COVID caused a mental health crisis in RI's kids and it hasn't stopped – The Providence Journal

Fourteen-year-old Sadie Schiller’s mental health challenges began to intensify about two years ago, during the early months of the pandemic.
“Body dysmorphia and not suicidal thoughts but, like, I didn’t want to be here,” she said during a recent interview from her home in Seekonk.
“She started to tell us that everything seemed so upsetting and depressing,” said her mother, Sonig Schiller. “She also felt like she was fat, like she was ugly, and she felt like she had no friends and was horrible at everything. And as you can imagine, when you hear that — as a parent, I felt like my heart stopped. I just felt nauseous.”
With its remote learning and periods of isolation, which prevented in-person contact with peers, a crucial element of healthy social and psychological development, the pandemic exacerbated underlying issues.
“It got a lot worse, because I was confined in one space, I didn’t have the outlets that I would normally be used to, and I was also stuck in the house all day eating,” Sadie recalled. “So my eating disorder got a lot worse.”
That, in turn, triggered severe depression and anxiety.
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Schiller and her husband, Jonathan, a pediatric orthopedic surgeon, brought their daughter to her pediatrician’s office, but like many primary-care providers, who are not typically trained in behavioral health interventions, the practice was not equipped to offer the level of care that Sadie required.
A long search ensued. And like many other parents seeking intensive mental-health care, they encountered waiting lists and other obstacles. They learned firsthand of what consumers, advocates and health-care leaders, including hospital presidents, describe as a broken system of care — one that has been the subject of fiery House and Senate hearings in Rhode Island this year.
“I was desperately calling people that we knew in the medical field, trying to get some information,” Sonig said. “It was close to impossible to find the help that we needed, and it wasn’t anyone’s fault. It was just, unfortunately, a lack of resources for this giant wave of mental health issues and challenges that we’re faced with.”
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Unlike some other families, the Schillers eventually found success.
They found Dr. Michelle D. Parker at East Providence’s Bradley Hospital, who after an evaluation referred Sadie to hospital psychologist Kerri L. Kim. After a year of weekly therapy, Kim recommended Sadie for Bradley’s Mindful Teen program.
The outcome was remarkable. 
The problems in delivering mental health services for children and adolescents are so pervasive that Bradley Hospital, Hasbro Children’s Hospital, the Rhode Island chapter of The American Academy of Pediatrics, and the Rhode Island Council of Child and Adolescent Psychiatry last month took the unprecedented step of declaring an emergency.
“As a child and adolescent psychiatrist working with teens, it is clear that the stress and disruptions caused by COVID have pushed many of the patients I see to the point of experiencing mental health crises,” Dr. Michael Wolfe, president of the Rhode Island Council of Child and Adolescent Psychiatry, wrote in the declaration.
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“Unfortunately, at the very time this is occurring many of our state’s outpatient community providers are underfunded and are losing staff to higher paying jobs in other sectors. This means our youth are not receiving the community-based care they need, leading to more mental health emergencies. This emergency declaration is a call to action to better invest in Rhode Island’s network of community and school-based mental health providers.”
Said Henry Sachs, president of Bradley Hospital: “Prior to the pandemic, we were already experiencing troubling trends, including increased youth suicides. The pandemic has pushed this situation into a full-blown emergency, with dramatic increases in emergency room visits for all child mental health crises.”
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Those increases were a factor in Hasbro Children’s Hospital’s announcement on Thursday that its emergency department has become unusually stressed, with waiting times rising to seven hours in some cases. 
“In my 21 years as a pediatrician, I have never seen so many children experiencing mental health challenges or lack of access to community resources to meet their mental health treatment needs,” Dr. Allison Brindle, president of the Rhode Island chapter of The American Academy of Pediatrics, wrote in the declaration.
“As a state, we need to come together to find ways to invest in our mental health system to better support our children through this emergency and to implement strategies that will promote positive mental health and prevent an emergency like this from occurring again in the future.”
The state Health Department’s Rhode Island Youth Risk Behavior Survey, published in 2019, depicts several troubling trends (results of the latest survey, conducted in 2021, won’t be available until June). Experts say the pandemic has heightened these trends. Add in other stressors not directly related to COVID that many kids face but that the survey did not explore — among them, pressures to achieve academically or athletically, finding one’s gender identity, the temptations of drugs and alcohol, and the impact of social media — and the overall picture is bleak.
Among the survey’s findings:
• 32.3% of Rhode Island middle and high school students in 2019 reported feeling “sad or hopeless for two or more weeks in the past year,” compared with 24.6% in 2011.
• Certain groups were more prone to these feelings, according to the survey, which found that “female students, gay/lesbian/bisexual high school students, and students with long-term health problems or physical/emotional/learning disabilities were more likely to report feelings of sadness/hopelessness.”
