Transcription:
How Parents Can Help Their Kids Navigate The Mental Health Crisis

Conan Gasque (Host): Welcome to Inside Pediatrics, the podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. In early December, the US Surgeon General issued an advisory citing an urgent need to address the mental health crisis among the country's youth. Many children and teens were then, and still are now struggling with mental health issues. Some of the problems stemming from the Coronavirus pandemic, but many problems predate that. Today, we're discussing the many reasons for this crisis and what parents need to know. I'm joined by Dr. Daniel Marullo, a Clinical Psychologist here at Children's of Alabama. Dr. Murillo, thanks so much for your time today.

Daniel S. Marullo, PhD (Guest): Well, thanks for having me.

Host: So let's talk first about what the state of mental health was before the pandemic. It's been well-documented that the pandemic has had an effect on mental health among children and teens. But let's talk first about where we were before the pandemic even began. What was the state of mental health for young people back then?

Dr. Marullo: Well, that's a really great, great question. You know, as you mentioned, the Surgeon General made a recent statement about us being in a mental health crisis. I think you could make the argument that there was a mental health crisis that predated the pandemic. Certainly, if you look at the statistics, you know, about 5% of kids in the United States prior to the pandemic had some sort of a diagnosable mental health issue and of that maybe 20%, only 20% or so actually were able to receive resources.

And the picture for Alabama, is perhaps even more dire looking at more recent statistics that have come out in 2022, Alabama ranks at the bottom in many of the mental health categories, you know, for example, we are 51st in a nation you might ask, well, what's the 51st state. It's the district of Columbia is what they are talking about. We are 51st in the nation in terms of mental health workforce availability. So mental health prior to the pandemic, I think it was already at a crisis level, you know, one in 20 kids between the age of six to 17 and have some sort of anxiety or depression diagnosis, but only one in five, you know, did not receive any kind of treatment.

So 20%, anxiety and depression rates, behavioral disorder rates have increased over time, predating the pandemic. And we've seen this consistently since at least the early two thousands.

Host: What would you say were the primary issues back then that America's youth were facing that were leading to some of the mental health issues?

Dr. Marullo: You know, it's an interesting question because I think if you take the pandemic away, many of the same issues that we're experiencing now, we were experiencing then, okay. The pandemic has certainly added an added layer and there's many reasons for that, that, that is unique to the pandemic itself. But I think one of the primary issues that we've been facing has been a lack of access to care.

So, for example, you know, a more recent study that's come out in 2022, you know, shows that there is a huge lack of providers, particularly in the state of Alabama. We, we actually will rank 51st in the nation in terms of the mental health workforce availability. And that includes our doctoral level providers, such as psychologists like myself, psychiatrists, counselors, all the different mental health providers that, that are available. We ranked 51st. Okay. That's only increased I think since the pandemic. We also rank 46th in the nation in terms of the number of children who actually have private insurance, but their insurance doesn't cover mental health resources.

That's a huge problem. So this whole access issue, we rank 51st again, and a number of students identified in our schools as having some sort of an emotional disorder, you know, and that could be a very broad term, but they don't have access to an IEP, a special education status. And certainly we, we rank 43rd in terms of our youth, with some sort of a major depressive episode that do not, or have not received mental health services.

So I think access is a huge issue within our state of Alabama, but also across the country. So that'd be one thing. The other is, is lack of awareness. You know, which then leads to access. You know, I think there's, there's still that old stigma of having some sort of a mental illness. And actually I really hate the term mental illness because I, I really, you know, the longer I've been in this field, the more I recognize that these are all healthcare issues primarily.

And so when we start breaking this out from healthcare in general, I think we are opening ourselves up to a lot of misunderstanding about what we are dealing with, you know, the traditional old views of mental health, you know, some sort of punishment or weakness or something within yourself that just wasn't right for whatever reason, but we know more and more that these are biologically driven disorders and certainly disorders that have their basis in biology. But they're also shaped by our experiences, particularly our early experiences.

