Dr. Ronnie Pollard remembers the moment he knew he was in the middle of a mental health crisis. It was the fall of 2020, and an influx of teen patients was forcing the pediatric unit of Medical City Green Oaks Hospital to expand. The 125-bed behavioral health hospital for children and adults in North Dallas, where Pollard serves as executive medical director, normally reserves 12 beds for pediatric mental health patients. Now they were converting an adult unit to a pediatric one, taking the total to 36. The psychiatric hospital was filling up with teenagers in critical distress.
“Something’s not right,” Pollard thought. “We are in a crisis, but we’re not hearing about it from anybody.”
One of the new patients was Katie (not her real name), a 15-year-old girl trying to wade her way through virtual high school. She didn’t like attending online, missed her friends, and lacked the organizational skills to keep up with her studies on her own. Her grades dropped, and the months of isolation made her irritable and defiant.
Also struggling with the pandemic, her parents didn’t know what to do. They couldn’t ground her; she was already trapped at home. So they took her phone away. For Katie, her phone was her only lifeline, the last remaining means she had to connect with friends whom she saw as more supportive than her parents. She became depressed, and one night she drank an entire bottle of Benadryl. When pressed, she confessed to her mother what she had done. Her mom called 911, and Katie, like many others, ended up at Green Oaks.
To better understand how the COVID-19 pandemic is impacting kids and find out how parents can help improve their children’s mental health, we spoke with two mental health providers in addition to Dr. Pollard: Dr. Hayley Fournier, a psychologist in private practice in Dallas who treats adolescents; and Dr. Meghna Joshi, a psychiatrist specializing in child and adolescent psychiatry based in Allen.
Their top advice? Stop with the old-school, Mister Rogers-style face-to-face conversations about feelings. Come at things sideways, and be prepared to shut up and listen.
D Magazine: When I asked my pediatrician wife if she knew any pediatric psychiatrists to interview, she said she didn’t know any—a telling response backed up by data. According to the Meadows Mental Health Policy Institute, 2 in 5 children in Dallas County face mental health and substance use disorders, but just 10 percent of children receive mental healthcare in integrated and primary care settings. Have you witnessed this shortfall of professional care firsthand?
Dr. Meghna Joshi: There’s definitely been a huge shortage. I first started maybe 10 or 12 years ago, and at that time child psychiatrists were truly scarce; there was one in the Sherman area and maybe two or three in all of the McKinney-Allen area. In the last 10 years, the numbers have definitely increased, but there’s still a shortage. We do get calls from pediatricians asking us if we can get somebody in within a week or two, and sometimes we absolutely can’t because we’re booked for a couple months out.
Dr. Hayley Fournier: Everyone is completely maxed out. One of the issues that’s been really hard is that we’re all going through the pandemic, too, which has been really a unique challenge as a mental health provider. We’re used to being very cognizant of checking our anxieties and issues at the door and working through those so that we can really make the therapy space all about the patient. But it’s been really difficult having highly anxious patients come in wanting to talk about something that you yourself haven’t really had time to wrap your mind around.
A lot of us have kids, and we’re trying to figure out these things alongside our patients. I think there’s been a lot of burnout with our colleagues really needing to take breaks but feeling like it’s necessary for us to see more patients than ever, because there’s such a demand. We’ve been aware for quite some time that our community has needed more mental health professionals on the ground, but the pandemic really highlighted this need.
D: What are some of the major mental health issues that you have seen teens struggle with during the pandemic?
Dr. Joshi: I saw an increase in depression, anxiety, and suicidality, as well as learning problems. There’s definitely a lot more depression from lack of social interaction. A lot of kids felt really lonely and isolated, and they missed having that social interaction that they got at school. And there were a lot more learning problems, because the kids here in the Dallas area, they have had virtual school. A lot of kids experienced a lot more trouble focusing. I think it’s natural for kids to have trouble focusing if they’re on a computer for eight hours. I think anybody’s going to have trouble focusing.
“It’s been really difficult having highly anxious patients come in wanting to talk about something that you yourself haven’t really had time to wrap your mind around.”
Dr. Hayley Fournier
Dr. Ronnie Pollard: When I see kids for a suicide attempt, a lot of them say they feel like they’ve been cut off from their friends because of the virus. That’s the No. 1 thing I see. They have a loss of their normal routines and their normal structure. I think another part of it, too, is that getting away from home and getting away from Mom and Dad for a period is healthy. With the pandemic, they’ve been quarantined at home with their parents. They’re already having conflict; this just magnifies that conflict.
Dr. Fournier: I think of all the ways we had those built-in connections, built-in social time that we didn’t even count as social time: seeing friends in the hall at school or before soccer practice or in line at the grocery store. I think we underestimated how important that was. I noticed that when I reopened my practice to patients, the first people that were wanting to take more of a risk by coming in were in the 13- to 15-year-old range. I think they really crave that face-to-face time.
