Getting children's mental health on track

Transcript [Edited for clarity]:

Contemporary Pediatrics®:

Hi and thank you so much for watching, I'm Joshua Fitch, editor of Contemporary Pediatrics®.

Benjamin Maxwell, MD:

Hi, Ben Maxwell chief of child and adolescent psychiatry at Rady Children's Hospital and UC San Diego.

Contemporary Pediatrics:

Dr. Maxwell, thank you so much for joining today we're discussing pediatric mental health, obviously a top reason of concern in today's pediatric health care space. First, can you just discuss some of these recent numbers you've been seeing? I understand that alarming rate in the last couple of years at your hospital.

Maxwell:

Yeah, you know, we've really been seeing an increase over the past decade, so starting around 2012. I mean, one of the ways we track that is the number of kids coming to our general emergency department in psychiatric emergency. So that's kids that are self-harming or thinking of ending their life even. So we've seen that increase starting around 2012 and it's been going up on an annual basis. The COVID pandemic obviously exacerbated that sort of preexisting problem that we're already seeing.

Contemporary Pediatrics:

With that being said, Dr. Maxwell, in these last few years have you noticed specifically in your hospital, of course different across the nation... In your hospital, what has the uptick been like in the last three years, really since the start of the COVID pandemic, and this declaration of a pediatric mental health crisis?

Maxwell:

We've seen more and more kids and families become socially isolated. That was a trend we had seen pre pandemic, but all the things that kind of went along with the pandemic, certainly decreased the social connection in the fabric of society that we saw. A lot of kids and families really struggled with that. So whether that was the parents not having the help and support they might have needed to help with childcare, or the kids being disconnected from their friends at school, or community, or decreased opportunity to engage in sports or extracurricular activities. It really took a toll on a lot of kids and families throughout our region.

Contemporary Pediatrics:

I want to switch gears a little bit to social media. Obviously, that is a huge topic in today's pediatric health care space. Recently, the Surgeon General's latest advisory on social media and youth mental health came out the advisory states social media use is nearly universal among young people aged 13 to 17 years, some 95% active on social media. Can you speak to some of the downstream effects that we're seeing whether it be habitual or new or otherwise related to social media and how it's impacting pediatric mental health?

Maxwell:

Yeah, in that advisory, you know, they cited this idea that the average teen is using social media something like three and a half hours a day. What happens with a lot of the kids we're seeing at our hospitals, there's a ripple effect. So those three and a half hours are taking the place of what we'd call 'pro social behaviors' that were happening before. In person social connection, playing with your friend down the street, or going to some extracurricular activity, those three and a half hours are taking the place of some of those things. It's also leading into sort of the nighttime routine. So a lot of kids are using their smartphone in their bedroom, the lights going into their eyes, and it's disrupting their sleep. Not to mention, you're exposing all these kids to the unregulated world of social media and the internet, and it's available to many of them 24/7 in their pocket and a lot of that is negative content, whether it's the fear of missing out, or just the selective posting, where they see all their friends that are going and doing all these cool things and they think their life is not as good as the people around them. I think adults struggle to deal with that, so think about the developing mind. These kids are really in this stage of life where they're developing their identity, developing their social identity and it does appear a lot of kids are really struggling with the exposure to that social media. So we're really excited to see Vivek Murthy's advisory on this topic.

Contemporary Pediatrics:

And since you see this on a day to day, is a bigger step from tech companies, policy makers, is that kind of needed to streamline this social media and all these potential effects? I mean, frankly, it's happening, so is something more needed? How do you kind of deal with that on a patient level now, given the fact that any kid can really log on and do it and see it?

Maxwell:

On a patient level from the clinical care perspective, we talk with patients and we talk with parents about how they might minimize the impact on kids mental wellness, and those are complicated discussions, because a lot of kids think well 'all my other peers are already on these social media platforms, how am I not allowed to be on them or restricted from them in some way?' So it's the sort of social norm right now, which is a big challenge for kids and the parents when they're trying to restrict these things. You know, what I'm hopeful for is that we'll move to sort of a situation where social media companies can start taking a bigger degree of responsibility and ensuring these products are safe for kids. I'm hopeful that government regulation can step in and make sure that there's some accountability there as well. It'd be wonderful to have more research on what are the sort of specific things that are detrimental and what are things that can have positive effects. This is a thing that's cited a lot of times, is social media can socially connect kids that might otherwise not have that social connection. Right now, how it stands, I think the pros outweigh the cons from what we see in our patient care and some of the research coming out. So how can we make that a safe thing for kids and utilize technology in a way that can actually support our mental wellness and our health.

Contemporary Pediatrics:

Yes, certainly time will continue to tell in relation to social media on a national level. On a patient-by-patient basis related to mental health, emergency department visits, what is the message to these pediatric patients and how is the connection made? What would you like to see in a pediatric health care visit streamlined in such a way to really connect with these kids and maybe curb some of these numbers?

Maxwell:

We really view the majority of kids that are arriving in our emergency department in crisis as a failure of the system. So a lot of these kids that we see, we asked the parents 'when did all this start', and they say 'it was five years ago, 10 years ago,' they didn't get the help they needed, things continued to get worse. But what we're doing at Rady Children's Hospital is trying to go upstream, working with pediatricians and the community, training them to deal with mild to moderate mental health concerns, giving them a support structure of social workers or master's level therapist or child psychiatrist that they could call or somebody that stops by their clinic and makes sure that they have the support they need to sort of lean into this care early on. What we're seeing in that program is we're catching kids that might have school anxiety at six years old. We meet with them one or two or three times and it sort of bumps them back onto a trajectory of psychological wellness and health and they're back off to the races. If we don't do that, I fear many of those patients end up becoming the 10-year-old that has generalized anxiety or the 12-year-old that's depressed, or the 16-year-old that ends up in our general emergency department, thinking about ending their life. And so really, we're trying to have this two-pronged approach in the healthcare side of things. We have to deal with the current crisis. There's a lot of kids that are really needing support right now. How do we get those kids the care they need, and at the same time, how do we work within the existing health care system to catch kids earlier, intervene earlier so that they don't get to that point? That's what really excited to see is this healthcare solution that no matter where you fall, no matter if you're the six-year-old, or the 16-year-old, or the 18-year-old that's struggling with their first break of psychosis, that there's care for these patients. We have a lot of work to do in that regard, because for the past few decades, this space has really been underfunded from the health care perspective.

Contemporary Pediatrics:

Thank you, Dr. Maxwell, for that. Is there anything else you'd like to add on this pediatric mental health space? I mean, it continues to dominate headlines and the topic of pediatric health care overall.

Maxwell:

I think the idea that health care alone is going to solve this is I think short sighted. You know, we can continue to develop clinics and programs that can serve kids that are in need, but it really is going to need to be a partnership with the social fabric that exists. So it's schools, its sports, its parenting classes, it's a number of things that we can do, to sort of start kids on the path where they experience more joy in life, and then have these healthcare systems in place that if kids fall off the trajectory, we're able to work with them and care for them. But the idea that we just keep growing more and more and more mental health programs in the health care space probably isn't sustainable, and it's not really the thing that's going to lead to kids really realizing their full potential. So my hope is we can find social partnerships, social structures that could improve the developing mind of the kids that are growing up today.