Major depression hit Nera Daugherty a year ago. Living independently in Spokane at age 18, she felt cut off from everything as the pandemic’s impacts mounted.
“I had gone through a breakup, and I had just moved out on my own,” said Daugherty, now 19. “COVID had just happened, so I had lost school, lost work, lost my partner. I was alone and just was broken down completely.”
It felt like a fog, clouded by anxiety and depression. “Every day when I would wake up, it would be like a struggle to get out of bed. I would cry at the drop of a hat.
“There was no high peak of being happy anymore. It was just either I’m sad or I’m OK.”
She eventually confided in a friend, who urged Daugherty to tell her mother. Her mom got her into a MultiCare primary care provider, who gave Daugherty a depression and anxiety quiz. That provider then invited Daugherty to walk on-site to meet someone else, a therapist, after her depression scores were “out of the roof,” she said.
Daugherty, who said the therapy helped, is part of a trend. Providers describe an alarming number of kids and teens seeking mental health treatment this past year. A number of them ended up at hospitals and emergency rooms for acute care or suicidal concerns, here and nationally.
Adults’ mental health needs also rose, but the spike among children is new, said Samantha Clark, who oversees Inland Northwest MultiCare behavioral health programs.
“I’ve never seen this phenomenon before, not in our emergency departments, not with our outpatient mental health clinics, and speaking with my pediatric mental health clinicians, they have seen some of the most depressed, anxious kids that they’ve ever worked with,” Clark said.
After the pandemic began, MultiCare moved 10 behavioral health clinicians from a central Spokane site to offices at different primary care, family medicine, internal care and pediatric clinics regionally.
Deaconess’ emergency department has 18 patient rooms, Clark said. “No fewer than eight rooms at a given time are filled by adults or kids with primarily behavioral health needs. Sometimes, as many as 15 are filled with adults or kids with primarily behavioral health needs.”
“In the last year, MultiCare Deaconess Hospital has had over 1,100 visits where suicidal ideation was on their problem list or part of why they were in the emergency department.”
Some kids in recent emergency department care are as young as 11, Clark said, but, in the past year, “We have had children in our ED and also in our outpatient behavioral health clinics express suicidal effect or ideation who are as young as 8 years old.”
A Washington State Department of Health February update said statewide mental health-related visits to emergency departments for children ages 5-17 between April and October 2020 increased by 24% to 31% compared with the same time period in 2019.
Similar trends have occurred at Providence Health Care facilities in Spokane, said Katie Morris, practice manager for BEST, Behavioral Emotional Skills Training that provides outpatient services for ages 8 to 12.
“Absolutely, we’ve seen a change in the needs of kids and families,” Morris said. “I’ve seen an increase in depression and anxiety, social isolation. I’ve seen increases in food scarcity among families. I’ve seen issues related to more of a dependency on electronic use among families and kids.
“I’ve also seen an increase in suicidal ideation.”
The reasons for distress vary, providers say, but common themes include missing in-person school, routines and friends. Other factors can be family hardships or trauma, parent job loss and isolation. It’s been difficult to get into counseling services with therapists booked. Many still are doing virtual-only sessions.
Cases aren’t necessarily declining with a return to in-person instruction, said Kristin Reiter, practice manager at RISE, for Resources, Insight, Support and Empowerment. Located near Providence Holy Family Hospital, RISE offers day treatment mental and behavioral health programs for adolescents and adults.
“We have definitely seen an increase with both our adolescent and adult patients seeking treatment since COVID, obviously, and it’s still continuing at the same rate,” Reiter said. “If anything, we seem to be increasing, which is a little off-trend for the season. Typically around spring, there’s a drop-off, and we’re noticing a spike.”
She said one problem that often is heard from the adolescents stems from being out of school and now transitioning. “With the isolation and distance learning that was difficult for a lot of kids and not conducive to lots of learning styles, now that they’re back in school, there are some challenges with transitioning.”
Some adolescents in school two or three days a week describe anxiety from feeling “in between,” she said.
Clark said parents or adult caregivers can try opening up conversations with children. She urged taking them to a family doctor if there are concerns, especially with warning signs such as disrupted sleeping, not eating and withdrawal.
It’s important how adults talk about mental health and depression, avoiding negative references, she said.
With mental health services, many kids have proven resilient, Clark added. “They’re still able to laugh, to make jokes, have fun, and they’re looking forward to school and summertime.”
Providence Health also is working on a plan to move mental health counselors or social workers into primary health care clinics regionally, said Reiter, who also encouraged families to reach out if they need support.
In a crisis, parents are right to seek emergency care for kids who are suicidal or need acute care, she said. Sacred Heart has a separate pediatrics emergency department and regular emergency space.
“A lot of kids who do come here (RISE) initially presented to the ER because they just had gone into crisis,” Reiter said. “On top of that, it’s really difficult to access services right now because so many providers and agencies are completely full, booked solid, with waiting lists.”
Daugherty, who started counseling in early summer, said the therapist helped talk her through job challenges and encouraged routines such as walks and regular meals. Her sessions ended in December, when Daugherty felt she was on a good path.
“Depression doesn’t really just go away, but seeing her definitely gave me a new outlook and made it a little bit easier to manage,” Daugherty said. “There’s been a huge shift in my life, and she helped me through that.”
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