SUMMARY: The response to the COVID-19 pandemic gave such deference to external circumstances and solutions, that it crowded out children’s confidence—in themselves, their relationships, and their creative capabilities. This aggravated a swelling mental health crisis for youth; a blow we may not fully comprehend for years to come.
*This article was updated on 07-15-24.
By Melanie Rae Tardell, J.D.
“Children are like wet cement. Whatever falls on them makes an impression.”
— Haim Ginott, child psychologist
If you’re fortunate enough not to know a child whose psychological health has suffered from the COVID-19 pandemic and its measures, chances are it’s an issue you’ve gleaned from the media or in everyday conversations. When one performs an online search for “children’s mental health post-covid,” the 262,000,000 returned results indicate the enormity and prevalence of the uphill battle kids face. Living through 2.5 years of perpetual uncertainty is nothing to bat an eye about for anyone, but it’s too considerable an amount of time in a child’s short life not to leave a serious mark.
Why a Child’s Psyche Is Especially Vulnerable to a Macro-crisis
Seven months into the pandemic, a developmental psychologist and professor of education at UCLA co-authored an article about the actual and potential adverse effects of the pandemic on juveniles and their developmental trajectories. Through the psychological lens of life course theory, the article explains, macro‐level crises, such as COVID-19, are especially influential on youth because extended trauma occurs during varied stages of neurobiological development, often stunting growth or manipulating outcomes.
It’s not to say that children don’t have a large capacity for resilience after trauma. After all, developing minds are malleable and can be reshaped by positive influence too. However, a child’s ability to apply resilience hedges on, amidst other factors, a child’s psychological baseline before a traumatic experience. With the burgeoning mental health crisis among children pre-existing COVID-19, the pandemic added insult to injury, creating a difficult path to recovery.
How Bad Is It? A Statistical Data Snapshot
Pre-pandemic, mental illness was the primary cause of juvenile disability and poor life outcomes in the U.S., affecting up to 1 in 5 children between the ages of 3 to 17. However, post-pandemic, juvenile anxiety and depression rose by 26% in America, prompting the U.S. Surgeon General to issue an urgent public health advisory in 2021. Meanwhile, juvenile anxiety and depression rose by a staggering 70% in California (nearly three times the country’s average) where kids in psychiatric crises have been flooding emergency departments (“ED”).
This echoes collaborative data published by the Centers for Disease Control and Prevention (CDC), reporting pediatric ED visits related to drug overdoses, self-harm, firearm injuries, and behavioral health concerns were significantly higher proportionally between 2020 and 2022 than in previous years. Most concerning has been an upwards trend of juvenile suicide; now the second leading cause of death among adolescents ages 10–14, and the third leading cause among teenagers ages 15–19.
More recently, data shows that while overall ED visits among youth decreased once most in-person schooling resumed and pandemic-related stressors began fading, acute mental health issues increased in adolescent females. This was evidenced by a significant uptick in mental healthcare visits, including ED visits, for teen girls as it relates to suicidal ideation, self-harm, drug overdoses, and eating disorders.
Key Pandemic Factors That Contributed to the Worsening of Childhood Mental Health With Few Exceptions
Children look to their elders for cues on how to respond to unfamiliar circumstances. Imagine being a child who feels panicked by an unprecedented emergency. You look to trusted adults for assurance only to learn they are just as afraid as you. The news reports people dying in masses and says not even healthy people are safe. You’re told you can’t see friends or family. Authoritative sources that you depend on to inform you are in disagreement with one another about how the crisis came about, how to respond to it, and whether it’s actually emergent at all. There is never a consensus.
Some say you should “do your part” to spare others from the consequences of the crisis, while others say “doing your part” may harm you, won’t protect others, and you should trust your gut instinct. Then just when you think you’ve begun to understand your responsibility, the rules change. It’s a disorienting reality, and that’s only the half of it. Viral-containment measures such as lockdowns, school and church closures, quarantining, social distancing, mandated masking, testing, vaccination, canceled arts and sports programs, social clubs, and milestones like graduation, prom, camps, and parties, not to mention the “on-again, off-again” of all of the above, caused stress, grief, social isolation, and major disruptions in routines.
Acknowledging Target Groups: Pandemic-based policies aimed at “stopping the spread” also created more unique issues for children in certain demographics. Less fortunate children from unstable homes suffered in silence from neglect, abuse, and even malnutrition as the pandemic prevented access to services and resources they would have otherwise had. Kids of divorced families found themselves in the middle of their parents’ ongoing battles over the safety of the COVID-19 vaccine, and whether their children should receive it.
A sharp increase in young children with cognitive and speech delays, in some cases mimicking autism, alerted professionals that long-term mask-wearing was not without consequence, as it prevented a child from learning through observation of lip-reading, facial expressions, and social interactions.
Noting the Blessings
Although the pandemic seems to have mostly harmed and not helped children, there are a few exceptions to the rule. Some children with pre-existing mental health issues found solace during the pandemic. They experienced a reprieve from daily stressors such as pressure to conform and social anxiety. Introverted or bullied kids preferred the online learning platform, as they felt less intimidated, and flourished in their studies and confidence.