Host: Do you feel like the public perception is starting to change about that as doctors like yourself learn more and more about mental, mental illnesses or mental health issues, whatever terminology you want to use?

Dr. Marullo: I do think it's changing, you know, it's, it's a slow change, you know, in the course of my career, which has been over 25 years now, even just working with my medical colleagues, I've seen the shift in how people are really thinking about anxiety and depression. You know, there's a greater awareness that this isn't just an isolated thing, that it really is integrated into a much more holistic bodily system, you know? So there's that. And also, you know, the I think the pandemic has really, oddly enough, it's probably helped a little bit in that because I think more and more people are experiencing distress as a result of the pandemic and the different changes that have happened in their lives.

And so it's not becoming such a foreign thing, you know, I think we're getting a little bit more better awareness that, you know, what things that happened to us in our lives actually do have an impact on our emotional functioning and how that affects us physically.

Host: As the general public starts to understand mental health better and better, as you were saying, how much does that help people to make progress and to maybe handle mental health issues better?

Dr. Marullo: I think it's huge because if you are receiving the message, that the thing that you were experiencing, the thing that is causing you distress isn't a real illness, that it's, you know, some sort of a moral failing or weakness on your part, you're not likely to seek out help. And these are treatable conditions. You know, we do have good therapies, psychotherapy as well as medications that can help people, but it requires compassion and empathy from all of us to make it possible for folks to say, you know, I, I, I would love it if people with depression or significant anxiety or some other emotional behavioral disorder received the same level of compassion as our kids that who are experiencing cancer or diabetes. They, they deserve that because it is an illness.

Host: We've talked about the pandemic a little bit already. Can you talk about how we got from the pre pandemic challenges to where we are now? How did the pandemic specifically affect the mental health of young people in the United States?

Dr. Marullo: Yeah. You know, we're still learning about that, but some of the things that we're understanding more and more right now, you know, include things such as, you know, the lack of opportunity or the reduced opportunity that kids normally have access to. For example, the simple act of going to school, certainly that's affected kids academically, but it's also affected them socially and in their ability to interact with their peers and do those things that are natural and needed to promote good growth and development. So I've seen a lot of kids in the hospital, for example, who have experienced increased levels of anxiety, depression, eating disorders, other issues along those lines.

And when you really get to understand them and talk with them, you know, it's that they they've lost out. You know, they're the kids who really like to go to school. That's part of their, part of their world. You know, it's where they get their emotional goodies, you know, if you're a good student and you're not getting to go to school, it's hard.

And so things that we took for granted and, you know, like missing out on prom and missing out on homecoming, things like that, those are, those are huge issues, you know, and if it makes sense from a developmental perspective when you think about what kids are doing in terms of normal development, particularly as you move in adolescence, and it's all about finding your place, it's about finding out who you are and you do that through your interactions with other people.

So the pandemic has made it much more difficult to that. I think some of the other things that have that have happened is kids learn from their, the adults and the adults haven't always acted well during the pandemic. You know, how do you manage the stress and distress of, of what's happening around you. They, they, they look to us and if we're not managing that well, then they're not going to manage so well either.

Host: So there are a lot of problems out there. A lot of challenges I should say, facing children and teenagers right now, what can parents do? What do parents need to know about how they can talk to their children about these issues? Things that they might be dealing with or the things that they might potentially deal with?

Dr. Marullo: Well, you said the word, talking. You know, we saw this before the pandemic, and it's certainly true with the pandemic, you know, talking to your children about what is going on. We have been in a crisis situation for what over two years now. And so being able to talk about and giving kids, you know, real information that they can use. Now, how you talk about these issues depends on the age of your child and the developmental level of your child. You know what you're going to say to your 16 year old is going to be very different than what you do with your six year old. You know, in terms of the type of information that that child needs and how you approach them and that kind of thing. So you gotta, you gotta be mindful of who your child is and where they are in their development. But giving kids information is usually a good idea. Okay. Particularly when things are very stressful. Younger children need to know that they're safe. They need that reassurance. And even babies and toddlers respond to that structure that the parents provide, the parent's ability to be calm themselves. So that's the other thing that needs to happen besides talking to your kids is parents need to manage their own stress and emotions. That's why I was getting back, what I was alluding to a little bit earlier, you know, parents have to be parents, they have to project calm and good coping.

