmental issues like autism or intellectual disability when they were in school had a whole matrix of support. And the loss of that was profound,” Maslow said.

Then parents or guardians of young people started dying from COVID-19. A report released by the COVID Collaborative said that by the end of last year, more than 3,600 children in North Carolina had lost caregivers during the pandemic.

“Then they have depression or they have anxiety, and some of the natural supports that could buffer them are missing,” Maslow said.

“I lost patience”

Dr. Samantha Meltzer-Brody walks and talks with urgency. As chair of the Department of Psychiatry at UNC-Chapel Hill, she works at the center of the campus, surrounded by UNC’s extensive system of hospitals and clinics.

“I’m dying to talk about it,” Meltzer-Brodie said shortly after sitting down in her office. “There is a crisis and we must act.

Over the past two and a half years, new variants of COVID-19 have periodically overwhelmed hospitals with sick patients. Now, Meltzer-Brody says, the mental health care system is overwhelmed.

“You try to find a mental health specialist but you can’t find one because they’re all booked up. Our emergency rooms are already full of patients with mental illness who couldn’t get care, and they go to the emergency room in crisis,” she explains.

Dr. Samantha Melter-Brodie

Dr. Samantha Meltzer-Brodie, chair of the Department of Psychiatry at UNC-Chapel Hill

“And there aren’t enough places to care for them, including those who need inpatient beds.”

Then there is the disparity in how much is spent on mental versus physical health care. In general, insurance companies do not cover behavioral health as robustly as primary care.

“The decisions that are made about what is assessed and what is not, what is reimbursed and what is not, and what we will fund and what we will not, are fundamentally about stigma,” Meltzer-Brodie said. “Do we see it as a real disease? Or do we see it as a character flaw?’

Treatment of young people

The nonprofit group Mental Health America ranks North Carolina 21st in the nation for mental health care for adults, but 42nd in the nation for mental health care for youth. The group’s ranking depends largely on access to care, which includes the availability of beds or youth programs.

“It’s really difficult to analyze the health of children outside of the context of the health of their families,” said Cody Kinsley, secretary of the North Carolina Department of Health and Human Services.

CDC studies show that children often suffer both mentally and physically if their parents suffer, especially if they don’t have health insurance.

Kinsley’s position was appointed by Gov. Roy Cooper, whose administration pushed North Carolina to expand Medicaid under the Affordable Care Act, a move that would cover about half a million North Carolinians who don’t have insurance.

“And nominally, most of those expansion beneficiaries will be seniors,” Kinsley said. “Yet we know that the way cost-shifting works in the health care system and how money flows to different hospitals and providers, it will go beyond just the beneficiaries themselves.”

Republican leaders in the North Carolina Legislature have historically opposed Medicaid expansion until this year. Senate President Phil Berger told WUNC in September that he supports it but remains concerned about its spread.

“We have to find a way to increase the capacity of the health care system to treat people if we expect 500,000 to 600,000 people with an insurance card that will be in the system,” Berger said.

There are state laws that control where, when and how many beds healthcare providers can add to their systems. It is up to the legislature to relax these provisions.

‘What do you need?’

“The thing that keeps me up at night is that we can identify that someone needs something, and then we can’t get them what they need,” said Dr. Gary Maslow, a child psychiatrist at Duke.

Maslow says expanding Medicaid and adding psychiatric beds will be only part of an effective overhaul; that there should be more ways to intervene before a child attempts suicide and comes to the emergency room.

“If I have a child in a clinic, I’ve diagnosed that child with depression and they’re not going to kill themselves today, what they can really benefit from is a two- or three-week day treatment program,” Maslow explained. “That doesn’t exist. We just don’t have it.”

Maslow is also in a constant battle against the stigma of mental illness, both as a doctor and as a parent.

“Our job is to be there for them, to try to communicate that we care about them, to communicate hope and safety,” he said. “… This idea of ​​getting to a quiet place and saying ‘what do you need?’

If you, your child or someone you know is experiencing a mental health crisis, dial 988 for the National Suicide and Crisis Helpline.

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