Yale Doctor Reflects on Mental Health Toll of Pandemic

My daughter was barely 3 months old when a New York Times editorial stated it was time for the US Government to declare a National Emergency.  As an educated mother of a newborn and a toddler, I was initially petrified, but then mobilized to do anything in my power to understand what the coronavirus was and how I could keep my immediate family out of harm’s way. 

Returning to work after maternity leave without much understanding of transmission of the virus and scarcity of PPE made me uneasy for fear of bringing sickness home to my children, but also guilty of not doing my part.  Doctors/nurses/first responders were being called heroes, but I did not feel worthy of such accolades, I was as scared as the next person.  It was evident that in the months to come, as were many others, I would be challenged in ways never imagined.  I was luckily supported by my department chair and colleagues and with the advances in telehealth was able to return to work “virtually” and in person a few months later.  In person work, meant my toddler and newborn had to go back to daycare with the obvious concerns for exposure to COVID.  I wondered the impact of masked teachers on my daughter’s language and social-emotional development.  

It appeared, most people I knew were trying to put one foot in front of the other while grappling with the uncertainty of when life would return to pre-COVID times.  While some coped in productive ways, those who had vulnerabilities pre-COVID were soon exposed.  In my role as a Child and Adolescent Psychiatrist, initially there was an eerie silence. The Children’s Hospital seemed mostly empty, likely due to parents feeling scared of taking their children out of the homes except for the most acute medical issues.  

As the months progressed, I witnessed a worsening in severity of mental health presentations, more kids with suicidal ideation, more suicide attempts, and more children needing to be hospitalized for eating disorders.  Children were waiting for days in the emergency department due to lack of inpatient psychiatric beds and long wait lists for other therapeutic levels of care.  Mental health providers were stretched thin, and the emergency department was bursting at the seams with mental health patients competing for the very same beds that medical patients needed.  

I was constantly asking, “How did we get here?” 

The answer is that it is complicated but numerous factors play a role for youth outside the COVID infection including: the confinement, parental stress as they try to balance work with caretaking roles, social distancing, transitions to virtual schooling, limit on health outlets such as music/dance/arts/sports, limited social interactions in the adolescent years as well as changes in most ways we lived life. Daily occurrences that we used to take for granted like going to school/work, getting together with loved ones, practicing sports, dining out, buying groceries, even sneezing or coughing took a new form or meaning.  Political as well as civil unrest added insult to injury as the pandemic unfolded.  Finally, the perennial stigma and lack of priority of mental health resources, left us underprepared for a catastrophe of such magnitude.  Mental health, traditionally under-reimbursed, was once again at the forefront. As a field we seemed to adapt more quickly to telemedicine compared to other fields but resources quickly saturated in an already underinvested system.   The latter is no surprise given the high stress that most were facing in their daily lives, coupled by lost wages, illness, and lack of reprieve, and if you will no end in sight.  

Now a year or so after this whole nightmare started, the pandemic has somewhat abated, and people are slowly embracing life again.  For some privileged and lucky ones, life will continue and this will seem like a blip in time, for others there are emotional wounds in different stages of healing or permanent scars.  I cannot pretend to understand how the aftershocks of COVID 19 pandemic will be experienced in the coming years, but as many of my colleagues I am weary of its rippling effects on the mental health of our youth and young adults.  

The pandemic has shown me the expansive flexibility and vast resilience of the human spirit.  That despite adversity, people thrive to heights never thought possible given the opportunity and with the right resources.   Most importantly, the pandemic has taught me that ignoring or postponing selfcare via either counseling, psychiatric treatment can have disastrous consequences when the unimaginable becomes reality.  If we are to come out of this ahead, schools, communities and government must make access to mental health for all a high priority in the years to come.   

Claudia Moreno
Assistant Professor of Clinical Child Psychiatry
Medical Director for Psychiatric Emergencies Children’s Hospital ED, YNHH
Medical Director for Child and Adolescent Psychiatry Consultation & Liaison Service, YNHH Children’s Hospital

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