The New York Times
For some teens, it was a year of anxiety and travel to the ER
When the pandemic hit the Bay Area for the first time last year, Ann thought her son, a 17-year-old senior, was finally on his way to completing high school. He kicked a heavy marijuana habit and studied in virtual classes while school closed. The first golf home orders ended his usual routine – sports, music with friends. But the stability did not last. “The social isolation since then has only come to him,” said Ann, a consultant in suburban San Francisco. She, like the other parents in this article, asked that she be left out for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. ‘He could not find work; he could not really go out. And he started using marijuana again, and Xanax. Subscribe to The Morning Newsletter of the New York Times The frustration of the teenager finally boiled over this month when he deliberately cut himself. “We called 911 and he was taken to the emergency room,” his mother said. “But there they just sewed him up and released him.” The doctors sent him home, “she said,” without support, no therapy, nothing. “Ann and her son have been like many families over the past year. Surveys and statistics show that young people who are naturally anxious or emotionally fragile have pushed the pandemic and its isolation to the brink. According to the recently published analysis of surveys of young patients who came into the emergency increased the rate of suicidal thoughts and behaviors by 25% or more from similar periods in 2019. For these teens, there are not many places to go, they need help, but it is difficult to come up with a psychiatric diagnosis.They are trying to interrupt a surprise in their lives, a vague loss.And without a diagnosis it is difficult to get compensation for therapy.And it is the assumption that parents know what kind of help is suitable and where they can find it.Eventually, when a crisis strikes, many of these teens end up in the local emergency department – the one place where desperate families so often seek help.Many ER departments to across the country see an increase in such cases. In a recent report by the Centers for Disease Control, the proportion of children in emergency care for mental health problems, such as panic and anxiety, was 24% higher for young children and 31% for young adolescents. and prevention. And the local emergency department is often unprepared for the extra burden. Workers are often not specially trained to deal with behavioral problems, and families do not have many options for where to go, leaving many of these pandemic-insecure adolescents in the ERT. “This is a national crisis that we are facing,” said Dr. Rebecca Baum, a developmental pediatrician in Asheville, North Carolina. ‘Children have to walk into the ER for days on end because there are no psychiatric beds available in their entire condition. And of course the child or adolescent is lying there and does not understand what is happening in the ER, why they have to wait there or where they are going. What teenagers feel Most teenagers and young adults did well in this pandemic year, provided their families remained healthy and economically stable. They may be irritated or miss their friends, but their support networks were enough to get them through the pandemic. For the young people who are undone, however, the pedantic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive, and after months of socializing with friends and activities, they have much less control over their moods. “What parents and children report throughout is an increase in all symptoms; a child who was a little anxious before the pandemic became very anxious in the past year, ‘said dr. Adiaha IA Spinks-Franklin, an associate professor of pediatrics at Baylor College of Medicine, said. It is this prolonged stress, Spinks-Franklin said, that over time, it dulls the brain’s ability to manage emotions. Jean, an artist and mother of two living in Hendersonville, North Carolina, said her 17-year-old son did well last year. But the months of virtual lessons and the loss of simple social pleasures – hanging out with friends, playing chess – changed him through the fall months. “Now he has become very withdrawn. He has moodiness. He cries a lot, “said Jean. “This giant boy is crying – it’s awful to see.” The young man had panic attacks, twice followed by an eclipse. During one, he fell and injured his face. Lisa, a mother of three in Asheville, said months of virtual classes and relative social isolation changed her extroverted 13-year-old son “in profound ways I would never have expected.” His grades slipped badly, and he began to withdraw. “Then he told us that he could not get the job done, that he did not want to disappoint us all the time, that he was worthless. Worthless. These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense that they have had a life-threatening experience (or the perception of one). Rather, they attempt an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep but vague sense of loss without any single, clear source. The result is sadness, but sadness without a name or specific cause, an experience that some psychologists call ‘ambiguous loss’. The concept is usually reserved to describe the experience of immigrants, displaced from all that is known, emotionally ending in a new and foreign country; or to describe disaster survivors, who return to hollowed out, transformed neighborhoods. “Everything