A COVID mental health crisis

Some months ago, Joshua Payne couldn’t take it anymore.

The Fairport resident and 20-year-old student at SUNY Oswego, who suffers from obsessive-compulsive disorder and attention deficit hyperactivity disorder and had them under control, was pushed to the edge with the pandemic. Payne was now batting with yet another mental health affliction: suicide ideation. 

Payne is not alone. Rochester-area adolescents and young adults have suffered psychologically at the hands of the coronavirus pandemic.

“The pandemic has really exacerbated feelings of uncertainty and feeling overwhelmed,” says licensed clinical social worker Kara Juszczak, co-owner of Tree of Hope Counseling. 

Of the patients aged 10 to 24 years, who have turned to the organization for treatment since March 2020, 75 percent have done so because of pandemic-related issues, including some form of anxiety or depression. In some cases, they’ve had thoughts of committing suicide.

“I’m seeing more gestures, more time and energy kind of spent on those types of thoughts,” Juszczak says.

The danger to those harboring such thoughts is real. While current data isn’t readily available, suicide ranked as the second-leading cause of death for U.S. adolescents and young adults in 2019, according to the Centers for Disease Control and Prevention. In 2019, one death by suicide happened almost every 11 minutes in the United States.

Prompted by such findings, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association in October declared a national emergency in child and adolescent mental health.

“As health professionals dedicated to the care of children and adolescents, we have witnessed soaring rates of mental health challenges among children, adolescents, and their families over the course of the COVID-19 pandemic, exacerbating the situation that existed prior to the pandemic,” the declaration reads.  

In December advisory, U.S. Surgeon General Vivek Murthy termed it the nation’s youth mental health crisis.

“Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression and thoughts of suicide,” he said. “COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating.”

Last month, the Department of Health and Human Services, through its Substance Abuse and Mental Health Services Administration, said $282 million has been allocated to help transition the National Suicide Prevention Lifeline from its current 10-digit number to a three-digit dialing code: 988. The funds will be used to strengthen the existing Lifeline network and boost staffing at crisis call centers in states.

“As we continue to confront the impact of the pandemic, investing in this critical tool is key to protecting the health and wellbeing of countless Americans—and saving lives. Giving the states a tool to prevent suicide and support people in crisis is essential to our HHS mission of protecting the health and wellbeing of everyone in our nation,” said HHS Secretary Xavier Becerra in a statement. “We know that remembering a three-digit number beats a 10-digit number anyday, particularly in times of crisis, and I encourage every state to rev up planning to implement 988 for the sake of saving lives.”

A vulnerable population

A SAMHSA 2020 National Survey on Drug Use and Health found 4.9 percent of adults aged 18 or older had serious thoughts of suicide, 1.3 percent made a suicide plan, and 0.5 percent attempted suicide in the past year. Among adolescents 12 to 17, 12 percent had serious thoughts of suicide, 5.3 percent made a suicide plan, and 2.5 percent attempted suicide in the past year, the report says. People of mixed ethnicity reported higher rates of serious thoughts of suicide.

It is evident that many have felt the negative effects of the COVID pandemic and the economic and social changes it has wrought, from the loss of income to the inability to see friends and loved ones. Adolescents and young adults can be particularly vulnerable to the pandemic’s ramifications, in part because of the changes they experience during the maturation process. 

“We’re talking about (a) stage of life that … is about identity development,” Juszczak says. “Those teen, preteen and young adults are really relying on relationships to learn about themselves and who they are—their sense of self.”

The need to avoid infection via face-to-face contact with others has prevented some adolescents and young adults from making those important connections. Participation in classroom instruction, graduation ceremonies, social gatherings, family outings, sports events and other activities were either curtailed or eliminated. 

“The changes (and) restrictions are inhibiting some of the experiences that are critical to that stage of development and are really an essential part of experiencing competence and achieving developmental milestones,” says Peter Wyman, academic head of the University of Rochester School of Medicine and Dentistry’s child and adolescent psychiatry division.

Such losses could be driving up levels of depression and anxiety among younger Americans. Researchers examined the emotional states of 451 youths and young adults during two periods: December 2014 to July 2019 and late March through mid-May 2020. All the subjects were living on Long Island, an early epicenter of the pandemic.

The 2021 study found that less than 5 percent of participants presented symptoms of depression during the first period examined, and 25 percent showed symptoms of generalized anxiety. During the second period, when COVID was raging through Long Island, those two measures came respectively to 10 and 40 percent. 

Those who suffered from pre-pandemic depression or anxiety disorders may be particularly vulnerable to the pandemic’s effects. As many as 75 percent of the Tree of Hope patients who were suffering depression when the pandemic hit have felt their conditions worsen. 

“The level of loss has really compounded … some pre-existing feeling of depression,” Juszczak says.

Higher levels of such disorders in turn can lead to more serious consequences for adolescents and young adults. Both have been found to be associated with suicide.

“When we get really into that mode, we don’t think as well, we become reactionary,” says William Pearson, program manager for child/youth mental health at Rochester Regional Health’s Genesee Mental Health Center. “I may make a bad decision. My bad decision could be suicidal.” 

