The Other Epidemic

In February, the boarding school called. Fifteen-year-old Brooke* had been there for two weeks, attending high school classes in person for the first time since Covid-19 quarantine, eating alongside the girls in her dorm, living under the watchful eye of the dorm parent.

Or so Brooke’s mother, Laura, had believed.

“When I got there, she hadn’t slept or eaten for four or five days. She wasn’t showered. She was becoming delusional,” says Laura, who lives with her husband and two daughters in Stamford. Brooke wanted to take her life, Laura learned. “When I looked at her, I knew there was only one place I could take her, and that was to the hospital.”

Laura drove her straight to Yale New Haven Hospital’s pediatric emergency room in New Haven, where about two dozen other youngsters awaited help for mental health issues. Laura and Brooke “lined up in the hallway,” Laura says, waiting their turn.

A few months later, Laura rode shotgun in an ambulance, this time to Stamford Hospital. This time, her eleven-year-old, Violet, had swallowed a bottleful of Motrin and then called the suicide hotline. The hotline called Laura, who called 911. They made it to the hospital quickly, but it was so busy there that it was difficult to find a “watcher,” someone to stay beside Violet to make sure she didn’t harm herself. “At one point, both of our children were hospitalized at the same time,” Laura says. “My husband and I were so distraught. We’d never had issues like this before!” When their girls were discharged, the couple contacted therapists and counseling programs, adding their names to long waitlists. Everywhere, the same result: We’re full. “There was nothing you could do. I wish I could scream from the mountaintops how difficult it’s been to have children hospitalized,” Laura says.

While Covid-19 has hogged the headlines over the past two years, many families here in lower Fairfield County have battled a second, silent epidemic: a mental health scourge plaguing kindergartners through college students. In May 2020, as Covid-19 stole proms and silenced stadiums, a Fairfield teen whom friends described as funny, gentle, sweet and filled with music, died by suicide. In February 2021 a Fairfield teen with a ready smile and a love of lacrosse died by suicide. In April, a Darien teen died by suicide. He was a poet, a wrestler, a Boy Scout. The Connecticut Chief Medical Examiner’s Office reported thirty deaths by suicide among ten- to twenty-four-year-olds in 2020, and thirty deaths through September 2021. Since the pandemic began, some experts estimate that thousands of our state’s children, teens and college-age kids have tried to take, or considered taking, their lives.

“Depression and anxiety among adolescents had been going up prior to the pandemic; among emerging adults, it was already skyrocketing,” says Dr. Frank Bartolomeo, the director of adolescent services at Silver Hill psychiatric hospital in New Canaan. “The pandemic was sort of like the tipping point in pushing things over. If you were already suffering or prone to anxiety, that just made it worse.”

In the spring of 2021, emergency room visits due to suspected suicide attempts by teens jumped nearly a third nationwide compared with 2019, according to a report in June by the Centers for Disease Control and Prevention. In the fall of 2021, after kids returned to school, emergency room visits for immediate mental health needs tripled at Connecticut Children’s Hospital. Here in lower Fairfield County, clinicians at emergency rooms and psychiatric hospitals in or serving the county report being “at record highs,” “overflowing with pediatric psych cases” and “bursting at the seams” with kids who are depressed, anxious or suicidal.

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MAKING THE CONNECTION
At Silver Hill, mid- to older adolescents represented the first wave of patients during Covid-19, “kids who were deprived of rites of passage,” says Dr. Bartolomeo. An influx of thirteen- to fourteen-year-olds followed. Normally, these kids are busy defining themselves through social interactions, such as lacrosse practice, dance class or hanging out at the skate park. But the pandemic limited those gatherings. “Since the job of adolescents is to develop a sense of identity, there was a lot of ennui and emptiness. If you visited the hospital, it was not what you imagined; it was like a dystopia.”

During his freshman year at college, eighteen-year-old Finn was thriving. The Westport resident was a top-ten college-division fencer, wrote for the university newspaper, and was looking into future internships. “I was doing well in school and was really, really social on campus. I was always hanging out with other people. I had a huge life,” he says. “And then suddenly it all got shut down.”