Okay. Cause that's how our kids learn to do that. So giving good information, this is true for when kids are really starting to show significant emotional behavioral issues, whether it's because of the pandemic or because of other things that are going on in their lives as well. I think parents sometimes are very afraid. Caregivers, are very afraid of, you know, asking their child about whether they're depressed or, you know, or-

Host: Should they be specific about that?

Dr. Marullo: Yes. Yeah. I think the, the, the fear is that if I say it and it's gonna put ideas, you see this a lot with the, the issue of suicide, for example. Parents see their child struggling perhaps, or seeing something that makes them concerned, but they're afraid to, to say the words, right.

And again, by saying the words, one, you're opening up that conversation. If a child is thinking those thoughts, you're not putting those thoughts there. You're giving them an opportunity to talk about it for one. And if they're not, it's not going to plant an idea into their mind.

Host: How do you know when to be specific with those questions, to specifically ask your child about issues related to suicide or about self harm. It should every parent be asking their child about that, or, or should you be focusing on if your child seems to be struggling, then ask those questions?

Dr. Marullo: I don't think parents need to hover over their children in any time they have a meltdown or, you know, have a little bit of difficulty that we got to jump around on the depression bandwagon or the suicide, you know, everybody's allowed to have a bad day kind of a thing. But in general, if a parent is noticing a significant changes in behavior, right. Particularly behaviors that are persisting, that may be a time to start asking about, well, how are you doing, what's going on here? And certainly if they seeing any, any kind of potential consequences of self harm, you know, an unexplained cuts or bruises and that sort of thing, that could be a tip off.

So, but talking about it. The other thing is, you know, parents can find natural teaching moments, you know when their child's not in distress. For example, you're watching a movie together, a, in a character has committed suicide or attempted suicide. That's a great time to just say like, you know, wow. I wonder what that, was going through that person's mind. And I wonder what it might've helped them. Have you ever felt that way yourself? You know, just finding those natural teachings moments can be a great way of addressing this kind of in a preemptive sort of way. The parents need to get comfortable with, with broaching the topic, if they have any concerns, you know, parents know their kids best. If they're seeing something that's out of the ordinary and it's persisting, and then it's okay to say something.

Host: Once a parent realizes, hey, something's not right with my child. What is the next step for them? What should they do?

Dr. Marullo: Well, a couple of things that they can do, you know, their number one resource is there a pediatrician, you know, they're going to know the more they're going to know the child. Typically, they're going to know the local resources and that could be a great person to reach out to. Another may be the school counselor as another resource. A great program here at Children's of Alabama's is our PIRC center. The psychiatric intake response center, you know, a parent can call in, it's not a crisis hotline, but a parent can call in and they can talk to a licensed counselor and, and about things that they see and they can get some information that can help them, you know, decide that there's anything they need to do.

Certainly if a parent is ever concerned that their child is actually suicidal, you know, imminently suicidal, really at risk of hurting themselves or others, you know, calling 911, getting them to the local emergency department for a emergency evaluation. But I like to think that most parents want to be proactive, talking to their kids, knowing what's going on with their child, you know, just being mindful of any significant changes in their mood and behavior and really just taking a proactive stance.

Host: It's very challenging time for children and teenagers right now. But as you mentioned, there are some resources out there and those conversations can certainly make a big difference for parents talking with their children about mental health. Once again, Dr. Daniel Marullo, Clinical Psychologist here at Children's of Alabama. Thanks so much for your time.

Dr. Marullo: Thank you.

Host: Thanks for listening to Inside Pediatrics. You can find more podcasts like this one at children'sal.org/inside pediatrics.