The pediatric mental health crisis and the COVID-19 pandemic

We in Illinois, like the rest of the United States, continue to confront a surge of COVID-19 infections. Amid this effort, children and families are experiencing tremendous suffering as the pandemic levies a toll on their psychological well-being. This crisis affects the most vulnerable and far too often voiceless members of our society and the consequences could echo for generations.

The current response to the COVID-19 pandemic is mostly aimed at the physical health of adults and the national economy. In a recent national study that involved Ann & Robert H. Lurie Children's Hospital of Chicago, one in four adults reported that their personal mental health had worsened since March 2020 and about one in seven said the same about their children's behavioral health. As physicians caring for pediatric patients in a variety of urban and suburban settings, we have observed these otherwise essentially silent impacts of COVID-19 firsthand: children and adolescents with increased anxiety, depression, eating disorders, confusion, self-harm, suicidality and increased interpersonal aggression.

Pandemic-related economic, housing and food insecurity are increasing across our state and nation. Childcare, school and treatment center disruptions continue to complicate access to specialized treatment for patients with autism spectrum disorders and intellectual and learning disabilities. Moreover, counseling and crisis intervention services for young people with anxiety, depression and trauma have been overwhelmed by diminished outpatient capacity, patchy and unequal access to telehealth services and a lack of inpatient bed availability. While the societal response to COVID-19 has many competing demands, unless we quickly and comprehensively address this mental health emergency, we may soon have more than a pandemic of infection.

In Chicago, Mayor Lightfoot's recent $8 million mental health grant initiative, with its focus on Chicago's communities that are most in need, has been welcome reform. To further combat cumulative trauma from economic, housing and food insecurity that is worsening with COVID-19, our leaders at the local, state and national levels should act immediately to enshrine long-term unemployment benefits, enact programs that provide workers and businesses funding to open safely and to weather the times they must close and expand food, child care and housing assistance.

Our state and nation must also deploy expanded mental health training and resources for existing pediatric providers in the same way we revamped our hospitals to treat an influx of COVID-19 patients.

Simultaneously, long-term initiatives must be enacted to fund an expansion of outpatient mental healthcare in under-resourced communities, preserve continued and longitudinal access to these locations, increase the availability of telepsychiatry services and support specialized long-term treatment resources like group homes and residential facilities.

We must also guarantee parity in mental health insurance coverage. And above all else, we need to coordinate our efforts toward cultivating strong healing communities that empower everyone, especially those plagued by ongoing racism and discrimination.

To do this, we must confront the stigma around mental health and use public health strategies developed to address global pandemics to mitigate a budding mental health pandemic. Physicians and other health-care providers must be vanguards of this change and re-imagine the role that we can play in our clinics, community hospitals and academic centers. We must seek to create an inclusive workforce that is as diverse as the patients we serve and leverage this diversity of backgrounds and perspectives to consider how we can better support the biological and psychosocial needs of all our patients.

And we must embark on this journey immediately. Children are among the most adaptive and resilient among us, but this pandemic threatens their current and future health in ways we have only begun to understand. In conjunction with our leaders at Lurie Children's Hospital, we stand ready to work with policymakers to address these needs in the short and long term.

• Drs. Nicholas R. Zessis, Michael Spewak. Michael Verre and Alba Pergjika are faculty members at Northwestern University Feinberg School of Medicine and practice in a variety of settings through affiliation with Ann & Robert H. Lurie Children's Hospital of Chicago.