Covid-19 sent Finn and his classmates home for spring break—where they stayed for the rest of the semester, attending classes on Zoom. Finn’s anxiety grew in this isolation, his doctors prescribing this medicine then that one. He grew lethargic. He gained weight. The day before Finn was to return to campus in the fall, the school emailed students, informing them that remote learning would continue. So he transferred to a university close to where his family has a winter house, hoping for social interaction. At that school, though, if he was caught socializing in someone’s dorm or connecting outside of his bubble, he risked suspension. So he holed up in the house.

All of his classes but one were online. The in-person option “was very bleak inside the classroom and was often worse than being online, where at least they had breakout rooms,” Finn says. “I have a really bad anxiety disorder, and with all that isolation, it became a lot worse. It was just me alone with my thoughts.”

Those thoughts focused on ways to kill himself. “I would be making sandwiches at the deli” where he worked part-time “and thinking of it. This was how I coped with my brain torturing myself. I thought if it got too much, I could just end it.”

One weekend, while visiting his girlfriend, he tossed and turned all night as a loop of life-ending scenarios robbed his slumber. Around 3 a.m. he had had enough. He hunted down a train schedule to find the next one in, so that he could stand in front of it and end his misery. But his girlfriend woke up and refused to let him leave. The next day, he was in the Norwalk Hospital ER, which began a cycle of ER visits, new prescriptions, more panic attacks and different rounds of drugs, as Finn searched in vain for a spot in an intensive outpatient program (IOP).

ONGOING CRISIS
In the continuum of care, kids in crisis may go from a doctor’s office or from home to the emergency room, where a clinician will evaluate them to determine if they pose an immediate harm to themselves or to someone else. Depending on the evaluation, a person is released or admitted. The person is stabilized, then sent to look for more help. This could be to an in-patient residential program, a partial hospital program (PHP) or an IOP. Says Laura, “You’re released, but there’s a waitlist for the IOP, and so you’re back in your room, trying to tread water. And by the time the IOP starts, it’s on Zoom, in your room, three hours, three times a week.” Laura’s oldest daughter lasted two weeks in one IOP before someone called to warn that Brooke was a threat to herself. So back to the ER she went.

Adolescents and young adults have filled intensive outpatient programs at the Anxiety Institute of Greenwich all pandemic long. Last summer, in 2021, the waitlist shortened to about thirty days. But when schools reopened to in-person classes, phone calls surged anew.

“We’re getting twenty, twenty-five, thirty calls a week,” says Dina Nunziato, LCSW, the Anxiety Institute’s clinical director. “We’re seeing a new crop of clients who tried to go back to school in person and are really struggling. It’s not that easy to transition back. We’ve got a lot of students who are still on high alert. They’re not feeling particularly safe. Children, adolescents, young adults—we all need a consistent message on how to feel safe.”

So many factors have contributed to teens’ and adolescents’ anxiety during Covid, concern for loved ones’ safety foremost among them. Add to that, staring at a screen all day, with all the comparisons it invites, torments many anxious kids. “It’s like looking at a mirror all day,” says Dr. Bartolomeo. Your skin is broken out and your friend’s is clear. Your room is littered with your little sister’s stuffed animals, while your classmates’ look like the decorator just left. When school is “out” and there’s nowhere to go, thumbing through everyone’s pretty pictures on social media can drag a kid even lower.

In lower Fairfield County, even without Covid, the competition and pressure for kids—and parents—to succeed “is enormous” to begin with, says Nunziato. People pile more, more, more on their plates, until they’re “teetering on the edge. At some point we have to change the narrative.”

Like their parents, many kids here believe that all their hard work will lead to a payoff. “But the payoff has been stripped away by something beyond your control,” Dr. Bartolomeo says. Coming from an affluent family actually exacerbates the problem. “Kids with affluence who have had very protected lives haven’t had those negative experiences that you can draw and learn from.”

