The public health crisis staring us in the face

Young people in the United States are struggling with depression as never before. The most recent national estimates indicate that this mental-health scourge has been increasing among young people since 2015 and that in 2020, prior to the pandemic, nearly one in five youth ages 12-17 had experienced depression in the past year. In comparison, the overall national estimate was nearly 10%, suggesting that for the first time in recorded history, children’s mental health is a raging public health problem that has surpassed adult depression.

By any conceivable measure, these trends had already worsened before the pandemic disrupted school, friendships and family life.

Twenty years ago, depression among children was considered extremely rare, if it existed at all — and was generally believed to be a disorder that did not affect youth until the late teens at the earliest. As a result, this was a problem that fell within the domain of child psychiatry — a small, specialized field — not within the realm of public health.

Combined with media reports documenting a lack of mental health care for all conditions among youth across the U.S., these latest numbers document an unprecedented level of untreated depression among youth. Yet the epidemic of children’s mental health still has yet to receive a prioritized, comprehensive public health response. This is a failure with tragic consequences.

Compare and contrast. It is flu season in New York, and public service announcements offer ubiquitous reminders for children and adults to get their flu shots.

If a child has flu symptoms, even mild, this is usually noticed quickly by gatekeepers (parents, caregivers, teachers), leading them to do something (e.g., refer consult a medical professional for evaluation). Even a single symptom — a fever alone — triggers adult attention and action and depending on symptoms and resources, yields prompt treatment, care instructions and follow-up.

In contrast, with depression, seeking treatment can be seen as something to be delayed and avoided at almost all costs. Studies have shown that a gap of several years between the onset of depression and treatment receipt is the norm. As a result, it is more common that treatment is not sought until depression is severe, and only then, might some professional help be deemed necessary. Early intervention and prevention, which are cornerstones of public health, still are not employed for children’s mental health on a broad scale because despite all this research, a mental health epidemic does not engender a public health response, while an infectious disease epidemic does. Even when its risks to children pale in comparison.

With flu, we have invested heavily in surveillance systems and built sophisticated digital dashboards for influenza at both the local and national level. These are used by epidemiologists and available to the public. There are extensive weekly reports on case counts, service use and other metrics, geocoded throughout the state to identify hotspots where more services should be deployed each week. The state Department of Health and federal Centers for Disease Control understand that lives are at stake and act accordingly.

In contrast, there is no comparable statewide surveillance of depression in New York or nationally. In particular, there are no data on the percentage of cases treated or hospitalizations, as depression is not a reportable condition for the state DOH or CDC. Despite the fact that this mental health crisis was evident before the pandemic and predicted to escalate after, there are no dashboards on hotspots with which we could direct services. There is still more coordinated public health attention devoted to monkeypox than to mental health.

Due to a comprehensive public health approach to infectious disease, in 2021, there were fewer than 200 pediatric influenza fatalities; influenza/pneumonia is the eighth leading cause of death among ages 10-24 nationally.

In contrast, in 2021, there were more than 6,500 deaths by suicide among young people ages 10-24, making suicide the second-leading cause of death among young people nationally.

Everyone knows what a fever is. Symptoms of depression are varied and often, but not always, quiet. Sometimes there is irritability and anger, not sadness. That can be met with punishment, not compassion, if one is unaware of the possible presentations.

What we need is early education for youth on what depression is, how to recognize it, and what do to if you need help. In addition, we need early education that regular use of common substances such as cannabis is especially harmful to mental health — will make depression and anxiety worse, and may lead to the onset of depression and anxiety, as research has shown.

This is particularly important in a city where cannabis is now openly illegally sold in convenience stores across the street from schools, completely unregulated with no enforcement of even the simplest statutes intended to protect children from increased exposure. New York State cannabis laws make California’s look strict, as here, unless the municipality has opted out of recreational sales entirely, local leaders are prohibited from enacting ordinances that put additional protections in place to avoid increased intentional or accidental use and secondhand exposure among youth that are stricter than the state law dictates.

It’s a critical moment in which young people’s mental health, already suffering, could get even worse. With the cannabis industry presenting the drug as a “treatment” for depression and anxiety, and a lack of information to the contrary, youth’s perception of risk associated with cannabis use has plummeted in recent years, and youth with depression are much more likely to use cannabis than those without.

Young people should be informed, counter to the industry’s claims, that using cannabis will not be a fix (quick or otherwise), may in fact worsen depression and will impede recovery from depression. Not only that, but we should keep in mind that depression can actually diminish young people’s ability to perceive risks accurately and act accordingly — creating a kind of vicious cycle where youth experiencing depression may be more prone to picking up cannabis and then even less likely to develop effective coping skills including, but not limited to, seeking actual professional help.

In contrast to influenza, young people’s mental health is interwoven inextricably with that of their parents, who are generally also the gatekeepers to treatment. Adults in New York City have now endured two mass traumas (9/11 and the pandemic) in the past 25 years. Trauma exposure is a strong risk factor for depression.

Adults are suffering, too, which makes it even harder to mobilize and respond to children’s needs with action — seeking care for children — which is among the most difficult parenting challenges in the best of times. To that end, a public health approach includes supportive programs and policies to facilitate access to treatments (e.g., by putting them on the street corners) which a purely clinical response does not.

Hand in hand with direct education to young people, we need education for gatekeepers — parents, teachers, coaches and others — on how to recognize depression and other common mental health conditions. We need to train gatekeepers that they should expeditiously refer children who may need help and give them the information and tools with which to do so. We should err on the side of caution. Early-stage or mild depression is much more easily treated than severe, complicated cases, further bolstering the argument for early intervention.

This can be aided by an extensive public education campaign educating the public on how depression manifests; how symptoms may not be the same in different people, that the sole hallmark is not limited to “someone who can’t get out of bed all day”; and that alcohol, nicotine and cannabis will make it worse, not better. Even though all those substances might make a person feel better temporarily, they will ultimately make it harder to recover from depression.

As we do all this, we must understand that stigma is still a huge barrier. Asking for help especially in the form of mental health care remains riddled with barriers both real and imagined.

There are national PSAs from the U.S. surgeon general about the availability of low-cost treatments. That may be the case, however we are not seeing this in New York.

In New York City, there is far more demand than availability among those who seek treatment on their own or are recommended to seek an evaluation by a school. For instance, there is a six- to nine-month waiting list — at least — for a neuropsychological evaluation here, even though in some cases, a child may be barely able to learn, benefit and/or attend school while waiting. That process alone — of waiting and remaining unable to learn and grow — can contribute to depression for a young person, depending on the conditions. For cases where such treatment is recommended, we badly need advocates to help parents and children to navigate the extraordinarily complex process of obtaining mental health services.

Prevention in the U.S. has little support. We’re expected to accept that “there is no money in prevention.” Hopefully, we can make an exception for children’s mental health when it reaches epidemic levels since we have a responsibility to advocate for those with whom we are charged to care for and protect.

Children need to feel safe. And if they are struggling, they need hope. As a community, we have a duty to provide a safe environment in whatever way we can. If you are in a position to listen, to sit with someone and be there in a time of darkness and need, do it. Hope and the feeling of being heard, and that one is not alone in a given moment may mean more than you will ever know.

Goodwin is a professor of epidemiology at The City University of New York, adjunct professor at Columbia University’s Mailman School of Public Health and a licensed clinical psychologist. Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.

Source:https://www.nydailynews.com/