By Dr. Arshia Qaadir
On a recent day at his pediatric office in Vienna, Virginia, Dr. Michael Martin noticed something unusual about his schedule. “Twenty-five percent of my visits that day were related to mental health issues,” said the president of the Virginia Chapter of the American Academy of Pediatrics. “During the winter and with the stressors of school, it might not have caught my attention — but this was the beginning of summer.”
Unfortunately, this has become the new normal during the COVID-19 pandemic, which has exacerbated an existing problem.
Emergency departments were already seeing a 60 percent increase in mental health visits from children over the past decade. Since the pandemic began, nearly a third of parents have now noted their child’s mental health being adversely affected.
An overwhelming majority of children reported feelings of loneliness or isolation, while others cited trauma, grief and loss as contributing factors to increased anxiety and depression. A June mental health screening in Virginia found 16 percent of adolescents had increased suicidal risk. Moreover, prior research has shown that in the immediate aftermath of disasters, including pandemics, as many as half of children may develop mental health problems, with a six to 10 fold increase in Post Traumatic Stress Disorder.
Coupled with this evidence is the stark reality of a mental health system that is stretched beyond capacity. In Virginia, more than half of our state’s counties lack even one child mental health provider. Prolonged school closures are also disrupting access to counselors. Approximately 100,000 children in Virginia suffer from mental health problems, and yet we rank 47 out of 50 states in access to mental health services for youth.
As pediatricians, we have been serving on a unique type of front-line as this disparity increases. We are frequently the first, and sometimes only, available option for seeking help, and often it is in our offices where unrecognized mental health concerns are first uncovered. Yet we are not traditionally trained for this role. In fact, over 65 percent of pediatricians polled felt they lacked adequate mental health training to address this need.
Recognizing this challenge, Virginia established the Virginia Mental Health Access Program in 2018. This program was designed to equip primary care physicians with the tools needed to effectively care for children with mental and behavioral health needs. By providing educational workshops, a direct psychiatric consultation line, a regional coordinator to help navigate services, and the use of telepsychiatry to reach underserved areas, VMAP gives pediatricians the support needed to manage these patients in their own offices. In its first year alone, over 200 physicians were trained, and over 82 percent of these were able to successfully treat patients without a need for referring out, offsetting the burden of care.
Yet it is this vital program that is in jeopardy of losing a critical amount of state funding. During the 2020 Virginia General Assembly session, the legislature passed a budget that included additional funding for VMAP; the $4.22 million a year allocated would have allowed VMAP to expand statewide and connect more children to mental health services.
Unfortunately, as a result of the pandemic and its economic impact, this funding was “unallotted” in April. On Aug. 18, the Virginia legislature will reconvene for a special session to determine budgetary priorities in these unprecedented times. Any additional cuts would effectively halt the program’s current progress.
If we have learned anything from the current pandemic, it is that preparation for an impending public health crisis is paramount. We know a mental health epidemic is already in formation. We also know that toxic stress and adverse childhood events, when experienced at an early age, cause life-long psychological and physical health consequences.
And we know that early intervention is the key to preventing these detrimental outcomes. As lawmakers, as pediatricians, as parents – we are the voice for our children. While safeguarding a mental health program may be easily overlooked in the midst of a pandemic, it is in fact one of the most critical policy decisions we must make at this moment in order to protect the future of a generation.
Dr. Arshia Qaadir is a board member of the Virginia Chapter of the American Academy of Pediatrics.