• 17% of middle schoolers in 2019 “have ever seriously considered suicide,” with 13% of high school students having “seriously considered suicide within the past year.”
• 38.5% of middle schoolers reported having been “bullied in school or electronically in their lifetime.” The corresponding figure for high school students was 21%.
• Among all students who had been bullied, 20.6% “avoided school because they felt unsafe.”
• 22.9% of students who had been bullied attempted suicide.
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The survey involved 21 randomly sampled high schools and 19 randomly selected middle schools; a total of 3,202 students participated.
A related study by the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals conducted during 2020 and 2021 also found high rates of emotional distress. A total of 18,151 middle and high school students participated.
Asked if in the last 30 days “were you very sad?” 19.8% of middle and high school students replied yes, compared to 18.5% in the 2018 BHDDH study.
Asked if in the last 30 days “did you feel helpless about the future?” more than a quarter — 27.1% — of students also replied in the affirmative, compared to 23.4% in 2018.
A third data source, Rhode Island Kids Count, confirms other troubling trends. Among other findings, according to the organization’s 2022 Factbook, released on Monday:
• Last year, 467 teenagers were admitted to an emergency center after attempting suicide, compared with 334 in 2020, a nearly 30% increase. 
• Bradley Hospital’s around-the-clock hotline, Kids’ Link Rhode Island, saw calls double from fiscal year 2019 to fiscal 2021, rising from 4,849 to 9,702.
• In 2020, about a third of children ages 3 to 17 who required mental health or counseling had difficulties finding care.
In an October 2020 data brief, the federal Maternal and Child Health Bureau reported that in “2018-2019, 13.2% of U.S. children ages 3-17 years — just over 8 million — had a current, diagnosed mental or behavioral health condition.”
The bureau provided more detailed insights, writing that “anxiety was the most common condition (8.5%), followed by behavior disorder (6.8%) and depression (3.8%). A greater proportion of males had a behavior disorder (9.1% vs. 4.5%), while a greater proportion of females had anxiety (9.1%vs. 8.0%) and depression (4.4% vs. 3.2%).”
And in a September 2020 report, “State Suicide Rates Among Adolescents and Young Adults Aged 10-24: United States, 2000-2018,” the Centers for Disease Control and Prevention chronicled an alarming rise.
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“Nationally, the suicide rate among persons aged 10-24 was statistically stable from 2000 to 2007 and then increased 57.4%, from 6.8 per 100,000 in 2007 to 10.7 in 2018,” the CDC reported.
Rhode Island was among the great majority of states where suicides among young people rose, with a death rate per 100,000 population among persons age 10 to 24 rising from 13 in 2000 to 37 in 2016-2018.
These are confirmed numbers, taken from death certificates. Some suicides are not recorded as such — in cases, for example, where the body of a person jumping from a bridge is never recovered.
Dr. Cindy Klipfel joined East Greenwich Pediatrics in 2015 after serving as a pediatrician at Women & Infants Hospital and teaching at Brown University. During her career, she has witnessed a profound shift in the care that pediatricians have been asked to provide.
“The level and degree of mental health that we as pediatricians are seeing in our community and in our patients is astronomically higher than it’s been in the past and it’s a real crisis,” Klipfel said in an interview last month.
Before the interview, Klipfel had looked at records to chronicle her patient visits on that same April day in 2016 — a typical day six years ago, she said.
“On that day, I saw about 25 patients,” the pediatrician said. “I saw seven well patients. I saw 10 with cough, cold, runny nose, ear pain, which makes sense. I saw six with a bump, a wart, a rash, something like that. I had one anxiety discussion with a patient and I had one prenatal consult with a mom who was pregnant.”
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Looking at her schedule for the day after last month’s interview, Klipfel said, “I have about 28 patients booked. I have 15 well patients. And the reason I have so many more well patients is because we have to divide out the sick and the well. And I have eight behavioral health patients — an eightfold increase — for anxiety, depression, ADHD, eating disorders.”
And this, she said, is a typical day in 2022.
East Greenwich Pediatrics has hired a behavioral health psychologist to help with this newer population, but not all practices have been able to, and severe issues, as the Schillers discovered, require more intensive treatment than a psychologist alone can provide. (Lifespan’s innovative and free Pediatric Psychiatry Resource Network, PediPRN, connects pediatricians to mental-health specialists.)
The net result for Klipfel, a fellow of the American Academy of Pediatrics, and her colleagues, according to Klipfel, “are heart-wrenching days triaging for children who are suffering from mental health issues. Pediatricians are thinking holistically with the goal of moving from crisis mode to that of prevention. Why are so many more kids being affected and in pain and suffering? And, how can we best meet their needs and the needs of their families? And, an even bigger question is how can we help prevent these issues from arising in the first place?
