Suffering in Silence: Addressing the Youth Mental Health Crisis Further Exposed by the COVID-19 Pandemic | Q&A with Dr. Jacqueline Wilson
Dr. Jacqueline Wilson
Less than 25%.
While mental health issues do not discriminate based on race, color, gender, or identity, the understanding of mental health and the availability of services does. Discrimination and bias based on the intersection of race, color, gender, and identity are indeed part of the institutionalized racism in our country.
Last September, Congress passed the National Suicide Hotline Designation Act. The Act created a new three-digit dialing code (9-8-8) for the National Suicide Prevention Lifeline, the nation’s main connection point to suicide prevention and mental health crisis response services. This is but one effort to increase access to mental health support for those in crisis and was recently made available to everyone across the United States on July 16, 2022.
While the 988 dialing code does demonstrate effort to address access to services, there is a long way to go in addressing equity in mental health care services.
When mental health issues take place in the context of foster care, there should be increased effort to address family crisis and trauma. In most systems however, this is not the case. We know that children involved in child welfare systems, who are disproportionately African American, as well as those living in poverty, face profound mental health challenges.
It is estimated that up to 80 percent of the over 400,000 children in foster care in America suffer from a mental health issue compared to 18-22 percent of the general population of children.
As many as 60 to 80 percent of children with severe mental health conditions demonstrate a positive response to therapeutic treatment, but less than 25 percent of children in foster care have received any mental health services after a year in state custody.
The pandemic has not only increased the need to address mental health services in child welfare but has also shed light on the race and socioeconomic disparities for children and families left to the devices of the child welfare system. We must do better than 25%.
ASCI spoke with Dr. Jacqueline Wilson, CEO of TRAC Services for Families, to discuss the impacts of the pandemic on the mental health of youth and the necessary supports the adults in their lives – including parents, caregivers, caseworkers, teachers, etc. – can use to help them.
ASCI: During the pandemic, children, adolescents, and young adults have faced unprecedented challenges concerning their mental health. Can you describe what you have seen some of these challenges to be?
Dr. Jacqueline Wilson: I think that the biggest challenges, other than the educational piece that certain children faced, was [the lack of] socialization. That was a major issue. We did see an increase of young people with depression and anxiety. And so, coupled with the lack of socialization from school, the safety net that school often provides our kids, impacted them greatly.
Within mental health, not everyone was able to do remote therapy. By law, we had to also give them the option to come in person, and most of the people that wanted to come in person were young people and teens. I know one, in particular, who had to be able to get out of the house. She had to be able to socialize with someone. Her anxiety had just kept increasing because of her inability to have human contact. Because we are all such creatures of habit, we are so used to routine that that was impacting all of us throughout the age spectrum. But for our kids that need to socialize, that is how they learn how to navigate the world around them. The inability to do that was really seen in that increase, as I said, in depression and anxiety for our kids.
ASCI: Were these challenges greater for children and youth of color? If so, how?
JW: When we have our youth, our Black youth, who are already impacted by racism and microaggressions all the time with the general distrusted systems that they learned from their parents and certainly also experienced on their own, I think children of color were impacted differently.
We have to remember that [the pandemic] also occurred around the same time we were seeing increased police brutality. Where we were seeing the murder of George Floyd right in front of our eyes and that trial. Then, with so many of our kids, particularly the kids that we work with, coming from poverty, my work has communities that are already facing so many systemic ‘isms.’
When you add that onto COVID and being afraid or not trusting of the medical system, knowing someone who has been impacted [by COVID], we know that we were impacted, our communities were impacted by COVID – you either you know someone who had or someone who died from it, or who got very sick from it – those were all those other fears that impacted our kids. You then have, George Floyd, you have police brutality, you have racism and other isms, and you have a lack of distrust on systems, just in general. When you add all of those things together, the impact on Black kids then became significant. I know one of the things that [Dr. McDaniel] often says, and others certainly, but, when society gets a cold, Black folks start getting pneumonia, because everything that we’ve been experiencing differently and excessively because of [those inequities].
ASCI: How have you seen COVID-19 impact youth socially? Has there been an increasing number of youth with social anxiety – whether diagnosed or undiagnosed – as a result of the pandemic?
JW: There has been an increase of social anxiety, and I think that one of the things that we’re not looking at, as closely as we probably could be based on those isms, but that social anxiety for kids has also been coming out in behaviors. Because they are lacking the socialization that normalizes things for them, we see an increase in inappropriate or negative behaviors in our children. While I have not seen any specific studies, I would almost bet that there’s been an increase in some of those behaviors once these kids got back to school. Again, trying to normalize things, we’re in, we’re out, we’re not in, some are in, some are out, all because of this pandemic. This kept them off balance. And so, when our kids are off balance, then we see it with the change in their emotional status.