Children of busy families expressed being grateful for a pause in hurried schedules to bond with their parents and siblings, and enjoy family dinners. Others reported having better nutrition or quality sleep. For the few, the pandemic allowed space to rest, grow, and reconnect.
Why Many Kids Are Having Difficulty Readjusting in an Endemic
Undeniable evidence showed the benefits of social interaction and in-person learning far exceeded a child’s risks of COVID-19, but by the time health agencies agreed, kids had already paid a hefty price. Even after stay-at-home orders phased out, and transmission mitigation measures relaxed, juvenile mental health continued to suffer. As it turns out, prolonged stress caused children difficulty returning to baseline. Like a soldier who has made it home safely after fighting in a high-conflict war, a child can physically leave the battlefield while the battle rages on inside.
In attempting to reacclimate to a “reopened” world, many children have brought new baggage with them. Some now have social anxiety due to a heightened fear of germs, or feeling insecure about rusty social skills, competing with their innate need for camaraderie with their peers. Although most children returned to school starved for connection, some childhood friendships did not withstand two years of separation, causing many kids to feel just as lonely at school now, as they did while sheltering-in-place at home.
Others have lowered self-esteem from doing poorly academically after transitioning from nearly two years of online learning to in-person learning. It is hypothesized that California decision-makers initially chose not to release the 2021–2022 standardized student test scores because results would be reflective that they failed children in an election year. However, after pushback, the California Department of Education released results on October 24, 2022, which clued in educators and parents as to where children fell behind in their studies and how severely.
Still, the latest test scores released for the 2022-2023 school year, despite a negligible improvement overall, remain below pre-pandemic levels and highlight the growing gap between student groups. Students with disabilities, who are low income, multilingual, or people of color are faced with steeper challenges in recovering academically.
Looking Forward: Challenges, Plans, and Resources
With numerous California kids struggling psychologically, and long overdue to receive help, why aren’t they being tended to? As parents and guardians have come to learn, there have been significant barriers to entry for treatment. Between the high cost of care, shortage of therapists, capacity reduction, or closures of institutions for mental wellness, and Medi-Cal’s longstanding “diagnosis first” policy for mental health services, access to care is fraught with hurdles.
As several health insurance plans don’t cover mental health preventative care services and/or private practice therapists don’t accept insurance, families are left paying out of pocket. Considering most therapy sessions cost anywhere from $100 to $250 per session, treatment is not practical or sustainable for most families, especially in this inflated economy.
Even if you can afford treatment, finding an available mental healthcare professional is a challenge in its own right. Before COVID-19, it was predicted that by 2028, California would be 40% short in supply of the demand for behavioral healthcare workers. Currently, 32% of California’s counties have no child psychiatrists at all. 2,000 Northern California Kaiser therapists, psychologists, social workers, and dependency counselors went on strike for over two months in late 2022. They reported they were unable to keep up with Kaiser’s caseload demand, putting their existing patients at a disadvantage.
Clinicians are exhausted not only because they are overworked, but also because people needing therapy are coming in with severe illnesses from mental conditions that have gone untreated. Pediatricians in California, despite their psychological training or lack thereof, have been the first and sometimes only line of defense for their patients who are struggling mentally, simply because there is a need not being filled. Families remain waitlisted for months for their child to see a therapist. Additionally, due to new federal red tape, from “California Needs to Step Up Its Support of Our Most Vulnerable Kids & Families”:
“California’s residential treatment providers no longer meet the federal interpretation of ‘“Institutions of Mental Disease (IMDs)”’ and must either significantly restructure and reduce capacity or face closure altogether.”
California had already lost more than 1,000 beds for residential treatment facilities since the pandemic began, leaving youth with severe mental health needs in the fray. Of the nearly 9 million young people residing in California, 60% are insured by Medi-Cal, California’s public health insurance program for low-income individuals and families. With this sizable youth enrollment, Medi-Cal has a profound impact, for better or worse, on juvenile health services. Regrettably, for mentally unwell youth, one of Medi-Cal’s conditional coverage policies is that a child must receive an official mental health diagnosis before they are authorized to receive mental health services. This chicken-and-egg problem is highlighted by the fact that Medi-Cal only covered roughly 5% of specialty mental health services (such as eating disorders, depression, schizophrenia, and attention deficit disorder) for its insured children, and California was ranked 48 out of 50 U.S. states for providing mental health care to children.
Although CalAIM launched in 2022 with an objective to remove some of the antiquated, bureaucratic processes that prevent young people from getting more expeditious help through Medi-Cal, staff shortages have hindered new policy implementation The mental health crisis is further exacerbated by a growing number of young adults, who experienced childhood during the pandemic, now struggling to find stability. The disconnection experienced during those formative years seems to have had lasting effects. Nearly three-quarters of young Californians aged 20-24 are not engaged in education, employment, or training. This lack of guidance and real-world experience during these crucial years is predicted to lead to long-term challenges for these young people.
