Mental health care for children in need

Amanda, a 4-year-old girl, sits on the floor in front of a dollhouse in a therapist’s office. But she won’t start playing until the lights are switched off and she’s protected by the cover of darkness. Then, instead of playing make-believe like other children her age, Amanda forces her dolls to hit each other, and scream and cry.

Amanda is recreating her family dynamic in the only way she knows how — through play — as part of the early childhood mental health care she is receiving.

At first, the idea that such a young child could benefit from mental health services might seem puzzling, even counterintuitive. How can we expect a preschooler, especially one under age 5, to “get on the couch” and discuss her problems with a therapist? Why would she be able to talk about her troubled childhood when she has barely lived it?

Yet early childhood mental health services do exist, and they are increasingly seen as a vital and effective part of supporting the emotional development of troubled children.

Mental health issues emerge between birth and five due to triggers including domestic violence, violence in the community, constant stress in the home, homelessness, poverty — or a toxic combination of these elements. When young children struggle with their emotions, they frequently go into “fight or flight” mode, which can overwhelm parents and teachers. These signs are easy to misinterpret, and can result in kids who are simply reacting to anxiety and stress being labeled as “bad.”

Amanda is a client of the newly opened Brownsville Child Development Center in Brooklyn, an early childhood mental health clinic. Created and operated by the Jewish Board of Family and Children’s Services, where I work, the center serves one of the most economically challenged areas in New York City. Child poverty in Brownsville exceeds overall rates, at almost 44% compared to 31% nationally. The area is the source of a third of the city’s child welfare cases, and half of Brownsville families have lived in homeless shelters.

Amanda’s mother brought her to the clinic out of frustration because Amanda was crying all the time. She wouldn’t play with friends, was doing poorly in preschool and ran away whenever something seemed overwhelming. The reality is that Amanda can didn’t know how to control her emotions; she was highly stressed after living in a domestic violence shelter with her mother.

Parents who themselves have been traumatized — by sexual abuse, domestic violence, poverty or other damaging life events — often don’t have the emotional capacity to help their children. A crying baby can make them feel like they are being begged for something they are unable to give. Helping parents develop the emotional resources to connect with their children is a key goal of early childhood mental health care. Sometimes it’s as simple as teaching parents how to get on the floor and enjoy quiet playtime.

As a society, we have a growing awareness about the value of early childhood education, but we have only just begun to recognize the importance of early childhood mental health care. A landmark Adverse Childhood Experiences study in the late 1990s proved that traumatic events in childhood — like witnessing or experiencing violence — can lead to high-risk health behaviors in adulthood, such as smoking, alcohol, and drug abuse, and are correlated with depression, heart disease and cancer.

So the earlier we identify and treat children with mental health issues, the better chance they will have for successful adult lives.

New York City has taken significant steps to help its youngest residents. But there are still far too few mental health resources for the city’s two million children under 5 years old. According to The Citizens’ Committee for Children of New York, the Bronx has the capacity to offer mental health services to only 1% of the children from birth to age 5 who need it.

What’s more, even parents who take advantage of available resources are often forced to stop because they can’t afford insurance co-pays, or because their work shifts fluctuate from week to week, making it impossible for them to keep appointments.

When communities become engaged — as Brownsville is today — children like Amanda have a much greater chance of receiving the help they need, and of enjoying childhoods full of laughter and light rather than playing in the dark.