Children are incredibly resilient. As Dr. Arizona Robbins said, “they believe in magic, they play pretend there is fairy dust in their IV bags. They hope and they cross their fingers and they make wishes, and that makes them more resilient than adults. They recover faster, survive worse.” But when a pandemic strikes in a country as inept as the United States and everything shuts down for months on end, social development is pretty irreversibly interrupted. The ground has shifted under everyone’s feet, but we’ve been treating children like miniature versions of adults and expecting them to adapt the same way we force ourselves to – and it’s beyond unreasonable to expect. Children are not small adults.
Ironically, the reduced capacity to understand death doesn’t serve them well in a pandemic, because they can’t pin this change on something concrete. No one’s teaching elementary schoolers about viruses, spike proteins, aerosolized spread, or any number of things that could help them rationalize their lives being upended. The sudden and confusing interruption, though not a traumatic event in the traditional definition of the term, still induces a trauma response – children end up “trying to manage a vague loss”. There's a confusing ambiguity of being sharp enough to comprehend the darkness of the times, but not necessarily informed enough to understand a virus and its social consequences. The result is known as “ambiguous loss”: trying to wrap your head around grief without a pinpoint cause and without any closure.
To understand the havoc this pandemic has wreaked on children and adolescents, it helps to think of COVID as a magnifying glass. We’ve stripped away all the frills and periphery of life, and all the social support that comes from them, so the issues at our core are laid bare and amplified a hundredfold. A young child with well-managed ADHD now has extraordinary difficulty with online learning because no teachers or resources are present at home. An adolescent with a tendency towards substance addiction now struggles with it much more. A high-performing college student is stripped of all sources of validation. There are too many examples of this magnification, all of which are more than enough to send anyone over the edge.
Since 2019, suicidal ideation and action have increased by at least 25%. And for parents who are not necessarily equipped to navigate their kids to primary care or therapy, the emergency room is the first place they can think of to go to when their child expresses suicidal thoughts or attempts to end their life. And while an ER isn’t the worst place to go in this scenario, staff are much better trained in physical trauma and disease than in responding to mental health crises.
Patients have to meet certain criteria in order for the psych department to even make the time to come see them, and when they do, it’s rare that a patient can be transferred to a psych facility without a hitch. The majority of cases go one of two ways:
They aren’t “actively suicidal enough” to be taking up an ER bed in a pandemic, and are sent home with a vague request to follow up with an outpatient therapist, with the hopes they won’t try to harm themselves in the meantime.
They’re stuck in limbo in the ER until a bed becomes available at a psych facility – this can take up to several days. That’s up to 100+ hours in the same bed, without any of your personal items or clothes, often with someone constantly observing you.
From a personal standpoint, I can’t remember the last time I saw the ER without at least one psych admission – and sometimes these crises make up half the patients in the ER at a time. This is all from observation of an NYC hospital with a relatively ample amount of resources – institutions elsewhere often have zero psychiatric beds available in the entire state.
Pediatric infrastructure is already overwhelmed with COVID and still bearing the weight of “normal” pediatric emergencies – this explosion of mental health emergencies isn’t compatible with the status quo. Not to mention that when COVID hit, pediatric ERs began taking in adults, sometimes up to the age of 30 (!!), and haven’t stopped since. Not only are pediatricians less experienced with treating adults, but adult injuries in a pediatric ED can often upset and traumatize younger patients. To think that this will be sustainable for much longer would be incredibly naive.
Talking about young people like they don’t understand what’s going on in the world right now does them a disservice – they understand quite clearly. They understand that their schools have to be closed, but their parents can dine indoors. They understand that they can’t see their friends for “everyone’s safety”, but people can sit in the Super Bowl stadium seats on TV. And the cherry on top: they can’t be vaccinated with the rest of us unless they’re over 16. We’ve upended their lives, and we’ve excluded them from our relief. To people who are still developing their image of the world, it’s a stunningly poor example to give. Every exception we make at the expense of our children is a betrayal. And every day this pandemic drags our children through the mud is a reprehensible travesty.
Loved loved loved this. I just wanna add that I don't think the simply proposed solution of "just open schools" cuts it either because schools will only do so much to repair the damage and it's still isn't safe to do so. I guess my personal belief, probably closely aligned with yours, is that the best way to get our young people back into the fold is to create a safer environment for everyone and drastically realign our priorities.