New Hampshire has seen increased demand for childhood mental health services during the pandemic.
Ken Norton, executive director of the state chapter of the National Alliance on Mental Illness, said each day an average of 16 school-age children wait in New Hampshire emergency rooms seeking hospitalization for mental health crises.
It reflects a steady increase from 7-per-day when COVID-19 began and 10-per-day in September.
On Valentine's Day, a record 51 children, ages 18-and-under, sought hospital treatment for serious depression, self-harm, or suicide risk.
"National data has shown that while we're seeing increased stress, anxiety and depression across all ages, it’s impacting youth and young adults most," said Norton during a roundtable hosted by Sen. Jeanne Shaheen on Friday. "For kids who may have missed significant academic achievements or milestones during the past year - social and developmental - this could have long-term and far-reaching impacts on their mental health."
More than a dozen mental health professionals took part in the roundtable talk.
They described a New Hampshire mental health system that was understaffed, underfunded, and falling short of meeting the needs of at-risk residents, including children whose lives have been disrupted by COVID.
"Even before the pandemic, New Hampshire’s statistics around mental health, and particularly adolescent mental health, have been worse than the national average," Shaheen said. "And the pandemic, we don’t have the specific data to confirm this, but based on everything that I’m hearing from people the pandemic has made things worse."
Dr. John Hinck, president-elect of the New Hampshire Psychiatric Society and a psychiatrist at New Hampshire Hospital, outlined the many ways that Granite State youth were impacted by the coronavirus.
"We are seeing adolescents who are suffering from a variety of COVID mental health problems. We are seeing increased depression, anxiety, self-injurious behaviors and suicidal ideation," he said, adding that those problems have occurred "in the context of COVID-related stress, isolation from friends, disruption to families, and disruption to education. The adolescents seem alienated from their friends and society."
He pointed to insufficient resources to meet the surge in demand.
New Hampshire lacks enough bed space for youth psychiatric patients. The average wait time for a hospital bed is five days, despite New Hampshire Hospital adding 10 beds in response to COVID demand.
At the same time, the state faces a shortage of nurses and mental health professionals. New Hampshire’s community mental health centers have more than 200 vacancies. Insufficient workforce not only limits access to services, but slows the implementation of the state’s 10-year Mental Health Plan.
Hinck called on the federal government to provide additional funding to improve and expand New Hampshire’s mental health system.
"Clearly we need better access to mental health services, in both in-patient and out-patient settings," he said. "Regarding in-patient care, I would recommend the restoration of bed capacity that has deteriorated over the years. Years ago there were many hospitals willing and able to treat children and adolescent psychiatric patients. Today only New Hampshire Hospital remains among them. We simply need more child and adolescent beds, so that our youth and teens no longer have to wait so many days for the care that they need."
He continued, "Regarding outpatient services, I would recommend increased funding to community mental health centers so youth may receive timely [treatment]. We need to have a better continuum of care to try and treat youth and teens where they are at, including home-based and school-based care models. We need more mobile crisis units, partial hospitalization programs, and psychiatric treatment facilities to better match the youths needs with the right type, and right setting, of treatment."
Maureen O’Dea, president of the New Hampshire School Counselors Association, said early interventions were key.
Working with students at a younger age has long-term benefits, she said, but noted that the state’s elementary schools have an average student-to-counselor ratio of 500-to-1.
Touching on the topic of equity, she said the ratio was worse in poorer communities.
"Depending on where you live, where you grow up, you have different access and that’s unfortunate," she said.
To alleviate those and other issues, New Hampshire schools will receive $350 million through the latest federal COVID relief package, and those funds can go towards school-based mental health services, Shaheen said.
Heather Moquin, CEO of New Hampshire Hospital, said the pandemic has revealed the important role that schools play in children’s mental health.
"From what we’re seeing from kids that are being referred, it really seems to be a direct correlation to the isolation. We’re just seeing more and more how important that school community is for kids across the state. Anything we can do to support the schools in the long range will help," she said.
Annette Carbonneau, a senior program manager for the North Country Health Consortium, talked about the pandemic’s impact on children in northern New Hampshire, including Coos and Grafton counties.
"We are finding that our youth in the North Country are saying that they are restless. COVID has been hard, they are stressed, they are looking for outlets," she said.
In order to help local kids, she said, it is important to remove the stigma surrounding mental health. If young people feel comfortable talking about it, they are more likely to access treatment.
"We need to make mental health something we can talk about. If we can get people to talk about mental health the way they talk about having a sore throat, we will then be able to connect people to help," she said.
Carbonneau and others talked about the wide-ranging factors that contribute to mental health — such as home and food security, social connections, family stability and substance abuse treatment — which have been disrupted by COVID.
She said all those factors were part of the same mental health puzzle, and should be addressed together.
"The concept is we are looking at children, youth, families as whole people. If you’re homeless, that’s going to impact your mental health. If you can’t eat, that’s going to impact your mental health. If you can’t get a dental appointment, that’s going to impact your mental health. All of these pieces," she said.