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“The answers to these questions is we will need funding to build a better system, and this better system is needed now.”
Dr. Elizabeth B. Lange, who practices at Coastal Medical’s Waterman Pediatrics office, has witnessed the same changes as Klipfel. Lange is president of the Rhode Island Medical Society and, like Klipfel, a fellow of the American Academy of Pediatrics.
“We have a shortage of primary care physicians and clinicians in the state across internal medicine, family physicians and pediatrics,” she said. “It’s very hard to recruit primary care physicians to come to the state to work. Fewer and fewer medical students are going into primary care, and it’s hard to financially support the debts that medical students have on a primary care salary.
“We also have an aging workforce in this state, with many primary care physicians anticipating retiring in the next five to 10 years. And certainly there are many national studies that in this pandemic, there’s a burnout that has added an accelerated retirement timeline for many physicians, not just primary care. So, we are at a workforce crossroads.”
Sadie Schiller’s journey brought her to Bradley Hospital psychologist Kerri L. Kim. 
“We instantly clicked,” Sadie told The Journal.
“She came to me with some pretty significant challenges with anxiety and depression,” Kim said, “but she was really motivated to do the work.”
After seeing Sadie weekly, Kim concluded that more was needed. 
Therapy alone “wasn’t providing the totality of what I believe she needed,” Kim said. “That dosing wasn’t high enough, in my clinical opinion. And so she and Mom ended up eventually admitting to the Mindful Teen program.”
The Bradley site describes it: “A six-month outpatient treatment program for adolescents who are 13 to 18 years old (attending grades 8 to 12) and who display signs of suicidality, nonsuicidal self-injury, or other self-destructive behaviors.”
It works, according to Bradley, “by developing alternative skills to manage emotions and tolerate distress.”
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“I’m going to be completely honest,” Sadie said. “I did not want to do it at all in the beginning. I even was talking with Dr. Kim and I was, like, ‘I don’t think this is going to work for me. I’ve learned all this stuff before, it’s not going to help.’ But I stuck with it, and it paid off.”
Said Kim, who manages Mindful Teen: “We’ve just seen tremendous, tremendous gains and growth for both Sadie and Mom. And I think that speaks to the power and importance of including parents and families within a child’s care.”
“Both parent and teen work with psychologists to learn how to build a tool kit that helps you with things like emotion regulation, mindfulness and relationships,” said Sonig. “The goal is to be able to use these tools throughout life and walk the middle path in order to achieve balance through personal awareness. I believe this program should be a fundamental component of our children’s curriculum in every elementary, middle and high school in this country.”
During her interview, Sadie explained her decision to go public with her story and why her parents agreed.
“I’m a teenager,” she said. “I use social media. I have a lot of friends and I’ve seen on social media that, like, everyone just says, it’s the norm, like feeling sad all the time, tired, always being anxious, having body-image issues.”
What she sees and hears are peers who believe that’s “normal,” she said.
“The reality is, it’s not,” Sadie added. “Of course, you’re going to feel sad from time to time, but you shouldn’t constantly feel that way. So I think it might help other people to start reaching out and getting help and noticing, like, ‘This kind of relates to me. I kind of feel that way, like, maybe I should talk to someone, talk to my parents, and see what they should do.’”
Sadie’s advice to children and adolescents who might be in the place she was, or who might have other mental-health issues?
Virtual and free: Suicide prevention courses offered to the public. 
“Talk about it,” she said. “I didn’t want to do that at all, and that’s one of the main reasons I got to such a bad place: I didn’t talk about it.”
The first steps, she said, may not be easy. They weren’t for her.
“Once I started openly communicating, it was scary. It wasn’t an easy thing to do. But once I started sharing — even if it was just like small things, you know, ‘I was a little upset today because lunch wasn’t my favorite,’ just small things like that, it can help form this trust and this bond. 
“And when you start sharing more, then you can finally get the help you need, because I don’t think anyone wants to stay depressed or sad. So I think you need to take those steps. People can hold your hand along the way, but you need to take those steps first.”
Anyone in immediate danger should call 911.
Other resources:
Prevent Suicide in Rhode Island: a Rhode Island Department of Health resource. If you are in crisis, call (800) 273-8255 or text TALK to 741741. Website:
Mindful Teen, or call 401-432-1119
Kids’ Link RI, or call 855-543-5465
Mindcast: Healthy Mind, Healthy Child Podcast,
Butler Hospital’s Adolescent Treatment Unit, or call Patient Assessment Services at 844-401-0111.


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