A catastrophic deterioration in the psychological wellbeing of children and adolescents all throughout the United States has been labeled a “urgent public health disaster” by the United States surgeon general. The Centers for Disease Control and Prevention (CDC) reports that the rates of suicidal behavior, self-inflicted injuries, anxiety, and depression are on the rise among adolescents. This pattern of behavior began before the epidemic.
This evening, we will take you to Milwaukee, Wisconsin, to visit a community that is attempting to assist its children and teenagers in coping with a mental health crisis. The state of Wisconsin has the sixth largest increase in the number of cases of adolescent self-harm and attempted suicide, as we originally reported back in May.
In the nation, with rates having almost completely increased since before the pandemic began.
At Children’s Hospital in Milwaukee, emergency room physicians like Michelle Pickett are seeing an increase in the number of children who are in urgent need of assistance with their mental health.
Dr. Michelle Pickett: Unfortunately, we see a lot of kids who have made attempts to end their own lives. I would say that we witness anything like that at least once on each shift.
Once upon a shift, Sharyn Alfonsi asks?
Dr. Michelle Pickett: Oh– yes. Unfortunately, the answer is yes.
Dr. Pickett has nine years of experience working in the emergency room.
Sharyn Alfonsi: Is there any population that is not going to be affected by this?
Dr. Michelle Pickett: No. We encounter children from various walks of life, including those whose families are wealthy, those whose families are not, those who live in the suburbs, those who live in the city, and those who live in the country. We’re– we’re seein’ it all.
Due to the increase in the number of families that want assistance for their children, there is a shortage of both people and places that can treat them.
It takes an average of forty-eight days to acquire an appointment with a therapist in the United States, and the wait time is typically even longer for young patients.
Sharyn Alfonsi: What kind of message do you think it sends that the only place they can go is the emergency room?
Dr. Michelle Pickett: that our current system has some fundamental flaws that need to be addressed. It is not appropriate to seek immediate treatment for acute mental health issues at a hospital emergency room when you are experiencing a mental health crisis. We are not a nice, calm environment.
But they’re desperate, Sharyn Alfonsi says.
Dr. Michelle Pickett: Yes, we are there, and we are able to observe everyone. But I really wish there were more locations where young people could go to get the assistance that they require.
Dr. Pickett presented an iPad with a series of questions that screen the mental health of every child 10 years old or older that comes to the emergency room for whatever reason. This was done so that he could better manage the mental health crisis as well as the large caseload.
There were other questions, including “have you been having thoughts about ending your own life?” and “have you felt that your family would be better off if you were dead?”
questions that are designed to be difficult yet have the potential to save the lives of the children who answer them.
Dr. Michelle Pickett: There have been four children that I am personally aware of who have presented themselves to our facility for treatment of completely unrelated issues, such as a broken arm, an earache, or whatever it was; however, upon closer inspection, we discovered that they were acutely suicidal to the point where we needed to immediately transfer them to an inpatient facility. So, what we’re doing is catching children that are, you know, in very much of a crisis like that. However, we are also catching the children who simply require assistance, are unsure about what to do, and have not really discussed this topic before.
The Centers for Disease Control and Prevention (CDC) has found that the number of teenage females who have attempted suicide has climbed by fifty percent across the country since 2019. One of them was a woman named Sophia Jimenez.
I remember crying every night and not knowing what was going on, and I felt so isolated. Sophia Jimenez:
When COVID came along, both Sophia and her best friend, Neenah Hughes, were in the eighth grade and excited about going to high school. However, their lives were flipped completely upside down.
Neenah Hughes: When I was a kid, I was known for being an extremely intelligent child, and I always had incredibly outstanding marks. After that, as soon as the epidemic started, I got a failing grade in one of my classes. When I was a virtual student, I lacked the motivation to complete any of my assignments. It was really evident that I was depressed because all I did was sit in my room all day and never venture outside.
