Addressing the Pediatric Mental Health Crisis
Experts are unsure why pediatric mental health conditions are spiking, but increased awareness and treatment options are bringing new hope to patients and their families.
From the outside, everything in Julia Paxton’s world looked perfect. She had warm, loving parents, plenty of friends, was active in student government at her Mount Vernon high school and was a trusted local babysitter.
“But on the inside, I was dying,” she says now. Hiding in her room at home in Howard, Ohio, northeast of Columbus, she would cut herself to relieve her anxiety. She imagined what it would be like to kill herself to halt the constant drumbeat of anguish that had become her life.
“I so desperately wanted a break, and death seemed the only way out,” she remembers. “I felt hopeless; I was so exhausted just trying to keep it all together.”
Paxton’s story is a familiar one to Dr. David Axelson, chief of psychiatry at Nationwide Children’s Hospital, and to other mental health practitioners who work with children and teenagers. “We have a real crisis in pediatric mental health, and we’ve got 1 in 5 teens with significant mental health conditions now,” Axelson says. “This is a public health problem nationally.”
Though experts aren’t sure why the number of youths with behavioral and mental health issues is rising, there is a growing push to help youngsters like Paxton who are diagnosed with conditions such as anxiety, depression, attention deficit hyperactivity disorder or disruptive behavior disorder, just to name a few, and to eliminate the stigma surrounding them.
The question about why these diagnoses are increasing can only be answered with suppositions, Axelson says, because there’s no scientific data pinpointing why the number of children with behavioral and mental health issues has jumped so significantly in the past few decades.
Yes, awareness is higher and many people are more willing to have their children or themselves treated, according to Axelson. But that doesn’t account for statistics showing that autism, anxiety and depression have increased in the last decade, and that suicide is the second-leading cause of death among young people between the ages of 10 and 24.
The Centers for Disease Control and Prevention says the percentage of children diagnosed with anxiety or depression has increased from 5.4 percent in 2003 to 8.4 percent in 2012, while the prevalence of autism in U.S. children increased by 119.4 percent from 2000, when it was one in 150 children, to 2010, when it was 1 in 68.
In reality, the numbers could be much higher because many youngsters with these conditions are never diagnosed. The National Institute of Mental Health, for example, estimates that the percentage of adolescents who have had an anxiety disorder is actually 31.9 percent. And the National Survey of Children’s Health found in 2017 that 51 percent of children ages 3 to 17 in the United States (44 percent in Ohio) had been diagnosed with anxiety, depression or behavioral/conduct problems but were not being treated.
Social Media Pressure
Axelson and other professionals point to the rise in social media and smartphones, which give constant access to these platforms, as one probable reason for the rise in anxiety and depression among children.
“There’s a lot of pressure on kids today,” says Sara Harrison Mills, who oversees clinical services for Syntero, a nonprofit Central Ohio counseling services organization. “This is the first generation that’s grown up with social media, and we’re just learning how it affects the brain.”
Because so much communication among teens goes on through text messages and social media, “Kids haven’t had the opportunities to build the same kinds of skills in interpersonal relationships” as other generations, Harrison Mills says. Social media can breed competition, which creates pressure to dress or act a certain way, she says, and teens often don’t have the coping skills to manage that pressure.
Dr. Megan Schabbing, medical director of psychiatric emergency services for OhioHealth, is convinced social media contributes to increased mental health issues among young people. “Teens are really susceptible to chinks in their armor, and there’s peer pressure to look better and to do more things,” she says. “There’s a positive correlation between time spent on Facebook and suicide rates. While every kid has peer pressure, social media has taken that to a new level.”
Home used to be an escape from peer pressure, but social media has taken away that safe space, she says. Schabbing also believes that constant exposure to the internet can convince children the world is a scary place. “Kids now are much more exposed to the horrors of what’s going on out there, and that does contribute to worrying in children,” she says. She says the opioid crisis, which is particularly severe in Ohio, likely is another factor in increased mental health problems in youngsters.
But There’s Hope
On the positive side, parents, teachers and physicians are more aware of mental health issues than in the past and are being encouraged by school districts, health care facilities and public figures to face them and seek help.
Twelve school districts in Central Ohio contract with Syntero to provide mental health services, ranging from skills training for staff and students to mental health screenings, individual and small-group counseling and full diagnostic counseling. “Districts are doing the best they can, but this provides another level of care,” says Harrison Mills.
Often, districts have one counselor on staff for hundreds of students, and the counselors can’t handle the ever-increasing number of kids seeking help. If funding is available through the district or other sources, Syntero can provide additional counseling during the school day to students at risk of developing a mental health problem. “We want to give them support and coping skills,” Harrison Mills says. “If a child is coming in with mental health problems, it affects their ability to be educated. The needs are great, but even with our partnerships, it’s not enough.”
In addition to counseling, some districts include information about depression and suicide prevention in health classes and more may follow suit, thanks to $18 million in the new state budget to fund education efforts.
Reducing the Stigma
Another driver for greater awareness of mental health problems is Nationwide Children’s Hospital’s “On Our Sleeves” campaign, which began in October 2018. It’s aimed at eliminating the stigma that surrounds mental illness, so it can be discussed as easily as cancer or heart problems.
“We know so little about the human mind,” says Stephen Testa, president of the Nationwide Children’s Hospital Foundation. “When you have a physical illness, you can see it and know what it is. But a lot of times, mental illness is like an invisible disease.”
