What We CAN Do About the Child Mental Health Epidemic

By Joshua Sparrow, MD

The child mental health epidemic began before the COVID-19 pandemic, which has only spread it further. Even before March 2020, there were not enough mental health professionals — not even in cities with lots of them — to work with all the children struggling with depression, anxiety, and other mental health challenges.

While access to mental health professionals should be a right — not a privilege — for every child who needs them, children who are struggling cannot wait for that day to come. Until then, what can we do to support them and their families?

I’ve been asking a few of my friends — pediatrician and founder of Vital Village Networks, Renée Boynton Jarrett; Boston Youth Sanctuary Founder and Director (and former Boston School teacher), Jana Karp; and the City of Boston’s first Chief Behavioral Health Officer (and Boston Children’s Hospital, Department of Psychiatry & Behavioral Sciences, and Division of Developmental Medicine colleague), child psychiatrist Kevin Simon.

First, triage, and prioritize professional mental health treatment for those children in greatest need.

Many years ago, the founder of the Magnolia Community Initiative, Alex Morales, told me about his car. A hybrid. With a gas motor, for the freeway on-ramps, and a self-regenerating electric one, for tooling around town. Some children do need high-powered mental health professionals. But others can heal and flourish with resources and supports outside of therapy offices, clinics, and hospitals. The Magnolia Community Initiative, for example, is a self-regenerating preventive model that builds safe and supportive environments for children — and it is powered by the community.

Second, build capacity in pediatric primary care providers and other professionals who work with children – for example, childcare providers, teachers, and after-school program professionals – but attend to their mental health too.

For example, the Massachusetts Child Psychiatry Access Program (MCPAP)  connects child psychiatrists with pediatric primary care providers. Across the country, the latter provides most of the medical care for children with mental health needs. MCPAP had already become a national model before the pandemic and is being scaled in several states. Another model for building capacity in non-mental health professionals to support children’s mental health is Supportive Trauma Interventions for Educators (STRIVE). Co-designed and co-led by the Vital Village Child Witness to Violence Project and Boston Public School Teachers, STRIVE also attends to educators’ wellness — with the wisdom of their own lived experience.

Professionals of any kind can only really nurture children’s mental health when they themselves are well. Often, they too have inadequate access to mental health professionals, or to living conditions that help promote well-being and reduce the need for them. And that’s where my next and final point comes in.

Third, and this may be what matters most for most children — and the adults who care for them — let’s look at what our world has been putting children through that started making so many of them miserable before the pandemic. Among these are the structural and systemic problems that mental health professionals can’t solve alone, and that affect so many more children than they can possibly treat.

So many are obvious — poverty, racism, political strife, climate change, toxic air and water, decrepit built environments, underfunded schools, underpaid and overworked parents, the erosion or loss of resources in schools and communities for activities like acting, building, creating, dancing, discovering, exploring, helping, inventing, serving, singing, storytelling — that bring children joy and give them a sense of purpose and belonging.

And then there are unintended consequences, for example:

• our risk-averse society — that robs children of the “blessing of a skinned knee”
• misfiring school readiness efforts (e.g., the legacy of No Child Left Behind) that constrain and narrow what schools, teachers, and families can do to foster the personal growth and life learning experiences that, by the way, also undergird children’s academic success
• the pressure on parents — to be perfect (not possible) and to raise “the happiest kid on the block” rather than children who can relish and reciprocate happiness yet are also learning to be ready for life’s inevitable ups and downs — including sorrow and suffering

COVID has made the lives of so many children, and their families and teachers, harder in so many ways (See, for example, Rider, E. A., Ansari, E., Varrin, P. H., & Sparrow, J. 2021. Mental health and wellbeing of children and adolescents during the covid-19 pandemic. bmj, 374.

To help children heal from the pandemic’s harms, we need to do all we can to fix what was already broken before it began.

Despite systemic and structural challenges, communities have always found their ‘way through no way’ to create collective assets and resources that promote wellness. Many communities are generously sharing their solutions with others, for example, in resources like the Networks of Opportunity for Child Wellbeing Playbook. Developed in partnership with community leaders, the Wellness Playbook is helping to spread community-driven innovations that promote belonging, connection, and flourishing.

We can supplement efforts to scale mental health professional treatment with efforts to make our world one that nurtures children’s mental health, a world that they can and want to grow and thrive in. Let’s mobilize to do whatever we can to stop the strife, heal, and protect our planet. I know that sounds lofty — but children need to know not just that we care about the future we are leaving them but that we are acting now to make it better than today.

Let’s partner with children and young people (examples: Boston Youth Sanctuary, Elevated Thought, and Zumix) in our neighborhoods and schools, our fields, streams, and streets. That’s where we can build opportunities for them to learn about and feel proud of who they are, who their people are, and where they come from; to experience themselves as creative and competent and contributive; to take risks to learn from as well as responsibility; to find and try out their voices, and to be heard; to find meaning in their lives now and most days and not just on one deferred someday.