Dr. Joshi: A lot of the parents lost jobs during the pandemic, so that was another thing that the kids really could feel—the financial stress that the parents were going through. Several kids would talk about that as contributing to their depression and anxiety. I had a few kids whose parents got COVID and ended up in the ICU. I had one girl that had so much depression and anxiety whether her dad would get better or not. Thankfully he did. But it was scary; I thought he was not going to make it. And then she felt guilt because she was the one who brought COVID home. Others had grandparents who died from COVID.
Dr. Fournier: I have seen a lot of patients who were in remission or doing quite well need to get back in for therapy, because I think the pandemic triggered a resurgence of some of the issues that they had taken care of. It was a stress that we really couldn’t be prepared for.
D: So, as a stressed-out parent, what’s the best way to help your kids deal with these challenges?
Dr. Fournier: I think parents, more than ever, need to focus on themselves first as a way to help their kids. I love that analogy of using your oxygen mask on the airplane: you have to put on your own oxygen mask before you help your kids put theirs on.
Kids are looking to us for that reassurance and modeling of good coping. For teenagers, it’s tricky, because it won’t be apparent, necessarily, that they are looking to parents for this reassurance.
D: OK. You’ve taken some deep breaths. You’ve centered yourself. What’s the best way to start a conversation with your not-so-calm kid?
Dr. Joshi: I feel like kids will talk if you ask the right questions. If you ask, “How was your day?” they’re going to say, “Fine.” Or if you ask, “What happened today at school?” You know, they’ll say, “Nothing.” But if you ask questions a different way, then they’re much more likely to talk to you.
Sometimes parents don’t think to ask, “Who did you sit with at school today?” The kid might say, “Oh, I sat with so-and-so.” Or, “Oh, I’ve been sitting by myself every day.” Or, “I eat lunch with the teacher.” That’s a specific question that you may not have thought to ask, but the answer could be really helpful in finding out what exactly is going on with your child.
I basically coach parents on different ways of getting their children to talk and communicate. The ones that do have open communication with their parents, those kids just seem to do better.
Dr. Fournier: That direct asking of “How do you feel?” or “Let’s sit down face-to-face and have a conversation”—that old-fashioned idea of communication is not how teens work. Instead of face-to-face, it needs to be more of a side-by-side conversation so it’s less direct.
For example, when you’re watching a movie, you might talk about the characters in the movie and ask them if they’ve ever known a friend to have an issue like the one depicted. Parents can also ease into the conversation by talking about their own experiences. “Gosh, I’ve been feeling pretty wound up about this pandemic, and I’m noticing I’m more tired than usual. How are you feeling?” I know that may seem to contradict what I said earlier about good modeling, but I think while parents have to model good coping skills and set the tone for the family, they also need to balance that with being human. Talking about their own feelings is a great way to open the door to talking about their kids’ emotions.
And do a lot more listening than talking. Sitting back and listening is much more helpful than giving advice or jumping in and having some sort of Mister Rogers moment. Just sit back and use one-word phrases to let them know that you’re actively listening to them but not jumping in and changing the direction of the conversation.
D: Is it ever OK to tread into deeper waters and ask directly about suicidal thoughts or self-harm? Or is that just adding fuel to what may not have been a fire?
Dr. Joshi: I would say 99 percent of parents are afraid to ask about suicidal thoughts. I’ve had a lot of parents say that they’re scared to ask about suicidal thoughts and cutting because if their child isn’t doing it, they’re scared that they’ll put that idea in their head. They’ve done so many research studies and they’ve proven that you’re not going to plant any ideas in your child. Chances are they’ve already thought of it before or they’ve heard of a friend or somebody at school cutting or having suicidal thoughts. So it’s not an idea that you’re going to plant in their head just by asking them.
D: If your child does have thoughts of self-harm or suicide, what can a parent do besides seek professional help?
Dr. Pollard: Parents need to talk about if their child has a good safety plan in case the child has suicidal or self-harm thoughts. They need someone who they feel comfortable contacting. Which parent are they closer to, or is it a teacher they feel comfortable with, or even a peer? They need somebody already in their mind that if things go bad in a hurry, they don’t have to think about it; they just go directly to their contact person.
D: Are there warning signs to watch out for?
Dr. Pollard: We tell the parents to watch their kids’ sleep patterns. Sleep is so important, especially when they don’t have any structure, they’re not going to school. The natural adolescent clock is to stay up later at night, but then they sleep later in the morning. We encourage parents not to let that happen. Keep a normal routine; give them the same bedtime every day.
