In The Pandemic, Children Face A Mental Health Crisis : Short Wave According to the Centers for Disease Control and Prevention (CDC), the proportion of emergency department visits by children in mental health crises went up significantly during the pandemic — about 30% for kids ages 12-17 and 24% for children ages 5-11 between March and October of last year, compared to 2019. For psychiatrists like Dr. Nicole Christian-Brathwaite, this is evident in her practice and personal life. We talk to her about how this past year has taken a toll on children and their mental health, as well as her advice for helping the kids in your life cope better.

In The Pandemic, Children Face A Mental Health Crisis

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MADDIE SOFIA, HOST:

You're listening to SHORT WAVE from NPR.

RHITU CHATTERJEE, BYLINE: Hey, everybody. Rhitu Chatterjee here. I cover mental health for NPR. And today, I want to introduce you to someone with insight into what this past year or so has been like for many kids.

NICOLE CHRISTIAN-BRATHWAITE: Shortly after schools closed in last spring, I started to have an increase in the number of calls and requests for psychiatric evaluations and psychiatric support.

CHATTERJEE: Dr. Nicole Christian-Brathwaite is a child and adolescent psychiatrist based in Boston.

CHRISTIAN-BRATHWAITE: The number of calls that I've received have only increased exponentially.

CHATTERJEE: Wow. And so were these calls from parents? Were they from schoolteachers or counselors who were reaching out to you?

CHRISTIAN-BRATHWAITE: All of the above, honestly. So certainly, parents are in crisis. They're feeling overwhelmed. Having children home obviously is difficult, particularly for parents that have to go to work.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: ...For parents that are essential employees. I also receive calls from schools even now - both schools, school systems requesting consultation for students in crisis.

CHATTERJEE: Another data point - last fall, the CDC reported that the proportion of emergency department visits by children in mental health crises went up significantly during the pandemic. We're talking 30% higher for kids aged 12 to 17 between March and October of last year compared to 2019. And Nicole has seen this in Massachusetts. She calls it a crisis.

CHRISTIAN-BRATHWAITE: Our emergency room physicians, our pediatric psychiatrists and pediatricians are completely overwhelmed. Then you also combine that with the decrease in the number of beds due to COVID. And pre-pandemic, there was already a mental health crisis for children.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: And of course, the most vulnerable children are the ones who are suffering the most. So children of color, LGBTQ youth, children from impoverished families - those are the children that are really experiencing significant stress.

CHATTERJEE: So today on the show - a conversation with Dr. Nicole Christian-Brathwaite about how this past year has taken a toll on children and their mental health and her advice for helping the kids in your life cope better. This is SHORT WAVE, the daily science podcast from NPR.

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CHATTERJEE: Nicole, I should point out something that a lot of mental health care providers have mentioned to me - that not all kids are struggling emotionally. Some, especially those who have social anxiety, have even thrived because school used to be a source of stress. So as you mentioned, there are some kids - the most vulnerable kids have been worst impacted by the pandemic. So tell me a little bit more about who those kids are, and why has the pandemic had such a profound impact on their emotional lives?

CHRISTIAN-BRATHWAITE: Sure. So certainly, children who are more vulnerable - so children who have preexisting mental health concerns like underlying depression...

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: ...Or anxiety or eating disorders, those children are certainly having a harder time because they're not able to access some of the services - so after-school programs that provided support or meeting with their school therapist or having group meetings with peers who were experiencing similar concerns or issues...

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: ...Or even, you know, going - a lot of kids use coping skills that are no longer accessible, like going to the gym or going over a friend's house to watch a movie or just going out to eat with friends or going to hang out. Many of those coping skills are no longer available. And so, unfortunately, for many kids, what's available are those unhealthy coping skills that we've been trying to support them and work with them on not utilizing, like self-harm or substance use.

CHATTERJEE: Right. So kids, you know, obviously depend so much on the adults in their lives to sort of navigate difficult circumstances, make sense of the world, changes going on in the world. And we know, like, everybody's mental health is struggling. So if the adults in the lives of kids are also struggling, that takes away some of that buffer against stress and change and traumas, right?

CHRISTIAN-BRATHWAITE: Right. Absolutely. I mean, our children look to us in terms of how to respond.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: Am I safe? Is this the safe - and kids do well when they have predictability, reliability and structure.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: Schools provide that. And even schools that are in person, there's often still disruptions. When there has been someone with exposure, then you're out for two weeks, and then you're back again. Or maybe there's...

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: ...A hybrid model, and that may change. And so the things that help kids thrive - that predictability, reliability and structure - that's been lacking.

CHATTERJEE: And you mentioned a couple other things that I want to - I would love for you to expand on. Other groups of vulnerable kids like kids in communities of color, LGBTQ kids - what's causing more distress in the lives of these groups of kids?

CHRISTIAN-BRATHWAITE: Absolutely. And I was having a discussion with one of my parents the other day, and we were thinking about the experience as a African American parent raising African American children and discussing that it feels like we're in the midst of two pandemics. There's the COVID-19 pandemic, and then for parents of color, specifically African American parents and families, Asian parents and families, they're in the midst of the racist pandemic.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: And these videos of people being hurt or killed or maimed in racial violence, our kids are watching these videos over and over again. It's, like, you know, they're on repeat. And so our kids are not only not in school - so they don't have that distraction and support that school provides - but then they're home, and they're completely immersed in social media and the news, and they're witnessing these acts of racism. And frankly, watching a video of someone being beaten or murdered is traumatic.

CHATTERJEE: Yeah.

