The US surgeon general has called it an ‘urgent public health crisis’ – a devastating decline in the mental health of children across the country. According to the CDC, the rates of suicide, self-harm, anxiety and depression are up among adolescents – a trend that began before the pandemic.
Tonight, we’ll take you to Milwaukee, Wisconsin, a community trying to help its kids navigate a mental health crisis. As we first reported in May, Wisconsin has the fifth highest increase of adolescent self-harm and attempted suicide
In the country, with rates nearly doubling since before the pandemic.
In the emergency room at Children’s Hospital in Milwaukee, doctors like Michelle Pickett are seeing more kids desperate for mental health help.
Dr. Michelle Pickett: We unfortunately see a lotta kids who have attempted suicide. That is something that we see I’d say at least once a shift.
Sharyn Alfonsi: Once a shift?
Dr. Michelle Pickett: Oh– yes. Yes, unfortunately.
Dr. Pickett has worked in the ER for 9 years.
Sharyn Alfonsi: Is there any group that’s not being impacted?
Dr. Michelle Pickett: No. We’re seeing it all; kids, you know, who come from very well-off families; kids who don’t; kids who are suburban; kids who are urban; kids who are rural. We’re– we’re seein’ it all.
The surge of families needing help for their kids has revealed a deficit of people and places to treat them.
Across the country, the average wait time to get an appointment with a therapist is 48 days – and for children it’s often longer.
Sharyn Alfonsi: What does it say to you that the place they have to come to is the emergency room?
Dr. Michelle Pickett: That there’s something wrong with our system. The emergency room should not be the place to go and get, you know, acute mental health care when you’re in a crisis. We are not a nice, calm environment.
Sharyn Alfonsi: But they’re desperate–
Dr. Michelle Pickett: Yeah, we’re there and we see everybody. But I wish there were more places that kids could go to get the help that they need.
To manage the mental health crisis and heavy caseload, Dr. Pickett introduced an iPad with a series of questions that screen the mental health of every child ten and older who comes to the ER for any reason.
Among the questions: “have you been having thoughts about killing yourself,” and “have you felt your family would be better off if you were dead.”
Harsh questions that can be lifesavers to the kids who answer them.
Dr. Michelle Pickett: We’ve had four kids that I know of personally that came in for a completely unrelated problem so, a broken arm or an earache or whatever it was and actually were acutely suicidal to the point where we needed to transfer them to inpatient — facility right then and there. So, we’re catchin’ kids, you know, who are in very much crisis like that. But we’re also catching the kids that just need help and don’t know what to do, and haven’t really talked about this.
According to the CDC, hospital admissions data shows the number of teenage girls who have been suicidal has increased 50% nationwide since 2019. Sophia Jimenez was one of them.
Sophia Jimenez: I remember crying every night and not knowing what was going on and I felt so alone.
Sophia and her friend, Neenah Hughes, were in eighth grade, looking forward to high school when COVID turned their worlds upside down.
Neenah Hughes: I’ve always been a super smart kid, and I’ve always had really good grades. And then as soon as the pandemic hit, I failed a class. When I was virtual I had no motivation to do anything. I would just sit in my room, never leave, and it was, like, obvious signs of depression.
Sophia Jimenez: My mental health got really bad, especially my– eating disorder. I was basically home alone all day. My parents– well, they noticed that I wasn’t eating. I would refuse to eat. So then they ended up taking me to the hospital.
Sophia had to stay in the hospital for two weeks before a bed opened up at a psychiatric facility.
Sharyn Alfonsi: Your generation, like, got hit with this in what’s supposed to be kind of a fun, carefree time. What was lost? What did you guys lose during the pandemic?
Sophia Jimenez: Myself.
Sharyn Alfonsi: Yourself.
Neenah Hughes: Yeah. I would definitely say there were big pieces of myself that I– were definitely lost. I lost friends because we wouldn’t see each other. we couldn’t go to our first Homecoming, I couldn’t have an eighth grade graduation. I know that doesn’t sound like that big of a deal, but we were looking forward….
Sharyn Alfonsi: But it is a big deal when you’re in eighth grade.
Neenah Hughes: Yeah. I feel like if the pandemic hadn’t happened at all, a lot of my, like, sadness and mental problems would not be as bad as they are. It just made everything worse.
Sharyn Alfonsi: Are we in crisis mode right now?
Tammy Makhlouf: We are. We are in crisis mode. And it’s scary.
Tammy Makhlouf has worked as a child therapist throughout Wisconsin for the last 25 years.
Sharyn Alfonsi: I think there was a hope that, you know, we’re back in school, the kids are able to see their friends again, and play sports, that this would all go away. Do you have it?
Tammy Makhlouf: No. No. I’ve noticed that the waiting lists are longer, kids are struggling with more anxiety, more depression. So we were in a mental health crisis prior to the pandemic.
Sharyn Alfonsi: Did the pandemic accelerate it?
Tammy Makhlouf: I believe so. We’re coming out of the pandemic, but kids have still lost two years. Two years of socialization, two years of education, two years of their world kinda being shaken up. So as we get quote-unquote, ‘back to normal,’ I think kids are struggling. Even when the pandemic is over, this crisis isn’t going to be over.
CDC numbers show that even before the pandemic, the number of adolescents saying they felt persistently sad or hopeless was up 40% since 2009.
There are lots of theories on why – social media, increased screen time and isolation, but the research isn’t definitive.
This past March, Tammy Makhlouf was tapped by Children’s Hospital to run an urgent care walk-in clinic specifically opened to treat children’s mental health.
Open seven days a week from 3 to 9:30, it is one of the first clinics of its kind in the country.
Tammy Makhlouf: So when they come to our clinic, we assess them, and we provide them with a therapy session. So we give them some interventions. We give them a plan, an action plan.
The plans are catered to each child’s situation. Actionable things families and kids can do while they look for a doctor or facility to make room for them.
Sharyn Alfonsi: How long have the wait lists been to get 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 important 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 depressed child, you know, maybe they started out where they were feeling depressed, and then as the days go on, they’re suicidal. So it really– you really do need to get that help and that support right away.
Eleven-year-old Austin Bruenger desperately needed that support during 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 heard 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 realized 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 the news that his parents were getting a divorce.
Melissa Bruenger: And that’s when I think everything just started to magnify. Hey, 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 tuck him in and he said, “Mom, I’m having suicidal thoughts.”
Sharyn Alfonsi: And how old was he?
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.
Sharyn Alfonsi: And talk about it.
Austin Bruenger: Yeah.
Produced by Ashley Velie. Associate producer, Jennifer Dozor. Broadcast associate, Elizabeth Germino. Edited by April Wilson.