The demand for urgent mental health care for children and adolescents has doubled with the pandemic
Summary
The mental health of children and adolescents has been particularly affected by the COVID-19 pandemic. At a crucial time in their lives when interpersonal and group relationships are key, a significant increase in anxiety disorders, behavioral disorders, eating disorders, self-harm, and suicidal ideation has been observed in this population group. Mental health emergency services have had to manage a high demand for care, both for new cases and for cases that worsened in recent months. This has been a significant challenge that required a tremendous capacity for response and a restructuring of the service.
The COVID-19 pandemic has been a stressful situation on all levels. The disease itself, as well as the associated recommendations and restrictions that are still being implemented to protect the population, have had an impact on the mental health of society.
Among this population are adolescents, a group more susceptible to being affected. Adolescence is a crucial time in which social contact is very important. The opportunity to interact with peers and to feel a sense of belonging to a group distinct from the family are essential aspects of this stage.
Measures to curb the transmission of COVID-19, such as the months-long suspension of in-person and extracurricular classes, the return to in-person classes with social distancing, limitations on the number of people at gatherings, and changes in how we interact (total confinement at home, mask use, social distancing, etc.), are crucial in controlling the pandemic, but they represent significant stressors for adolescents. These factors can lead to feelings of isolation and loneliness, and contribute to emotional distress.
New cases and worsening of mental health disorders
Since the start of the pandemic, there has been an increase in the number of users (visiting once or more) of the child and adolescent mental health emergency service, as well as the severity of the clinical conditions they have presented.
Regarding the increase in children and adolescents treated in the mental health emergency department of the Sant Joan de Déu Hospital in Barcelona , in 2021 we have observed an increase of up to 47% compared to the same period in 2020.
There has been an increase in initial consultations for individuals presenting with symptoms or clinical conditions related to mental health. Some of these cases may be attributable to the onset of symptoms caused by the environmental stress of the pandemic. Others are due to an exacerbation of symptoms that had been present for some time but which, under baseline conditions, had not previously warranted specialized care.
A worsening of conditions has also been detected among children and adolescents already receiving follow-up care within the mental health network, caused either by the direct consequences of the pandemic (fear, uncertainty, etc.) or by indirect ones (reduced in-person care at community-based services, loss of social activities that acted as protective factors, etc.). This deterioration has shifted consultations from community care to hospital emergency departments.
The increase in the number of adolescents receiving care, who are experiencing mental health conditions, and the greater severity of these conditions, has directly impacted a higher demand for hospital admissions to the mental health unit. At Sant Joan de Déu Hospital in Barcelona, an increase of up to 73.91% was observed when comparing the first quarter of 2020 with the same period in 2021.
Anxiety, self-harm, and eating disorders
The main reason for consultation in mental health emergencies is usually behavioral problems (disruptive or self/other-aggressive), with the most frequent diagnoses being conduct disorder, anxiety disorders and suicidal ideation or attempt.
During the pandemic, many children and adolescents experienced emotional and behavioral problems , predominantly anxiety symptoms (they were nervous, restless, irritable, with varying changes in appetite and sleep). Some were experiencing these issues for the first time, while others sought help due to a worsening of pre-existing symptoms, which in some cases were already being addressed by the community mental health network.
Anxiety in childhood and adolescence
In most of these cases, the anxiety or depressive symptoms they presented fell within the category of what we know as adjustment disorders, that is, stress-related conditions. When a person is subjected to more stress than they would normally expect (in response to a highly stressful or unexpected event), significant symptoms (emotional or behavioral) may appear that interfere with their family and friendship relationships, or with their academic performance.
Although self-harm and eating disorders were already prevalent among emergency department patients before the pandemic, a significant increase has been observed during the pandemic and continues to this day. Regarding eating disorders, in addition to the significant increase in cases, there has also been greater severity.
In the case of people treated for suicidal ideation or attempt , despite the increase there are no clear differences in terms of greater severity.
Coping with demand and professional challenges
Managing a health crisis inherently creates many professional challenges in the healthcare field.
In the field of mental health emergencies, an enormous capacity for reaction and reformulation has been required from the outset to cope with the increased demand and severity without compromising the quality of care. This is why a paradigm shift in child and adolescent mental health emergency care has been necessary.
On the one hand, it has been necessary to analyze emerging needs in order to redesign parts of the emergency care pathways and adapt them to the new situation. For example, one of the challenges has been managing the increased waiting times (due to the number of patients and the severity of their cases), since longer waits can cause discomfort and worsen symptoms.
On the other hand, within the framework of the multidisciplinary approach , the service has had to be provided with more support staff during peak periods (additional psychiatry and social work staff, as well as the inclusion of a mental health nurse). This possibility of addressing the issue through different disciplines trained in the field of mental health, while always necessary, has become even more important given the urgency of adequately addressing existing deficits in the community during the pandemic (initially related to the restrictive measures implemented to control the pandemic and the subsequent saturation of services once normality was restored).
Being able to intervene urgently in different areas of the lives of the people who consult us aims to reduce the symptoms that interfere with the lives of our users and their environment in a faster and more robust way (taking into account the multifactorial nature of mental health pathology), contributing to an improved prognosis and facilitating a de-escalation in community intervention, which is the most natural way to support the population that requires our attention.
Towards an expected normalization of the situation
The increased demand for child and adolescent mental health emergency services is a reality already known to the general public through the media. This pandemic seems to have raised societal awareness of the importance of mental health.
Even before the health crisis, Hospital Sant Joan de Déu Barcelona was already committed to contributing to the prevention and comprehensive care of mental disorders in childhood and adolescence , as the onset of mental health problems at these ages can have a significant impact on adult life. Prevention and early detection of mental disorders in childhood and adolescence are crucial, representing an investment in the future in terms of prevalence, morbidity, disease progression, and school failure rates, among other factors.
Knowing the most frequent reasons for consultation and diagnoses in emergencies (all framed within the context of the pandemic and bearing in mind the multifactorial nature of it), it is expected that the evolution of the pandemic towards its resolution will entail a natural return to the previous situation: we have more knowledge of what is happening and, therefore, less uncertainty.
Meanwhile, community services have been gradually resuming normal operations, practically at pre-pandemic levels, but are still experiencing a high demand from first-time patients arriving with more severe needs. Everything suggests that it is only a matter of time before the situation normalizes and directly impacts the number of children and adolescents requiring urgent care.
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