Master Plan or Too Little Too Late?
Considering how bleak the reality appeared, it follows that in August 2022, Governor Newsom announced a $4.7 billion “Master Plan for Kids’ Mental Health” (“KMH Plan”) to increase youth access to mental health and substance abuse services in the golden state. Among other things, the plan boasts it will hire and train 65,000 new mental healthcare workers. In conjunction, from 2021 to present, California passed legislation related to mental health reform affecting children. Specifically, in the 2021 and 2022 legislative sessions, Assembly Bills 2317 and 2508 and Senate Bill 221 passed with bipartisan support and are now signed into law. Respectively, these policies make the following claims:
1) Develop psychiatric residential treatment facilities for youth in crisis, 2) Beef up the role of school counselors to include providing mental health support for students. 3) Require health insurers to provide enrollees with timely access to mental healthcare providers for continued treatment/care. In addition, California’s Proposition 1 narrowly passed in 2024, which includes a bond to build treatment facilities and provide housing for those with mental health issues. Although 6.4 billion has been earmarked for this plan, it’s too early to tell how it will be executed, and the extent of its impact on youth in crisis.
Critics of Newsom’s KMH Plan say it reminds them of an “arsonist who starts a fire, but then calls the fire department to put out the blaze he started.” It’s an exorbitant reform cost for taxpayers for a problem Newsom fueled by choosing to be an outlier, and keeping schools closed in contradiction with up-to-date scientific data. Even advocates of Newsom, while commending his efforts to invest in solutions, expressed, “The state is playing catch-up, having failed for years to address the spiraling need.” The most troublesome issue with the KMH Plan, assuming it will be a viable resource, is that it projects a five-year rollout, and kids in mental distress don’t have the luxury of time. They needed help yesterday.
Encouraging Healthy Skepticism
And what about the elephant in the room? The government has a less than stellar track record when involving itself in mental healthcare. Throughout U.S. history, both in the distant and recent past, federal and state agencies have not only mismanaged funding, and failed at effective implementation of healthcare programs, but also gravely harmed people in the name of mental healthcare. Federal agencies have sponsored unfathomable experiments for scientific research on unwitting mentally unwell children (and adults) under the guise of “medical treatment.” There has been severe abuse, neglect, and over-medicating of the mentally ill in state-run psychiatric institutions. Meanwhile, the state placed individuals on involuntary psychiatric holds based upon the subjective opinion of government agents. Unsurprisingly, there remains legitimate skepticism as California steps in with an aggrandized plan to aid in the mental health crisis of youth.
Although California has erred on the side of individual autonomy for those who are mentally unwell as compared to other states, Newsom’s CARE Court plan would broaden the existing mental health laws. Doing so would give more power to the state to order involuntary treatment, raising significant concerns that the state may abuse its power, regressing to past civil rights violations. Therefore, if the past predicts the future, a strong argument can be made that this juvenile epidemic won’t be overcome by political policies or plans, but instead by communities, at a grassroots level.
Resources for Your Consideration
Although the KMH plan is still evolving, the following program is now available: CalHOPE. They provide mental health and wellness resources to support CA students, including virtual behavioral health services. The good news is that traditional mental health care is only one of many tools in the toolbox. There are several effective alternative services. As the source of mental illness can be different for each child, so might the solution. Knowing this can broaden the scope of possibilities and options for a child’s healing. If you have been unable to find help for your child through traditional means, or prefer an integrative approach, the following is a list of options to consider:
- Virtual Counseling: As access to mental health care has become a country-wide issue, there are several resources available and emerging for virtual therapy sessions.
Online Therapy For Teenagers And Kids
More Online Therapy Resources - Alternative Approaches: There are several effective healing modalities that consider the interrelationship between mind, body, and spirit.
Effective Alternative Therapies - Faith-Based Involvement: Studies continue to find that those who practice faith are more resilient, and fare better with mental wellness and health outcomes.
Harvard Study: Childhood Faith Promotes Adult Wellbeing
Research: Religion Boosts Resilience In Adversity
Harvard Study: Spirituality Linked To Better Health Outcomes - Join or Start a Support Group (in-person or online): A support group is a great reminder to a struggling child that they are not alone.
National Alliance On Mental Illness: California Chapters - Meditation/Breathing Techniques: There are several free online guides and videos for meditation and breathing techniques that help to calm a child’s mind and nervous system.
Mindfulness Guide For Kids - Go Outdoors/Spend Time In Nature/Exercise: Sunlight, scenery, grounding, and movement can elevate mood.
Time Outdoors Promotes Mental Health
Health Benefits Connecting With Earth
Physical Activity Benefits Brain Health - Ask For Help: Encourage kids to seek help from a trusted adult by calling a hotline that is operating 24/7, or seek other online resources.
California Mental Health Resources
Mental Health Resources
This crisis is an “all hands on deck” moment in time, and everyone has something to offer. Be on the lookout for opportunities to help a child in distress, as your time and care could be their saving grace. “Children are one third of our population and all of our future”; they are worth taking pause over.
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Originally published on October 27, 2022.
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