Oklahoma kids’ mental health down in pandemic
Virus revealed gaps in treatment system
The mental health of children in Oklahoma suffered significantly during the COVID-19 pandemic, a new report finds.
The pandemic accelerated a crisis in children’s mental health and revealed gaps in the treatment system for kids, according to the report released last week by Tulsa-based Healthy Minds Policy Initiative.
Oklahoma emergency rooms were on the front lines of the crisis, seeing a surge in children with suicidal thoughts. At Integris Health, there was a 117% increase in inpatient pediatric
admissions stemming from suicide-related ER visits in 2021.
Across eight of the health system's emergency rooms, 332 children were admitted for suicidal thoughts or behaviors between January and June.
At Saint Francis Health System in Tulsa, an 84% increase was seen in behavioral health encounters at its pediatric emergency centers. About 8 out of every 10 of those encounters was for suicidal ideation or suicide attempts, according to the report.
“This tells us that COVID really exposed some gaps in our mental health crisis continuum of care,” said Zack Stoycoff, executive director of Healthy Minds Policy Initiative. “We aren't catching kids' crises at the point we want to catch them. And for whatever reason, those crises are boiling over into emergency rooms, and we think that should really sound an alarm.”
At Integris Health, the largest surge in those ER visits was around April and May, and they began to decline in the summer months. In August and September, however, those numbers began to rise again — although not to the same heights, said Allie Friesen, director of behavioral health clinical programs for Integris Health.
For many reasons, the ER shouldn't be the answer to mental health crises, she said.
“If we can work to standardize the process of how we're evaluating these kids, intervene earlier, screen them consistently so that we catch these problems before they become a true crisis situation, that will help us reserve those high-acuity beds for the patients that have no other choice,” Friesen said, noting that for years there has been a dearth of availability for inpatient psychiatric beds in the state.
Several health systems this summer reported having seen an increase in mental-health related emergency room visits across all age groups. At Mercy Hospital Oklahoma City, there was a “huge rise in people coming for issues related to depression, anxiety and suicidal ideation,” said Dr. Lance Watson, the hospital's medical director for the ER, in a July interview.
Adults have certainly suffered too: another report from Healthy Minds Policy Initiative last month found that rates of anxiety and depression in Oklahomans increased dramatically — at some points four times higher than 2019 levels. And suicides in the state rose by between 8 and 10%, with rural areas seeing a 27% increase.
Children facing major losses
The report on children's mental health included a number of sobering findings about trauma, health care access, housing and education, all of which play a role in kids' mental health.
An estimated 570 Oklahoma children lost a parent to COVID-19, based on epidemiological data, the report showed. The calculation was based on a death toll of 7,394 in mid-August, and that number has risen significantly since then.
"We really do need to to kind of wake up and think, 'What are we doing to help kids right now who have gone through this now for a year and a half ?'" said Jennifer Hays-Grudo, director of the Center for Integrative Research in Childhood Adversity and professor of psychiatry and behavioral sciences at the OSU Center for Health Sciences.
Suffering significant stress and adversity during childhood and adolescence can affect a person's health, functioning, and ability to parent down the road, Hays-Grudo said.
"Some [children], their lives will never be the same again because they have lost parents, grandparents who are caregivers for them, other significant people in their lives, and children who have have been devastated by the economic impact this has had on their families, and on their learning and development," she said.
The report also highlighted that many Oklahoma households with children — over 323,000 — delayed medical care during the pandemic. And fewer than 20% of households with children reported that the pandemic didn't affect their child's education.
Stoycoff said it's no coincidence that the state Department of Education last week reported a decline in students' test scores during the pandemic.
“It is no coincidence that as the data show us our children's mental health is declining, the data also show us our students' test scores are declining,” he said. “Until we adequately address our children's mental health needs, including in school settings, we will continue to see academic challenges.”
Recognizing the red flags
The report calls for a whole-community approach to strengthening mental health support for children, including increased school-based mental health services and making sure primary care is an entry point to mental health services for kids.
“Mental health doesn't happen in a bubble,” Stoycoff said. “It impacts every sector, every industry, every level of government, because we all deal with it. Whether you care about education or the criminal justice system or health care system, mental health has a role to play there. … Our whole community has to be engaged in the solution.”
Involving all sectors that work with kids is critical, Friesen said, because you never know when a child is going to show a sign that they need mental health support.
“The more consistently we can educate everyone — from our primary care physicians or pediatricians, to our teachers, our coaches, our church leaders — the more we can educate them on the red flags to recognize and the clear steps to take once they do identify those red flags, then we have a much greater chance of success to catch these kids before they show up to the emergency department,” Friesen said.
For parents, Friesen urged them to keep communicating with their kids, even if their children don't seem receptive, and to ask questions if they notice variations in their kids' normal behavior.