The Impact of COVID-19 on Youth Mental Health: An Interview with Leigh Fischer

Abt Senior Associate Leigh Fischer, MPH, focuses on behavioral health research and policy. She recently sat down with us to discuss how the COVID-19 pandemic has exacerbated mental health issues, especially for youth. Fischer serves as the co-lead for Abt’s Behavioral Health Market Center and has worked on several projects focused on evidence-based prevention, early intervention, and treatment practices for youth. She is the project director for Abt’s evaluation of the Hilton Foundation Youth Substance Use Prevention Strategic Initiative. She also serves as a team lead for the Substance Abuse and Mental Health Administration’s (SAMHSA’s) Evidence-Based Resource contract, reviewing evidence-based practices for youth and young adults. 

Q: The pandemic has extended longer than many would have predicted at the beginning of 2020. What trends are you seeing in the U.S. related to mental health among youth, and how is the pandemic impacting youth programs and services?

A: Emerging research suggests the pandemic will have a lasting impact on the mental wellbeing of young people. Systems serving youth anticipate far-reaching consequences, particularly for youth with exisiting mental illness: increases in suicidal thoughts and behaviors, mental illness, and substance use. Marijuana use, depression, and suicide among youth were growing concerns even before the pandemic. Providers, researchers, school personnel, and youth advocates are concerned about prolonged social isolation and the various traumas that youth are experiencing and are seeing a greater demand for mental health services.

Q: Can you elaborate on these traumas?

A: Many youth are experiencing layers of trauma caused by racism, wildfires and other natural disasters, loss of parents and other loved ones due to COVID-19, unemployed parents and caregivers, increased homelessness and hunger, and the uncertainty of it all. Some youth live in unsafe environments, and now they're isolated within these unsafe environments, separated from their friends or their schools, which were previously safe places to be. How long this period will last is very concerning. So provider systems--behavioral health professionals, schools, primary care providers--all are working to figure out how we reach youth and their families to provide services and supports during this time.

Q: What is being done to substitute for youth programs that are essentially shut down?

A: Many community organizations and behavioral health prevention and treatment programs are stretched thin and struggling to stay afloat financially. Limited funding for prevention, treatment, and recovery programs will continue to be a problem for the foreseeable future. Yet we are seeing promising examples of collaboration and innovation to support youth. Community organizations, schools, parents, and health care providers are mobilizing in ways that they haven't in the past and coming together to figure out how to address mental health needs in a more efficient and integrated way. By coordinating care, sharing resources, and offering briefer and less intensive interventions, they can reach more individuals.

There's a renewed focus on addressing the social determinants of health and promoting protective factors that lower the likelihood of negative outcomes, such as family support, physical activity, and sleep. People are using technology to provide services in ways that wouldn’t have happened before and to engage parents as partners in adolescent health. There's emphasis on screening to identify mental health and substance use risks early and new types of screening tools are being tested.

Q: Which practices stand out to you?

A: I think the expansion of telehealth technology is a good example of of an innovative solution. Systems of care adopted telehealth technologies rapidly as the coronavirus spread. Governments and commercial insurers in some states are now figuring out how to cover telehealth services permanently. Telehealth has become more mainstream, and we've heard from healthcare providers that patients have fully embraced it. One adolescent addiction treatment provider told me that she's not sure her patients will ever want to come back to the clinic because they like the convenience of virtual appointments. Telehealth also provides health professionals the opportunity to get a glimpse inside of their client’s or patient's home. You get a sense of the environment around them and sometimes the opportunity to meet the individuals that they live with.

Q: Has telehealth done anything to address the stigma around mental disorders?

A: Technologies that increase access to treatment and facilitate the delivery of private, confidential evidence-based programs help reduce the stigma associated with seeking behavioral health care. Telehealth provides an opportunity to meet individuals where they are. It can be used to reach people in underresourced communities or rural settings who otherwise do not have access to mental health services or substance use disorder treatment. That said, many people in the United States do not have access to reliable internet, smartphones, or computers that would enable them to receive telehealth services.

Q: What's been the most surprising thing to you around mental health prevention and treatment since the pandemic started?

A: Overall, I'm pleased with how much attention the social and emotional needs of young people are receiving in the national dialogue around the pandemic. Schools and health systems rapidly adapted their approaches last spring and have continued to evolve to better engage young people. Numerous resources, web-based platforms, and community-wide strategies have emerged focused on promoting the mental wellbeing of youth and families during this uncertain time. For example, school districts are rolling out virtual calming rooms and comprehensive screening questionnaires that youth and families can use to self-assess physical, mental, and emotional needs. Some of these web-based platforms are pre-populated with up-to-date community-level resources and will tell the person that based on this assessment, here are the places you can go to access services and supports.

Q: What recommendations do you have for the future for treating youth mental health issues?

A: My recommendations for youth-serving providers are to closely monitor the substance use and mental health needs of young people and to be open to new ways of reaching out to youth in response to emerging issues. I think that's one of the biggest concerns right now. We have evidence-based interventions. We're ready to provide them in new ways. But how do we reach youth and continue to engage them in a meaningful way as times goes on? How do we prevent burnout of virtual expectations now that most aspects of youths’ lives are online – remote learning, school activities, social events? To do that, providers serving youth are creating virtual experiences that mirror physical interactions. More importantly, we need to involve young people as partners in the design, development, and implementation of programs and mental health promotion messages to make sure our efforts are relevant and accessible.

If you’re concerned about a young person’s mental health, you can get help here:

• The Society for Adolescent Health and Medicine website, which incudes links to COVID-19 and mental health resources for parents, teens, clinicians, and researchers.
• The National Suicide Prevention Lifeline or call 1-800-273-TALK (8255)