One measure of the success of the ongoing campaign is the amount of money raised for mental health treatment at the hospital, Testa says. “Traditionally this is something you couldn’t raise money for. People didn’t want to talk about it or lend their name to it,” he says.
When Nationwide Children’s started to focus on the subject in 2014, less than $200,000 had been raised for mental health treatment in the previous five years, according to Testa. But since that time, the hospital has raised $80 million for mental health programs, with donations coming from large corporations down to youth football leagues. “It’s the No. 1 focus for our donors,” Testa says.
Much of the money is being used to create the hospital’s first freestanding facility for treating children’s mental health: the nine-story, 386,000-square-foot Big Lots Behavioral Health Pavilion. Scheduled to open March 10, it was built, in part, with a $50 million gift from Big Lots and its foundation. The new facility, located north of Livingston Avenue west of the main hospital, is the largest behavioral and mental health center located on a U.S. pediatric medical campus. “The building itself is stigma-breaking,” Testa says. “We built it in the middle of the hospital complex, an optimum location for care. Often [mental health facilities] are put in the corner of a complex.”
The $159 million pavilion, which eventually will have 48 inpatient beds, has a psychiatric crisis department where new arrivals are evaluated, extended observation beds, a crisis stabilization unit and intensive outpatient programs. It replaces services that had been scattered throughout the hospital complex, including a 16-bed inpatient area.
Before the pavilion opened, youth with a mental health crisis were treated in the main emergency room, which was far from ideal, Axelson says. The pavilion provides comfortable consulting rooms with soft light, privacy, camera monitoring if needed and the extra physical space and time to assess the needs of each child, he says.
How does a parent or other caregiver know if a child has an emerging mental health condition? Axelson says signs include ongoing issues at school, social withdrawal, drug or alcohol abuse, impairment from that abuse and a sudden shift in peer groups.
Schabbing says it can be difficult to differentiate between normal childhood behavior and mental health issues. “But if your kid starts failing tests and that’s not normal for your kid; if your child is isolating socially or isn’t hanging out with friends or is quitting a sport or having difficulty sleeping; any time you suspect your child might be struggling with a mental health problem, get them in to see a pediatrician,” she says.
A pediatrician or primary care physician can do an initial screening and make a referral if needed, and could catch a mental health problem before it becomes a crisis, Schabbing says, adding that concerned parents also should check with their child’s teachers or school counselor.
Some warning signs need immediate attention: hopelessness, giving away possessions, and talking about suicide and how life is not worth living. Sometimes parents and friends may minimize talk of dying as a child just being dramatic. Instead, they should call 911, take the child to an emergency room or call their pediatrician for help, Schabbing says.
Parents also should keep a close eye on their child’s screen time. “Always have kids doing screen time in a public area, where you are,” she says. Be aware of what they’re doing online—ask them if necessary—and have a daily “unplug time” when screens aren’t allowed, such as during dinner, she suggests. That also can be a time when parents and kids can have conversations to keep in touch with each other—another important way to know when a child is having trouble, Schabbing says.
Sometimes, mental health issues become obvious when children reach school age. That’s what happened for Courtney Earliwine of Worthington and her son, Caden, now 12.
Caden started having trouble in school as a first-grader. After he was diagnosed with oppositional defiant disorder and attention deficit hyperactivity disorder, Earliwine attempted to find the best fit for her son, trying two alternative schools and a regular elementary before sending him at the age of 10 to the Buckeye Ranch, a nonprofit organization that provides behavioral and mental health services on both inpatient and outpatient bases. “At times I question myself,” says Earliwine. “What could I have done better? I’m always trying to find another way.”
Caden has been a patient at Nationwide Children’s mental health unit numerous times and recently was diagnosed with disruptive mood dysregulation disorder, which his therapists say is a precursor to bipolar disorder, Earliwine says. He now sees a counselor once or twice a month and attends a Worthington middle school.
One way that Earliwine copes is by helping other parents whose children have mental health issues. She’s the Franklin County regional coordinator for parent peer support for the National Alliance on Mental Illness. Peer supporters help parents figure out how various organizations and systems can help their children. “I’ve been where a lot of these parents are, and part of my job is to get help for them,” she says. “My best advice is, there is a light at the end of the tunnel and to take one day at a time; that’s all you can do.”
Finding Her Path
One day at a time is how Julia Paxton moves forward, and it has helped her manage the crippling anxiety and suicidal feelings that landed her in the Nationwide Children’s inpatient mental health unit as a high school senior.
“It was terrible [to be admitted], but the most sense of relief I’ve ever felt,” she says. “I was finally being kept safe from myself. I was able to focus on getting better.”
Paxton learned that her anxiety was the result of a chemical imbalance in her body—one that could be minimized with medication. Finding the medication and therapy that worked for her, however, took more than 18 months, including a hospitalization at Ohio State Harding Hospital.
Now, Paxton is a junior at Ohio State University studying to be a social worker and sharing her experiences with anyone who will listen. She’s a patient advocate for “On Our Sleeves” and has told her story on the Today show.
“When I finally found recovery, I knew I needed to talk about it, for the sake of others and for my own sake,” she says. “Shame is deadly. It almost killed me. But more and more shame dies when I share my story. I want to let people know there’s help out there, and you don’t have to stay stuck where you are.”
Note: This article was first published in the Spring 2020 edition of Columbus Parent and is republished here with permission.