Opinion: More Than Ever, We Must Prioritize the Mental Health and Well-being of Children

By: Rachel Velcoff Hults, National Center for Youth Law and Dr. Steven Adelsheim, Stanford Psychiatry Center for Youth Mental Health and Wellbeing

The COVID-19 pandemic has dramatically changed the lives of families across the country and left many adults feeling stressed, anxious, and struggling to cope. It has also put the mental health of our youngest and most vulnerable at risk. Now, three months into the pandemic, youth are experiencing further stress and trauma, as our country grapples with another profound crisis: the murder of George Floyd and the pervasive pattern of police brutality and systemic racism against Black Americans that has led to a wave of protests and calls for action against discrimination across the U.S.

As we navigate our way through the COVID-19 pandemic, we have a collective responsibility to keep the well-being of children and youth at the forefront of our response and recovery. We must also recognize racism, discrimination, and race-based violence creates additional stress and trauma for youth, exacerbating the already significant challenges that youth of color have experienced during the pandemic, and threatening to further widen existing mental health inequities impacting communities of color.

At a time of year when children and youth would typically be attending their last days of school, celebrating graduations, and making plans for summer break, they are instead navigating a difficult new normal. For many, this period brings stressors that can contribute to new mental health issues or a worsening of existing ones. Some youth may be experiencing fears of illness or death for themselves or a family member, or grief associated with the loss of a loved one. These stressors are heightened for youth in communities of color, which have suffered a disproportionate number of COVID-19 infections and deaths. Youth may still be adjusting to the abrupt changes in their daily routine and finding it difficult to function without the structure that a traditional school day provides. Social isolation and lack of peer support also pose challenges. Youth miss opportunities to connect with their friends and classmates—even in simple, informal hallway conversations—and the need for visual and physical connection seems to be growing. Youth may also be experiencing grief over a lost sense of important school rituals, like prom, sports events, or graduation. Some youth may also have limited access to school- or community-based services or supports that they previously relied upon. (And while we focus our comments here on older youth, who too often face negative stereotypes and insufficient supports, younger children face challenges, too, as they attempt to process intense emotions about a situation that is difficult to understand.)

For vulnerable youth, such as those in low-income families, the list of challenges goes on, and the potential impact compounds. Youth may have parents or caregivers who have experienced job losses, and they may be worried about their families being able to afford basic necessities, such as food and ongoing shelter. Others may have parents or caregivers who continue to work out in the community—many in low-wage positions—and fear for their health and safety as they do so. Some youth may have family members who lack access to regular health care or cannot afford prescriptions for ongoing treatment for hypertension, diabetes, or other conditions that pose a higher risk for complications of COVID-19 infection. Older youth may be struggling to meet their own needs while helping provide care for younger siblings. In addition, some youth lack access to the computers and internet service needed for even basic engagement with school and learning, further isolating them from their peers and social support system.

As youth struggle to cope with these ongoing challenges brought on by COVID-19, they are now also processing news of the violent murders of George Floyd and other Black Americans, the country’s reaction, and the impact on themselves, their families, and their communities. Many are experiencing a range of intense emotions, from grief to anger to hopelessness, to hopefulness about the possibility for real change, to name just a few, with limited access to the support they need to process these complex feelings.

With increasing stress comes increasing risk for mental health symptoms, or reoccurrence of symptoms, at a time when there are fewer options for getting simple supports that can help lower stress levels. When our homes have increased stress, the chances of depression or substance use rise, as does the possibility of abuse or violence at home. These are all factors identified as potential Adverse Childhood Experiences (ACEs), and we know from many studies of ACEs that when young people have these early experiences, they face increased risk of lifelong morbidity or mortality.

Adults are no doubt experiencing our own challenges right now. Nevertheless, it is imperative that we recognize these potential mental health impacts on the next generation and take proactive steps to mitigate them. We can do this at multiple levels.

Across the country, leaders and policy makers can increase investments in, and use their voices to promote, early mental health screenings and interventions, resiliency and wellness efforts, suicide prevention programs, and strategies that create positive connections for young people.

There are ways to do this now, even with schools closed and communities in varied stages of re-opening.. Additional school and community program staff might be trained in screening and early identification models to help identify young people at current risk and link them to supports online or over the phone. We can continue to promote stress management through educating youth about the value of exercise, breathing, self-monitoring, and connection. It is important now to help youth connect with one another online in supportive informal dialogue through shared activities and buddy networks, or in more formal check-in structures through schools, clubs, community centers, and other networks. We can also increase awareness of online tools, whether websites or apps, for support and community connection for mental health and well-being.

When schools begin to reopen, we will need to implement more formal structures for mental health screening in schools and community settings. Stigma remains a significant barrier to accessing mental health care, so we need to expand mental health awareness and stigma-busting programs, such as Bring Change to Mind and NAMI high school. We can expand social-emotional learning programs to help build wellness and resilience, and bring in evidence-based trauma-focused treatment and suicide prevention programs, like CBITS and Sources of Strength.

We must also support school districts and behavioral health care agencies in working together locally, to ensure that when schools reopen, students will have the mental health services they need on campuses and in their communities. These could include more individual and group mental health services at school-based health centers, or bringing additional mental health providers onto campuses to provide screenings, interventions, and referrals. This might also include community-based one-stop shops for young people that provide integrated youth mental health programs, such as the developing allcove program in California, Foundry in British Columbia, or headspace in Australia, all with strong youth connections back to schools and employment settings.

Across all of these strategies, policymakers and leaders must recognize, acknowledge and address the deep inequities that already exist in access to mental health care for youth of color, and the many ways that communities of color, especially Black youth in this moment, are experiencing disproportionate negative impacts from these crises. Efforts to increase mental health supports and services must specifically focus on expanding access and reducing structural barriers to care for Black youth. These efforts should also leverage research from the National Child Traumatic Stress Network and other organizations regarding best strategies for addressing the traumatic impact of racism and exposure to violence on youth. We must also invest in creating and expanding mental health career pipelines for people of color, to ensure that the community of pediatric mental health providers reflects the diversity of the children and youth they serve.

As parents, caregivers, educators, or other supportive adults in the lives of youth, we can help by being aware of the heightened challenges many youth are facing, listening to what they are saying and experiencing, and responding to their requests for support on their terms. We should also help our youth navigate the sometimes challenging process of seeking and accessing mental health care.

Our young people are the future of our country. They need our focus and support through this time of unprecedented isolation, fear, conflict, and confusion. We must not lose sight of the fact that the period from age 12 to 25 remains a critical time of brain development and maturation. Both the experiences our young people face now and the supports they receive from us in coping with and navigating these challenges will have profound impacts on their abilities to be successful adults, parents, and citizens for years to come. By making the investment of support, commitment, and care for our youth right now, we will be building the foundation for a hopeful and viable future.

Dr. Adelsheim and the Stanford Psychiatry Center for Youth Mental Health and Wellbeing have a longstanding relationship with the National Center for Youth Law; conferring on guidance around issues related to school health and consent of minors.