My mental health, particularly my eating disorder, had gotten to be in extremely horrible shape, said Sophia Jimenez. I spent the majority of the day by myself at home. My parents, on the other hand, observed that I wasn’t eating, and they became concerned. I would picky about what I ate. As a consequence of this, they ultimately took me to the hospital.
Before a psychiatric facility could accept Sophia as a patient, she was forced to wait in the emergency room for two weeks.
Sharyn Alfonsi: Your generation, in particular, was affected by this at a period of time that was intended to be carefree and enjoyable. What exactly did we miss? What have you guys been forced to give up as a result of the pandemic?
Sophia Jimenez: I, Personally, Am.
Sharyn Alfonsi: You Should Look at Yourself.
Neenah Hughes: Yeah. I believe it is fair to say that there were significant parts of me that were, in all likelihood, lost. I had to let go of certain pals because we just stopped seeing each other. We were not able to attend our very first Homecoming, and I was unable to graduate from the eighth grade. I’m aware that doesn’t appear to be a very big thing, but the fact remains that we were looking forward to….
Sharyn Alfonsi: However, it is a significant event by the time you reach the eighth grade.
Neenah Hughes: Yeah. I have the impression that many of my feelings of depression and other mental health issues would not be nearly as severe if the pandemic had never taken place at all. It did nothing but make the situation worse.
Do we currently find ourselves in a state of crisis, Sharyn Alfonso?
The answer is yes, Tammy Makhlouf. We are in the midst of a catastrophe. And it’s very unsettling.
For the past quarter of a century, Tammy Makhlouf has maintained a career as a child therapist across the state of Wisconsin.
Sharyn Alfonsi: I believe that there was the hope that now that we are back in school, the children will be able to see their friends again, and they will be able to participate in sports, that all of this will go away. Has it?
No, said Tammy Makhlouf. No. I’ve noticed that the wait lists are getting longer, and I’ve also noticed that more children are battling with anxiety and despair. So we were in a mental health crisis before to the pandemic.
Sharyn Alfonsi: Do you think the epidemic played a role in its acceleration?
Tammy Makhlouf: If I had to guess, yes. Even though the pandemic is nearing to an end, children have nonetheless lost two years of their lives. Two years of socialization, two years of schooling, two years of their world sorta getting rocked around. As a result, I believe that children are having difficulty adjusting as we get “back to normal.” Even if the pandemic is brought under control, this predicament will not be resolved.
Even before the pandemic, the number of adolescents who reported feeling continuously depressed or hopeless has increased by 40% since 2009, according to data provided by the CDC.
There are lots of theories on why – social media, greater screen time and isolation, but the study isn’t definitive.
Tammy Makhlouf was selected by Children’s Hospital to lead an urgent care walk-in clinic that was opened particularly to address children and adolescents’ mental health issues in the month of March.
It is one of the first clinics of its sort in the country and is open seven days a week from three in the afternoon until nine thirty at night.
Tammy Makhlouf: When patients come to our clinic, we first conduct an evaluation, and then we schedule a therapy session for them. So we give them some interventions. We give them a plan, an action plan.
The plans are adapted to each child’s situation. Actionable things families and kids can do while they hunt for a doctor or facility to make room for them.
Sharyn Alfonsi: How long have the wait lists been to obtain help?
Tammy Makhlouf: Normally you’re put on you’re scheduled an appointment within a few months.
Sharyn Alfonsi: Months?
Tammy Makhlouf: Yeah. And then if you want a child psychiatrist you’re looking at months to a year.
Sharyn Alfonsi: How crucial is it to get them help when they need it, immediately?
Tammy Makhlouf: As days go on, the symptoms get worse. If you have a sad child, you know, maybe they began off where they were feeling depressed, and then as the days goes on, they’re suicidal. So it really— you really do need to receive that aid and the support right away.
Eleven-year-old Austin Bruenger sorely needed the assistance throughout the pandemic. He’s a fifth grader at Roosevelt Elementary School in Milwaukee.
