Children's Mental Health Still Big Concern as Schools Begin Reopening

Mental health professionals say the toll of the pandemic on children and teenagers means schools will need extra resources to prepare for an influx of children in crisis as they reopen for in-person instruction.

“Reopening schools isn’t the answer,” to addressing the needs of kids experiencing mental health problems during the pandemic, said Marisol Cruz Romero, a psychologist at UCSF Benioff Children’s Hospital Oakland, where the number of suicide attempts coming into the emergency department doubled last fall compared to the previous year.

“The stressors of the pandemic don’t go away when schools reopen. Schools need to be ready for dysregulation, depression, kids who can’t focus,” Romero said.

Schools need to prepare and train their teachers and staff to recognize that some kids will need more help as they return to the routines of schooling, because distance learning was taxing and many families have suffered great losses from the virus, Romero said. She argues that schools should provide these mental health resources, but for children who are already in crisis, more targeted counseling services and psychiatric beds are needed.

Hospital beds, mental health programs, psychiatric beds and therapy services for young people were hard to find even before the pandemic, Romero said. Now the influx of children in crisis to hospital emergency rooms has put more pressure on a system that was already stretched thin.

Romero described a 6-year-old boy who recently spent hours in the emergency room while waiting for a placement in a psychiatric hospital. The waitlist was long and his family became homeless due to the pandemic. The hospital reminded him of the recent death of a family member. Waiting in a small hospital room with loud noises and people coming and going was triggering to the boy and also a challenge for providers, creating “a lot of additional stressors in providers and not knowing really how to access these resources or what to do to improve the system.”

Some children in crisis have to wait two months to see a psychiatrist, Romero said. Telehealth is an option but it doesn’t work for many children. Kids are experiencing loss, grief and economic uncertainty as they watch their family members get sick, lose work and even die. Because of social distancing, it’s also harder for children and their caregivers to take breaks by going to a relative’s home.

“A lot of kids fall into the gap between needing a couple weeks of inpatient care at a psychiatric hospital or just a weekly therapist visit,” or partial hospitalization or behavioral therapy, Romero said.

Many of the programs designed to fill that gap are built around in-person or group therapy, like the hospital’s 30-day after-school program for children recently released from the hospital after experiencing mental health crises. But Romero says those programs are now carried out primarily online, which can be less effective.

“The program is still going on, but it’s not as successful via telehealth,” Romero said. “Some kids do well with telehealth, others don’t — just like at school, just like adults at work.”

Romero said there is also a need for more psychiatric beds. “I wish we could focus on prevention. But the reality is kids are in crisis and we don’t have enough beds,” she said.

With these added stressors, Children’s Hospital emergency room staff have instituted universal screening, to make sure they ask directly about self-harm and suicidal thoughts. That’s something a teacher in an in-person classroom might help identify, but with kids taking online classes, those interactions are happening less frequently.

“Many of the primary care providers have expressed concerns and sometimes hesitation around asking about suicide directly because it might put [self-harm] in their head or because it’s a really hard conversation. I want to advocate that it is important to ask. The research does show that it does not increase the risk of suicide. It actually reduces it,” she said.

Romero and her colleagues are bracing themselves for an increase in referrals, which have been delayed because of distance learning. She’s encouraged to see many large school districts finally rolling out plans for children to return to in-person instruction, but there’s already a backlog of children waiting for appointments and services.

Schools are in the best position to help the most children, and screen those who need more intensive support. School-based mental health resources can provide “a safe space for kids to address their emotional challenges,” Romero said. Plus, they target some barriers to care, like lack of transportation or insurance. “If kids have trauma or abuse at home, they only say something if someone asks. There’s a space for that at school and with teachers.”

Finally, if young people are feeling sadness or overwhelmed, Romero encourages caretakers to find ways to help them stay connected and communicate. “The most important thing to keep note is that communication is key for our youth and providing them a safe space to express their emotions,” she said.

To get help for a child or teenager in crisis, call the National Suicide Prevention Lifeline: 1-800-273-8255.