Troubling trends

The mental health treatment provider serves those five to 21 years old at its Rochester offices, as well as offering treatment at local schools. Suicide was already considered to be a serious problem among U.S. adolescents and young adults prior to 2020. From 2007 to 2017, the suicide rate for those 10 to 24 years old rose to 10.6 per 100,000 population, a nearly 56 percent increase. 

Though suicide rates among adolescents and young adults during the past two years is still being researched, a recent Centers for Disease Control and Prevention study indicates that the pandemic might be driving more 12- to 24-years-olds to think about taking their own lives. 

The CDC’s researchers discovered that the mean number of weekly visits by those in the 12-17 age bracket to emergency departments for suspected suicide attempts has increased by more than 39 percent this winter compared to that of 2019. The rate at which 18- to 25-years-olds have visited emergency departments for suspected suicide attempts during the current winter has also risen substantially compared with the winter months of 2019.

Local mental health professionals say they have seen the effects of the pandemic first-hand among their patients. 

“We’ve seen an increase in discussion (of) ‘I can’t take this anymore,’” Pearson says. “We’re seeing a significant number of kids with high acuity, (a) high need of having some supports, intensive services of a therapist, to continue to function.”

Patients who have histories of suicidal ideation in some cases have been more affected by the public health crisis. 

“About one-half of patients with pre-existing suicidal ideation experienced an increase in frequency and intensity of suicidal ideation,” Juszczak says.

For Payne, things took a turn in his second semester at SUNY Oswego. The college was forced by the pandemic to severely limit all face-to-face contact among students and staff members. He suddenly found himself alone in his dorm room, taking classes on Zoom.

“You weren’t allowed to go out and see other people, so I got really lonely and, like, depressed,” he says.

Neither he nor his parents thought the situation would last, and Payne’s room and board had already been paid for, so he stayed on campus.

“It was just something I thought I could handle,” he recalls.

For the remainder of his first year on campus and through his second, Payne spent nearly all his time alone in his room, but for breaks and vacations. Though he “met” with Juszczak every three weeks by telephone or online, the confinement worsened his OCD. He found himself repeatedly engaging in such actions as turning his room’s light switch on and off and washing his hands.

“A lot of the things … I had obsessive thoughts about were, like, family health,” Payne says. “If I don’t wash my hands, someone I know is going to get COVID, or someone I know is going to pass away from COVID.”

Payne’s ADHD also grew harder and harder to control.

“I had the TV right there, or had easy ways to avoid doing classwork,” he says.

Under the pressures caused by his difficult living situation and disorders, Payne’s depression worsened. Early this year, he found himself searching through his room for something he could use to commit suicide.

“I was in the phase of looking for a knife, or whatever I was going to use,” he says.

Luckily, a friend notified SUNY Oswego of Payne’s condition. The college sent campus police officers to make sure he was safe and put him in touch with an on-campus counseling service. In addition to continuing to meet with Juszczak, he received therapy from peer counselors who were living in his dorm. Eventually, the crisis passed.

By the time Payne returned to college in August, he was once again able to attend classes in-person and participate in on-campus recreational and social activities. Instead of staying alone in a room, he took an off-campus apartment with other students.

“I’m doing a lot better,” he says. “I’m living with pretty good friends now.”

The lifestyle changes, coupled with the counseling he has continued to receive, have helped Payne keep his OCD and ADHD under control “for the most part,” as he puts it, despite the pandemic.

Increasing contact

Local mental health treatment providers have tried to respond to the increasing needs of local adolescents and young adults. Juszczak says that 1,400 of the more than 3,000 new patients that Tree of Hope projects adding to its roster before the end of this year are expected to fall within the age range of 10-24 years.

Pearson’s program, which had just 110 patients in treatment in July 2020, expected to have about 500 at the beginning of December. The program, which had just five therapists in mid-2020, plans to have 17 on its roster by the end of January, and to increase the number of times its therapists meet with their clients each week. 

“We’re identifying that we need a more hands-on (approach) with them,” Pearson says. 

The program’s school-based therapists, who used to meet with clients once a week, now do so twice weekly, or more. 

Contacts of this kind can help children, adolescents, and young adults ward off some of the pandemic’s effects on mental health, even if the contacts are not with counselors or therapists.

“There’s strong evidence that young people who have positive and strong connections with adults are more protected from suicidal behavior and suicidal thoughts,” Wyman says.

Parents can be the first line of defense against such thoughts and behaviors.

“Open up the conversation, and have parents be asking, ‘What kinds of things are you thinking about? What are you feeling?’” Juszczak says. “Helping kids put words to their feelings is always important.”

Parents should also be on the lookout for signs that their young or older children might be in danger of committing suicide. Those signs include mood swings, increased use of alcohol or drugs, and the outright expression of a desire to take one’s own life.

Parents who fear that their children might be considering suicide should contact mental health professionals. When the risk is great, they can call 211 Life Line, or the National Suicide Prevention Hotline.

As the Delta and Omicron variants ravage the state, Payne worries that he might have to return to Zoom college classes before the school year is out, increasing his stress. 

“They might go back to doing lockdown stuff,” he says.

Mike Costanza is a Rochester Beacon contributing writer.