Reopening schools will help, but won’t end Mass. child mental health crisis, experts say

Replacing in-person learning with Zoom has left many students struggling with isolation from friends and teachers, and logging too much screen time.Suzanne Kreiter/Globe staff

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Child health care experts say that a return to full-time in-person learning, which Governor Charlie Baker moved to mandate this week, will help alleviate some of the pressures placed on children’s mental health over the past year but will not be a silver bullet.

In pushing the state Board of Education to force elementary and middle schools to reopen, Baker cited one of the more troubling outcomes of the pandemic on kids — the dramatic increase in mental health problems among students.

Nationwide, the average share of emergency room visits related to mental health among children rose 44 percent from mid-March through October last year, compared to the same period in 2019, according to a report from the Centers for Disease Control and Prevention.

Boston Children’s Hospital reported more than 270 admissions for youths having suicidal thoughts or attempting suicide from July through October 2020; that’s a 40 percent increase over the same time period in 2019, officials said.

But experts say the state’s mental health care system for youth has long been overtaxed. The challenges are deep-seated — and will likely persist long after students return to classrooms.

“Massachusetts had a pediatric mental health crisis long before COVID hit,” said Dr. Elizabeth Pinsky, a pediatric psychiatrist at Massachusetts General Hospital. “In-person learning won’t fix the problems that existed before the pandemic, [but] I don’t know of any better single intervention.”

For years, the state has lacked adequate numbers of pediatric therapists, outpatient mental health services, and in-patient psychiatric beds, experts said. Those shortages have led to lengthy wait lists; some children experiencing suicidal thoughts had to wait in hospital rooms without any therapeutic support for days or weeks until a suitable bed opened up in a facility.

COVID then exacerbated those longstanding problems by increasing the number of children needing services, decreasing the capacity of many psych units due to social distancing, and limiting access to school-based health services for children learning remotely.

“This has been going on for several years and now is acutely exacerbated by the pandemic . . . it’s significantly worse,” said Dr. Patricia Ibeziako, associate psychiatry chief at Boston Children’s Hospital.

Baker, echoing the concerns of health experts, specifically cited mental health concerns when he announced Tuesday that the state would move to require elementary and middle schools to fully reopen this spring.

“The harms that we’re seeing are significant,” said Dr. Lloyd Fisher, the Massachusetts chapter president of the American Academy of Pediatrics. “This is a good move to do whatever we can to get as many children as we can back to in-person learning as soon as possible.”

To Ibeziako, reopening schools will likely help students’ emotional states, as they will have more sense of normalcy, routine, and social connections. But she cautions that children will still be reeling from the pandemic’s toll on their families.

“Children will not be returning to school in a vacuum,” Ibeziako said.

The state and federal governments have provided school systems with more than $1.1 billion to cover costs related to the pandemic, including mental health support for students, according to the Baker administration.

While some students have reported benefits of remote school, particularly those who felt unsafe at school due to bullying or racism, depression and anxiety have skyrocketed. And more children are coming in with eating disorders and obsessive compulsive disorder, pediatricians said.

Many students have struggled with the isolation from friends and teachers at home, as well as too much screen time. Some students have lost family members to COVID, while others have had to juggle jobs with school, or care for younger siblings in cramped apartments.

Experts urge families to ensure their children get daily exercise, maintain connections with friends, and seek mental health services, even if there are significant delays.

They also stress that preliminary Massachusetts data show youth suicides did not significantly rise amid the pandemic. Last year, 23 young people under the age of 19 died by suicide—higher than the year before but lower than in 2016 and 2017.

For many children who already had mental diagnoses, though, the pandemic has caused them to spiral.

Karin Broadhurt’s 9-year-old son is one of dozens of patients “boarding” at hospitals across the state right now who can’t get access to appropriate psychiatric care. For years, her son has struggled with mental health issues and aggression toward himself and others, leading to hospitalizations. But amid COVID, his emotional instability escalated faster when his mother tried to get him to log on to Zoom classes from their Jamaica Plain home. In late January, he needed to be hospitalized. He has been in Boston Children’s Hospital for 31 days, not receiving the counseling and medication assistance he desperately needs, she said.

“There is a very serious children’s mental health crisis right now and no one is treating it like the very serious crisis that it is,” Broadhurt said. “My kid has been sitting in a hospital room by himself. He hasn’t been outside, hasn’t been allowed out of his room. It’s like jail, except nicer.”

Meanwhile, many children who didn’t suffer from psychiatric disorders pre-COVID are now struggling.

Over the course of the school year spent online, Fabienne Eliacin has watched her vibrant, active daughter withdraw and become more isolated. The 13-year-old has lost motivation to do school work or attend her online classes at the Eliot K-8 School. The eighth-grader, according to her mother, only wants to spend her days in bed, watching anime videos, with the lights out.

“She said she wants to live in the anime world; she doesn’t want to be in this world,” said Eliacin.

Sending her daughter to school isn’t an option for Eliacin. She’s lost family members to the pandemic and fears her daughter would catch COVID-19 and bring it home to the rest of the family. She wants local and state officials to take more steps to address the safety and mental health needs of students before ordering schools to reopen. “I want my kid to be in school — just not right now.”

Yet Hathalee Higgs, of Somerville, feels differently. She says her 10-year-old daughter’s anxiety has been increasing during the pandemic. The child is nervous about going outside. She’s more sensitive to loud noises, and she has become fixated on longstanding fears.

For Higgs, the best way schools can tend to the social and emotional needs of their students is by having them return to their classrooms.

“I know the teachers are working hard and doing the best they can,” she said. “But I would say the schools are pretty maxed out with what they are doing in trying to deliver the remote learning.”

The Samaritans 24-seven crisis helpline can be reached by calling or texting 877-870-4673. People experiencing a crisis can call also the Disaster Distress Helpline: 1-800-985-5990, the National Suicide Prevention Lifeline: 1-800-273-8255, or the Crisis Text Line: Text CRISIS to 741741.

James Vaznis and Bianca Vazquez Toness contributed reporting.