that used to be known and gave structure to their lives, and the predictability and normality, is gone,” said Sharon Young, a therapist in Hendersonville. “Children need all these things even more than adults, and it’s hard for them to feel emotionally safe when they are no longer there.” System overload The resulting changes in behavior may appear sudden: a bright sixth pupil is found to be cutting herself; a sweet-hearted sophomore swinging to a parent or sibling. Parents, scared, often do not know where to go for appropriate help. Many do not have the means or knowledge to hire a therapist. Families who end up in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. Staff are better trained to deal with physical trauma than mental diversity, and patients are often sent back home immediately, without proper evaluation or support. In severe cases, they can stay in the emergency department for days before a bed can be found elsewhere. In a recent report, a research team led by the CDC found that less than half of the emergency departments in U.S. hospitals have clear policies for dealing with children with behavioral problems. If you have a problem with a complex behavioral problem, psychiatrists can take at least days of patient observation. And many emergency departments do not have the specialists, the dedicated space or resources that are not on site to help do the job well. For Jean, it was difficult to diagnose her son. He has since developed irritable bowel syndrome. “He lost weight and started smoking pot because of the boredom,” Jean said. “It’s all because of the anxiety.” Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with sleeping accommodation for 62 children or teens. But long before the arrival of the coronavirus, the department was dealing with the increasing number of patients with behavioral problems. “It was a huge problem pandemic,” said Dr. David Axelson, head of psychiatry and behavioral health at the hospital, said. ‘We are seeing an increase in visits to emergency departments due to mental health problems in children, specifically for suicidal thoughts and self-harm. Our emergency department was overwhelmed with it and had children walk into the medical unit while they waited on psychic beds. To address the crowd, Nationwide Children’s opened a new pavilion in March last year, a nine-story facility with 54 beds for observation and longer accommodation for people with mental challenges. This eased the pressure from the hospital’s regular emergency department and significantly improved care, Axelson said. Over this pandemic year, with the number of admissions for mental health problems rising by about 15% compared to previous years, it is difficult to imagine what it would have been like without the additional, dedicated behavior clinic, Axelson said. Other hospitals from outside the country regularly call in hopes of putting a patient in a crisis, but there is simply not enough space. “We have to say no,” Axelson said. Dr. Rachel Stanley, head of emergency medicine at Nationwide, said most hospitals have far fewer resources. “I worked in a hospital in Michigan for years, and when these kinds of kids came in, everyone was scared to see them because we didn’t have the tools to help,” she said. ‘They must go to a safe room; they cannot be in a shared area. You must provide a babysitter for the child, a staff member, who must stay with them at all times to make sure they are not suicidal or murderous. It can take hours and hours to involve social workers in it, and all this time they are getting worse. Anne, the consultant in the Bay, said that her son’s visit to the emergency room this month was his third in the last 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a closed psychiatric ward. “The experience itself – which was locked up in a ward for days, and no one told him why or how long he would be there – was the most traumatic thing he had ever experienced,” she said. Like many other parents, she now cares for an unstable child and wonders where she should go next. A drug rehabilitation program may be needed, as well as regular therapy. Lisa hired a therapist for her son, a Zoom session every other week. It apparently helped, she said, but it’s too early to tell. And Jean is currently hoping that the risk of infection will soon decrease so that her son can get a secure job. All three parents have become a keen observer of their children and more aware of changing moods. Listening on its own usually helps alleviate distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville, said. “And of course, we need these kids in school so badly.” But medical professionals say that until parents in health care find a way to equip and support emergency departments for what they have become – the first and sometimes the last resort – to mostly navigate on their own, depending on others who are similar in it passed. problems. “COVID has scrutinized our system for things that are not working,” said Baum, the Asheville pediatrician. ‘We had a shaky care system in the mental health of children before this pandemic, and now we have all this extra stress on it, all these children are coming in for pandemic problems. Hospitals are scrambling everywhere to adapt. ”——— If you are thinking of suicide, call the National Suicide Prevention Helpline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources. This article originally appeared in The New York Times. © 2021 The New York Times Company