Sharyn Alfonsi: how old were you when the pandemic hit?
Austin Bruenger: I was nine. I was still going to school, but then I kept hearing on the news in the car, just like, pandemic, stay put, quarantine, 14 days.
Sharyn Alfonsi: When they first said, “Hey, you don’t have to go to school,” what was your reaction at that moment?
Austin Bruenger: Heaven. But then I understood it’s the complete opposite.
Opposite because like millions of school age kids, Austin was forced into remote learning for more than a year and disconnected from friends.
Austin Bruenger: I was like this shut in. The only way you could see people is through like, phones or your family that you live with.
That isolation took a toll on Austin who was already struggling with news that his parents were getting a divorce.
Melissa Bruenger: And that’s when I think everything just started to magnify. He, you know, he was always asking to see his friends. We couldn’t. And I remember there was one moment that he was just on the floor, like, kicking and punching the air. Just– but couldn’t describe why he was upset.
Unable to vent with friends, and without access to in-person therapy, Austin’s mother Melissa says his world began closing in on him.
Melissa Bruenger: It felt like he was interacting less and just kinda withdrawing into himself and spending a lotta time by himself. And I went to go tuck him in and he said, “Mom, I’m having suicidal thoughts.”
Sharyn Alfonsi: And he was how old?
Melissa Bruenger: He was nine. And, like, I was kinda like, I– I didn’t know what to say. I didn’t know what to do.
Austin Bruenger: I just imagined myself going through all these things like jumping from a building and taking a knife from my kitchen and ending my life. It was over 50 of them that just flooded my mind. I don’t really know if it was from all the, like, anti-socialness and not being able – it also felt like with the divorce came a lot of yelling and it felt like my parents didn’t need me anymore. It’s just really hard to think about that moment.
Desperate, Melissa called Austin’s pediatrician who referred her to outpatient therapists and in-patient psychiatric programs – only to be told there were long waiting lists and no beds.
Melissa Bruenger: All this stuff is racing through my head. And then for them to say, “Well, there’s no beds right now.” And I’m like, “How am I going to keep him safe?”
In an effort to try and keep kids safe, Wisconsin is trying another approach that’s being adopted in other parts of the country.
Seventeen pediatric clinics across southeastern Wisconsin have incorporated full-time therapists inside their offices. Offering mental health screenings and treatment as part of routine care. Dr. Brilliant Nimmer was the first pediatrician in Milwaukee to create a therapist’s office inside her office.
Sharyn Alfonsi: You’re saying, “We’re here together, we’re gonna all work on this together,” not “We can’t help you, go see somebody else.”
Dr. Brilliant Nimmer: Exactly. And so having the therapist in our clinic to really just have– get a team together to discuss that patient and family together, to bounce ideas off of each other, ’cause we both know them so well– is so much better for patient care.
Dr. Nimmer’s clinic treats an under-served community where families typically struggle to get mental health help. Therapists have treated more than 500 kids here since the pandemic started.
Dr. Brilliant Nimmer: I think as pediatricians and primary care providers we can no longer just solely say, you know, ‘Mental health providers, you’re the only ones that are going to be taking care of our patients in regards to mental health.’ This is now something that we need to be doing too.
Austin Bruenger’s pediatrician now has a therapist in her office too. Their family was fortunate to find regular outpatient therapy for his depression.
Sharyn Alfonsi: How do you feel now?
Austin Bruenger: I don’t know. It’s much better than before. Everything’s going up in my life, knowing that, like, I’m friends with everyone in my class, I’m building better, like, social life. It’s fun to just know there’s others that like the same things as me.
Sharyn Alfonsi: Austin, it’s not an easy thing to talk about all this stuff. Why did you agree to tell us about what you’ve been through–
Austin Bruenger: Because the world needs to, the world needs to know. Mental health and stuff like that needs to be treated, or bad stuff could happen. if you’re going through that by yourself, try and contact someone you know, like your friend, your family.