CHRISTIAN-BRATHWAITE: Also, the more trauma you have as a child, the greater the risk of developing diabetes, heart disease, even early death.

CHATTERJEE: Yeah. There are serious long-term effects. As we know, sort of childhood trauma has a long tail. And I can't help but also ask you, if you feel comfortable answering this - you're African American. You have kids of your own.

CHRISTIAN-BRATHWAITE: Yes.

CHATTERJEE: You have sons, right?

CHRISTIAN-BRATHWAITE: Yes. Yup. I have two sons.

CHATTERJEE: How are they doing? How have they navigated this past year?

CHRISTIAN-BRATHWAITE: You know, to be completely transparent, the first few months were difficult. My children are 6 and 4. And my 4-year-old really regressed those first few months at home. He - I was still working. My husband was still working. And so trying to support them - we're also caretakers for our parents, and so we have a multigenerational household, and because of that, we were taking extra precautions.

CHATTERJEE: Yeah.

CHRISTIAN-BRATHWAITE: And my kids are social butterflies. They love being around other people. We - my husband has a large extended family, and they would see their cousins almost weekly, and so suddenly, to abruptly discontinue those relationships was very difficult. So my 4-year-old, who was previously potty trained, was suddenly having accidents. My 6-year-old was having nightmares. And unfortunately, my mother is one of those 24-hour-news watchers. CNN or MSNBC, they're on 24/7. NPR - 24/7. And so, of course, when my 6-year-old visits with her, he's seeing and hearing the news. And he would ask me questions like, Mommy, am I safe? Is someone going to hurt us?

When the Ahmaud Arbery incident happened, whenever my husband and I would go out for a walk, my 6-year-old was afraid. Are you going to come back? Are you - is it OK for you to walk? And obviously, that - you know, that's devastating for us because we want to maintain our children's innocence as long as possible. But so much of that has been taken from them, from our children, from African American children in general because of the trauma that they're exposed to.

CHATTERJEE: So Nicole, you've had to help your own sons deal with all of this in addition to the kids you're seeing in your practice. Do you have any advice for parents and caregivers of children to help the kids navigate their emotional lives at such a difficult time?

CHRISTIAN-BRATHWAITE: One of the things that I encourage parents and tell parents is that communication is key. Particularly with adolescents, they have no desire to talk to their parents. They have no desire to open up to their mother or their father, but we have to continue to encourage that. And so one technique that I always recommend parents utilize is something called reflective listening. And that essentially means you're not listening to respond; you're listening to understand. You're listening to hear what the child is saying. And so reflective listening essentially means that we're not in the position to give advice. We're not trying to respond and help our kids feel better. We're just letting them know that we are listening and that we understand and helping them build their emotional vocabulary. So most kids, the emotions they feel are happy, sad or angry.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: That's the extent of their emotional vocabulary. But if we can help them expand on that and understand what they're feeling, we can also help them address it. So when you're frustrated, what's helpful? When you're lonely, what's helpful? And so being able to identify it, helping kids know that we hear them, then we can take that next step in actually addressing those concerns. But the first answer is just listening.

CHATTERJEE: Yeah. That's great advice, but given how overwhelmed parents already are, I'm wondering if there are also roles for, like, older siblings, cousins, family friends, you know, our listeners who may not have kids themselves but may have nephews and nieces or younger cousins. Do these people have roles as well that they can play?

CHRISTIAN-BRATHWAITE: Absolutely. There is an incredible child psychiatrist. His name is Dr. Bruce Perry. He wrote a book called "The Boy Who Was Raised As A Dog," and it really - it chronicles his experience working with children with significant trauma - I mean, devastating trauma. And one of the things that he always emphasizes is that the more healthy relationships a child has, the more likely that child is to recover from trauma and not only recover from trauma - being able to thrive.

CHATTERJEE: Yeah.

CHRISTIAN-BRATHWAITE: And so having additional supportive, healthy relationships from other adults in their lives can only increase resilience and increase a child's capacity to recover from trauma and be able to learn how to use this experience to learn how to manage stress and potentially even find meaning in some of the great loss that they've experienced.

CHATTERJEE: Yeah. And where do you - and do you see any hope on the horizon? And if so, what's giving you hope?

CHRISTIAN-BRATHWAITE: You know, I - actually, I do see hope. I, again, have received so many calls from institutions and schools and individuals who are suddenly more aware of trauma. And, you know, I - all the time, I have principals and superintendents calling me, saying, I did not realize that so many students were struggling; I did not realize that trauma was a thing; I had - I didn't even realize that racism was trauma. And now that people are paying attention and they're more invested and involved in this anti-racism movement, more people are actually willing to invest the time and resources and manpower into trying to change that.

CHATTERJEE: Yeah.

CHRISTIAN-BRATHWAITE: And I always tell people when I consult with them, this is not a one and done.

CHATTERJEE: Right.

CHRISTIAN-BRATHWAITE: This is just the beginning of this process. This is a long-term process. Every institution needs to have a strategic plan on how to address trauma and how to address racism. And more and more people seem to be listening, and they seem to be invested in making this change. So I'm hopeful that when our students go back to school full time, they'll find that their teachers and the school are more aware of mental health.

CHATTERJEE: Dr. Nicole Christian-Brathwaite, thank you so much for your time and all the work you do. We appreciate you.

CHRISTIAN-BRATHWAITE: Thank you so much for having me.

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CHATTERJEE: Today's episode was produced by Rebecca Ramirez, edited by Viet Le and fact-checked by Rasha Aridi. Josh Newell was the audio engineer. I'm Rhitu Chatterjee. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.

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