Then we often see it in the change of their behaviors. Additionally, I think one of the things that we had to look at is that when they were in lockdown and they couldn’t go outside, then our kids often lost their safety net of school. Kids who were in abusive relationships at home that the school would usually see and then could report, got lost. So, those kids then were in homes with parents that also had an increase in their poor mental health status, and who lost their jobs. We already have people that are in food insecure places and so now ‘I don’t have my lunch or my free breakfast,’ and people tried to do the best that they could with [supports like] drop-and-go lunches, but you had to go somewhere, and you had to get there.
[As adults], we don’t often know what [youth] are saying to us because we’re looking for words. And when you get to a point where you’re just so overwhelmed as adults, we can kind of say those things where our kids can’t often put the words to that. And so they then display in their behaviors. And so when we talk about isms, then in one segment of the population, we would be able to say, oh, this mental health is really bothering our children. But then when you look at minoritized communities, then it’s talking about the badness of kids and behavior issues of kids. And they’re often seen as separate instead of one in the same.
ACSI: What supports would be beneficial for parents and caregivers to help their youth navigate social barriers?
JW: I think there are a few things. One, I think adults and caregivers have to be able to understand their own feelings around mental health and emotions and the impact that COVID had on them.
We need to have those community-led conversations about how we then help our kids. With the extra schoolwork or the socialization, how are we intentional about what we do? I think, unfortunately, for a lot of our communities, our families can’t, they may want to be intentional, but being intentional also often includes financial [support], after-school programs, or activities in the community, a lot of our communities don’t have those activities or some [require] a cost.
But the main thing we could do would be to talk to them and help them to express what [they’re feeling], and be able to allow them to say those things in their own words.
Sometimes, people in the system have to be able to allow those words to come out without having to be punitive and corrective of those words. Rather, let [youth] express it in their language because that’s all they know right now. They may only say, ‘This sucks,’ but what does that mean to them? ‘I can’t go play basketball,’ or, ‘I miss being around my friends, I miss being able to talk to people.’
We have to get down to what it means to them and what their fears are that surround this, and what they need for help. We can come up with a lot of strategies but if none of them are strategies that the kids feel help them, then it’s for naught.
ASCI: What role do caregivers play in the day-to-day needs of a child in care with social anxiety or who may struggle with their mental health?
JW: I think that caregivers play an extremely important role in being able to first identify [mental health challenges] and then be able to again, talk to them about it. They have to be able to talk to their workers and the other people of the system. I think this gives our caregivers a great opportunity to begin learning how to truly advocate for our kids. This is what this kid in the system needs. This is how we get what they need. They have to be able to advocate for them, and I think this is one of the primary roles that they play as a caregiver. Listening to them, certainly hearing them, but then advocating for what they need. Our kids in the system, they’re all very different, so they’re all very unique and we can’t come up with a one-size-fits-all. Because Jamal might need something completely different than Jeremiah in order to help them to get through this.
Caregivers need to find out what [resources] exist. It’s up to us as people in those places that work with the caregivers, to assist them in that, in their advocacy. What is it that we need to do for them? Then we drill that down. Even further, what conversations do we need to have with our staff so they have a broader understanding of what’s going on with our kids so they can then help the caregivers?
ASCI: What are some mental health supports that TRAC Services for Families provide to assist children and families?
JW: We do have a full mental health clinic. We also have a psychiatrist one day a week as well. We get a lot of referrals, but [we try] to make sure that the kids know [mental health support] is not a taboo in the Black community. That’s the first thing that we have to start learning in our community is that it’s not taboo.
Taking care of our mental health is not something that we should be ashamed of. That’s why our mental health is always at such a greater degree when it’s [addressed], or when it’s caught, or when it’s recognized because we’ve lived the life for centuries, that ‘we’re not crazy,’ or ‘we don’t go to counseling.’ Or, ‘What happens in this house stays in this house.’
So, we’ve lived through that for generations. Because we haven’t addressed that it’s not a taboo.
For July – Minority Mental Health Awareness Month – we need to make sure that people know it’s really okay to not be okay because we’re all just hanging in there the same way.
We have to be able to address every day, that there’s trauma, some level of trauma that [youth in care] are living through. So that, [for example] they have ADHD, looking at how that is impacted by first being in the system, being removed from family, and even if I’m placed with family, there’s still an impact that needs to be addressed. The sooner we’re able to address that with kids, their mental health outcomes will improve. We don’t get on it quick enough, we wait until there are explosive behaviors or things like that. But we need to address it from the very beginning. That being removed from your house is an emotionally traumatic experience. Being abused is an emotionally traumatic experience. We need to address it that way.
We have to be able to address it and we’ve not done it for so long. That’s why we have an increase in diabetes and high blood pressure and things like that, because, a lot of [challenges] are because we haven’t addressed the traumas, so we self-medicate in order to make things feel better. But we still have not addressed [the trauma].
We’re already such a resilient people, and when we address the things that we have to openly say and openly discuss, our communities are going to be so much better in the long run.