A syndemic refers to multiple interrelated epidemics happening at the same time. Covid-19 has unleashed and amplified a number of simultaneous personal, social, medical, political, and economic crises. This article is part three of a series of articles exploring the impact of the Covid-19 syndemic, read part onepart two and part three.

Colorado Children’s hospital has declared a pediatric mental health emergency having witnessed suicide attempts and psychiatric help-calls for children spike during the pandemic. The hospital says they have seen a 90% increase in demand for behavioral health treatment in the past two years. Despite expanding their behavioral health services, they cannot keep up with the demand. Emergency transport teams have been reporting three to four suicide attempts per week and have requested additional training on how to deal with these situations. Suicide is now the leading cause of death for children over the age of 10 in the state 

Unfortunately, the crisis is not limited to Colorado. According to the Centers for Disease Control and Prevention, the proportion of mental health-related emergency room visits increased 24% for young children and 31% for teens from March to October of last year compared to 2019 as seen in the below chart (Figure 1). Colorado Children’s Hospital Chief Medical Officer Dr. David Brumbaugh says in 20 years, he’s never seen such a demand for services.

Graph of Number of pediatric mental health-emergency visits per 100,000 in the United States.
Number of pediatric mental health-emergency visits per 100,000 in the United States. ACCESS HEALTH INTERNATIONAL. DATA SOURCE: CDC

As we begin to control and develop defenses against Covid-19, we need to give equal priority to the syndemics that have evolved from the pandemic. Covid-19 will leave deep scars on our psyche and impact the mental health of our population for years to come. I have previously written about the increase in depression, anxiety, loneliness, and substance abuse in young adults aged 18-24. But the crisis in pediatric behavioral health is just as urgent and can also lead to greater health and socioeconomic disparities later in life for these children.                                      

With the many interruptions that Covid-19 has brought to the developmental needs of children and the multiple chronic stressors, many children are losing their resilience and are sometimes unable to deal with the disappointments of everyday life. Dr. Brumbaugh has noted this worrying trend, recalling a father who brought in his ninth-grade son who tried to take his life after he didn’t get on a baseball team. Jenna Glover, MD, child psychologist and Director of Psychology Training at Children’s Colorado, said many children are “feeling a sense of hopelessness,” which is one predictor of suicidal ideation.

With the spike in mental health issues in children, organizations and medical professionals that serve these populations are overburdened and hampered by long wait lists for appointments. When parents arrive with their children in the emergency room, it is often as a last resort or as a result of untreated conditions. But emergency rooms are ill-equipped for mental health care and often the experience of staying in the emergency room is a traumatic one, further exacerbating issues. Yet what is known as “emergency room boarding” continues to rise. In Massachusetts, emergency room boarding has been up between 200% and 400% throughout the pandemic. After their release from the emergency room, pediatric patients still face long wait times for follow-up care. For children admitted for suicidal ideation or attempted suicide, they can not afford this disturbing delay in treatment. 

We must invest heavily in treatment and preventive services to begin to address this crisis. Children’s hospitals should be the last line of defense in fighting this crisis. Hospitalization is the most expensive option and least effective option and frequently comes too late to address the underlying causes of illness. We can provide training to teachers and school administrators to recognize the early signs of mental health issues, we can use school curriculums to raise awareness and provide resources. Schools can lead dialogues around stressors that have plagued children long before the pandemic such as social media addiction, anxiety about grades, and bullying. Most importantly we can create links between schools and treatment services, to address these issues at the root.