“Look for changes in sleep and appetite. if they start withdrawing from the family, that’s a big warning sign.”
Dr. Ronnie Pollard
Look for changes in sleep and appetite. If they start withdrawing from the family, that’s a big warning sign. And aggression. Sometimes kids don’t know how to talk about what’s going on with them, and they may not even consciously recognize it. But aggression is a big warning sign. Parents may see a drop in grades, or see the adolescent become more apathetic about everything. Substance use is an obvious kind of warning sign.
If a teenager talks of death and dying in general terms or their own death, that can be very concerning as well.
D: Has technology helped to fill the service gap for teens?
Dr. Joshi: When the pandemic started, like everybody else, we didn’t know what to do. We decided to go 100 percent telemedicine. Every physician I knew joined doxy.me. We were able to immediately change all our patients to telemedicine so we didn’t really have to take a break or stop seeing anybody.
Some of my patients don’t like the videoconferencing and want to hide under a blanket or pull a hoodie on top of their head. But usually after a couple of times they’ve gotten used to it. I would say the majority did just fine, because I think we live in an age of technology. All the kids are FaceTiming their friends constantly.
And then it was pretty flexible because the kids could go to their room and talk to me privately. Then they would call their parent in for the end. One advantage was you could log on from different locations, so parents could join from work. Another advantage was that they would have a lot less driving time, so they didn’t have to miss as much school or the parents didn’t have to miss that much work. Some of the parents were even pulling the kids into their car during school and just doing the appointment in the car. That way the kids missed very little school.
D: Sometimes making the first call can be the hardest part of the process. What’s the best way for someone new to therapy to find help?
Dr. Pollard: In one study I reviewed recently, adolescents were asked if they thought they had a mental health problem and should seek help. Seventy-five percent of the teens interviewed thought that they did need help and should seek out assistance, but the majority of them stated that they didn’t know how. So although 75 percent of the adolescent population believes they need help for a mental health problem, 60 percent of them are not reaching out for help and not getting the help they need.
Dr. Fournier: I do think parents are very nervous to make that first call. I think it’s important for them to understand that sometimes you do have to make multiple calls to find the right fit. But don’t hold off on making that first call because you don’t know exactly where to start.
“I coach parents on different ways of getting their children to talk. The ones that do have open communication with their parents, those kids just seem to do better.”
Dr. Meghna Joshi
Psychology Today [psychologytoday.com] is a really good resource because you can narrow down your search by insurance, modality of therapy, population seen by the therapist, location, etc. So there are good tools. Many universities now have their own search tool on the website of their mental health center to help students find community resources.
I encourage parents to involve their children in the process of selecting their therapist. Many
therapists have bios and pictures online, which can help children and teens decide ahead of time who they might feel most comfortable speaking with. Making this a collaborative process can help young people feel more engaged in the therapy and eventually establish a stronger therapeutic relationship.
Another thing that I think is really a big deal with that first phone call is knowing that you don’t have to sign up for therapy by calling. Many therapists offer phone consultations or are able to provide more streamlined referrals to help your family find a good fit for your needs.
D: In the meantime, don’t just take away your teen’s phone?
Dr. Pollard: It’s a double-edged sword, but in the pandemic time, I’ll tell parents to relax the phone privileges. Make sure they have positive social outlets, whether that includes social media or phone calls. Kids, especially teenagers, need to socialize. Sit down with your child and explore with them how they deal with stress. Ask them about their coping skills. Coping skills are not something that we are naturally blessed with. We usually have to be taught coping skills.
There are healthy coping skills and very unhealthy coping skills. Healthy coping skills are exercise, meditation, journaling, socializing, music, yoga, while unhealthy ones are alcohol, smoking, vaping, increased promiscuity, or runaway behaviors. You need to ask not only do they have coping skills, but how many do they have. Because if the first one doesn’t work and they’ve only got one, they’re likely to fall back on something unhealthy. They need at least five healthy coping skills.
It’s also important to make sure that parents are good role models and practice self-care and healthy coping skills. They can’t be going out and drinking and smoking all night. That’s using unhealthy coping skills and modeling that behavior for the child.
The next thing is for the parents to provide a safe, supportive environment, so the teen feels comfortable expressing what they want and what they need as well as how they are feeling. If they don’t feel like they can trust the parent, then they’re not going to open up and tell them, “Last week I was having suicidal thoughts.”
D: What if your child just won’t open up?
Dr. Pollard: If they are not open about it, that creates a different challenge. At that point, seeking professional help is recommended right away. Tell your child that you love them and that you’re always there for them. Even though you may think it’s a given, I think that the child needs to hear that a lot of times. Life gets so hectic that we don’t say, “I love you. I care about you. I’m here for you.” The teens need to hear that.