Busy kids—especially the athletes, the dancers, the debaters, the actors and actresses, the strivers and thrivers—have found themselves at sea. “One way in which people manage stress is by moving or doing something. A lot of our students were on teams, where they got physical exertion as well as the support and camaraderie of the team. It was a way to express and vent the anxiety, and a way to get the endorphins kicking in,” says Nunziato.

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PRACTICE, NOT PERFECT
Laura’s youngest daughter was a competitive swimmer. Though practice continued during the pandemic, Violet grew more anxious and eventually quit the team. She retreated to her room, attending classes virtually and keeping to herself as her family scrambled to get the care that her sister, Brooke, needed. Brooke was home, on suicide watch, and her medications weren’t working. Each day, Laura kept vigil beside her older daughter. Each night she slept on the couch in the hallway outside of Brooke’s bedroom.

When school started again, Violet returned to the classroom in person. One day she showed her mother her finger: “I got a paper cut today,” Laura recalls her saying. “I remember thinking, Wow, that must have been cardstock. It was a weird shape.” The next time, Violet told her mother the cut wasn’t an accident: She was cutting her fingertips with scissors at school. “I was thinking, Oh my God, how is this happening? What is happening that is making you so distraught?” Laura recalls. “I tried to get her in to see her pediatrician, but they couldn’t see her.” Brooke’s psychiatrist recommended three colleagues for Violet, and they were all full. “I reached out to at least twenty people—that charged $500 an hour—and none of them were taking any new patients,” Laura says. “Not a single one would take me.”

Stories like this make Wendy Ward, of Darien, sad, angry and frustrated. But not surprised. Throughout his adolescence and teenage years, Ward’s son struggled with mental illness, which remained undiagnosed despite regular visits to the pediatrician and daily interactions at school. When his illness finally became apparent, “our world blew up,” Ward says. Now, she wonders, Why do we wait until a child is in crisis to find help for him or her, when we can step in much sooner to assess mental wellness? Why must everyone scramble to prevent another episode, when the first one might have been avoided to begin with?

“Systemically, we’re looking at the problem too late. We don’t screen for cancer at stage 4. If a child is in the ER, they’re at stage 4. Why are we trying to solve the problem then? We’ve got to look at this much earlier,” she says.

Early detection of mental illness is not only Ward’s passion, it’s now her work. In 2021 Ward founded futuresTHRIVE, a web-based mental health screening tool built on a gaming platform that doctors, schools and families can use to identify indicators and risk factors for mental illness. The tool establishes a baseline for a child, and when the child’s anxiety spikes, parents can reach out and get help. “Time and time again, you hear, ‘I waited too long.’ But why?” Ward says.

Assessing a child’s mental health could be just like checking vision, hearing and weight as part of an annual physical, Ward says, “but, for the most part, it doesn’t happen until the age of twelve or so here in Fairfield County, if it happens at all.” She reports a nine-year gap between the onset of mental illness and the eventual diagnosis. “Would we ever let that happen with cancer?”

Regular checkups at the doctor’s office could also temper the taboo for families whose kids are mentally ill. While parents willingly share their distress when, for example, their child spends the night in the ER with an allergic reaction to peanuts, “we’re not running around saying my child was in the ER because of a mental health issue,” Ward says. Some parents have upped their drug and alcohol intake during the pandemic, and their kids have followed suit. “The older kids are suffering to begin with, and now you’re adding comorbidities: access to drugs, to pot, to alcohol, especially in a town with money,” says Ward.

Evan Pagano, of Darien, co-facilitates a support group for NAMICAN (National Alliance for the Mentally Ill, Children and Adolescents Network) in southwest Connecticut, where parents and caregivers of children and adolescents with mental health issues gather for information and support. Prior to Covid, the group met monthly in Greenwich and in Westport. Since Covid, though, the group has gathered weekly on Zoom. “We’ve seen a large number of people, and the kids have, to a ‘T’, pretty severe mental illness. More kids are depressed and cutting. There’s a lot of isolation and uncertainty. The kids are hospitalized or in crisis,” Pagano says.

Living in lower Fairfield County can add to the problem. “There’s pressure to be perfect, to have everybody’s life look like their Instagram account. Everybody has to put their best face forward. You go to the store and chat with acquaintances: They’re listing all the accomplishments and the normal things their kids are doing, and where do you start? You don’t want to be Debbie Downer in the grocery store. Even if you find a way to gloss over it, as a mom it’s a knife to your heart just thinking of the comparison.”

Helping other parents connect during the pandemic has been both rewarding, and heartbreaking, for Pagano. Where she used to be able to at least offer a list of therapists who might help, now even that seems impossible. “The providers are overwhelmed. People are beating down their doors. And here in Fairfield County, almost none of them take insurance. If you’re lucky enough to get an appointment, you’re paying out of pocket.”

With mounting anxiety and no therapist, many kids end up in the emergency room. At Yale, which has an emergency unit specifically for children and adolescents, the surge for mental health care for kids has been “off the charts,” said one clinician who will not be identified because she was not authorized to speak to the media. The weekend prior to our conversation she had counted forty-eight patients in a pediatric emergency department set up for twenty. “We had twenty-four psych kids. plus the usual gunshot wounds, motor vehicle accidents, child sexual abuse,” she said. “Under normal circumstances, there’s usually a family room where you can interview the family in private. But there were kids in rooms, kids on cots along every stretch of the hallway in the pediatric emergency department, sitting on the beds, on stretchers. I just had to stand there in the hallway and try to be as discreet as I could, trying to have a conversation while trying to make sure that the child doesn’t bolt. I’d never experienced anything like that.”

And when a child has needed to be admitted, they might be stuck in a holding pattern. “The inpatient units are full. So instead of going right over to a bed, the child has to wait in the ED [emergency department] until a bed is open for them,” the clinician says. Though the unit works to discharge patients into the community as quickly as possible, “there are no providers because they are all full.” Even schools have fewer resources available for mental health, she says. “Kids haven’t had as robust a connection with a social worker or guidance counselor or even a kind teacher because the demands on their time and attention are intense. It’s a system under complete strain right now.”

Each hospital visit and each medication change takes a toll. “The children are in a crisis—they’re repairing so many systems of their life,” the Yale clinician says. “Their bodies have been through a massive experience, as if they’ve been hit by a truck. It’s the psychiatric equivalent of the intensive care unit.”

Finn eventually found a therapist. He searched the Psychology Today website for someone who looked kind and capable. She initially told him she couldn’t take any more patients, but after she heard his story, she wouldn’t turn him away.

Brooke has enrolled in a new boarding school. “She’s day to day,” Laura says. “We’re hoping she’ll be well enough to stay.”


HELPFUL RESOURCES

Where to turn to find help, a list courtesy of YourMomCares (yourmomcares.org), a nonprofit for the mental wellness of children.

While not a service-provider organization or medical institution, YourMomCares believes that all children, parents and families should have access to help. Below is an excerpt of their resources for individuals who may need mental wellness support. They note, of course, that if there is an imminent crisis, calling 911 or going to the local emergency room are the best options.

CRISIS MANAGEMENT:
The National Suicide Prevention Hotline at 1-800-273-TALK (8255) is a 24/7 service available nationally.

Crisis Text Line: crisistextline.org/text-us/

Lifeline Crisis Chat: didihirsch.org/chat/

BULLYING:
kidshealth.org (search “bullying”)

CHILDREN’S MENTAL HEALTH & GENERAL MENTAL HEALTH RESOURCES:
thementalhealthcoalition.org/resources

upmc.com/services/behavioral-health

American Academy of Child and Adolescent Psychiatry: aacap.org

National Alliance on Mental Illness: nami.org/your-journey/kids-teens-and-young-adults

LGBTQIA+ MENTAL HEALTH RESOURCES
nami.org/your-journey/identity-and-cultural-dimensions

thetrevorproject.org

trevorspace.org

LOCAL SUPPORT:
Contact your child’s medical providers in your region. This is often a best first step to learning about local behavioral resources.

Note: YourMomCares staff are not doctors nor is our organization run by a medical institution. The content contained on [our] website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. In the event of a true emergency, contact 911. Otherwise, please consult your healthcare provider with questions or concerns.

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