This article is part of an ongoing series in The Recorder focusing on the child and adolescent mental health crisis. This in-depth series will examine the barriers and difficulties teens and children face in receiving care, as well as a ground-breaking local initiative to address the problem. Future articles will share the perspectives of students, parents, mental health providers and emergency practitioners, among others. Articles contain material that some readers may find upsetting.
Therapists Emily Gifford, Stephanie Perell, and Dana Hyman, specialize in treating young children, adolescent and college-age students. BERNADETTE DURHAM PHOTO.
By MELISSA WHITWORTH
For the first time in her 20-year career, Emily Gifford, PsyD., has parents calling her to make preemptive therapy appointments for their children, just in case a mental health issue comes up in their future.
The children have no symptoms or concerns, but the parents want a child psychologist on speed dial should that change.
“I have recently had four separate family calls saying, ‘We want to get our son in to see you so that we have a person in our back pocket for the future.’”
Gifford also has a waitlist. “People are not leaving my practice at the same rate they were leaving the practice five years ago. In some cases, the clinical treatment is taking longer. In some cases, people don’t want to leave.”
The Recorder assembled three therapists, Gifford, Dana Hyman, and Stephanie Perell, all of whom have worked in either adolescent in-patient psychiatric facilities, hospitals or residential child care agencies during their careers, and who also run private practices locally. They spoke about the adolescent mental health crisis, its causes, its exacerbating factors, and what they are experiencing day-to-day in their offices and in our community.
“It is absolutely a crisis,” said Gifford. “I don’t think that’s overstating it. It’s not hysteria.”
Her practice is located in Mount Kisco, and she is also a part-time clinical psychologist for a local private school and, in addition, supervises students in the psychology doctoral program at The City University of New York.
Perell trained at Columbia University with a specialty in trauma and worked in their specialized trauma unit at NewYork-Presbyterian Hospital. She went on to work at Andrus, a residential treatment center for children, and also at Silver Hill, a psychiatric hospital in New Canaan, Conn. She mostly specializes in therapy for older children and young adults. She began her private practice 10 years ago.
“I think that the crisis is twofold,” she said. “We know that 20 percent of children [according to the National Institutes of Health] anywhere from the age of three to 17 currently have a mental health diagnosis, whether that’s anxiety, depression or an attention diagnosis. Those are the kids that are formally diagnosed.”
And then there are children who are struggling but undiagnosed, she said. One of her specialty areas is college-aged youths, because, she said, “This is when a lot of people have their first episode of serious mental illness. Those kids come in not knowing what had happened to them. They went to college when they were not ready. Then, all of a sudden, they just broke.”
To assess the scope of the crisis in mental health, “I zoom in on, unfortunately, suicide rates as my meter,” explained Perell. “I just think we are seeing more people in distress. Then the flip side is that we don’t have enough mental health providers to meet the needs of those children. And so those two pathways create what I am certainly experiencing as a true crisis.”
Hyman has worked at The Children’s Village, which, like Andrus, is a residential treatment center for children, at the Payne Whitney Psychiatric Clinic and at the NYU Langone Child Study Center. Hyman specializes in early childhood development and sees children mostly between the ages of three to 12.
“My favorite thing is to work with the younger kids and I generally will embed evidence-based therapies in play therapy. So, I’m not doing [only] play therapy, but I’m embedding the treatments in that kind of atmosphere,” she said.
Hyman said she is seeing where children are becoming vulnerable at a much earlier point in their lives.
“I see the expectations we have in our society. Let’s just say math curriculums for elementary school students, for example — they are not appropriate in a lot of this area,” she said.
While early intervention for real psychological issues is a gift, Hyman is seeing unrealistic academic and social expectations at developmentally inappropriate ages placed on young children. This is damaging not only to the children, she maintains, but it is creating anxious parents, too.
“The stressors in our society are then making us feel like our children have mental health symptoms. There are real vulnerabilities, that’s definitely true. But the stressors are coming at everyone,” she said. “I have a lot of feelings about the educational curriculum in this area and, specifically, the lack of support for parents — and let’s say moms specifically. I think women are being put in very stressful, impossible situations. So, education and parental support — those are two things that I think about a lot.”
Hyman called the current crisis “a microcosm and a meshing of so much coming together.” Something has to just relax at some point because people can’t keep this up.” In her view, “Something needs to shift — whether it’s coming from changing healthcare so that people can access services, whether it’s changing college costs, or more education for parents, especially moms, or changing those curriculums.” Even introducing a longer school recess could have significant benefits, she observed. “I would love to do a research study on helping mental health in young children through adding a second recess,” she said.
Starting in the early 2000s with the No Child Left Behind Act, many schools cut back or removed recess time in favor of more classroom instruction. According to the Education Advisory Board, (national education consultants), playtime has declined in schools nationally by an hour weekly since 2001.
All three therapists agreed that the turn away from play-based learning, shortened free playtime and changes in social and educational systems are major contributors to the mental health crisis.
Gifford points to the use of missing children’s photographs appearing on milk cartons in the early 1980s as the moment a generation of anxious and scared parents was formed — and what put an end to the free play without supervision for generations of children to come.
While all three therapists said that “typical” or “developmentally appropriate” is the better term to use therapeutically, parents are routinely terrified by the avalanche of information on what they might be getting wrong. Parents also are at a loss as to what is a sign of true psychological distress that needs professional help, as distinct from what previous generations may have dismissed as growing pains. Panicked parents may call a therapist because their kindergartner bit another child, said Hyman. “Well, some of this is normal. Kindergartners may hit or bite or eat crayons. That’s how they learn about the world.”
“Parenting in today’s society is almost impossible because of the social media,” said Gifford, “because of the constant input of information at our literal fingertips that tells us we’re terrible parents. That people are only posting their best moments in the world. And, so we think, ‘Oh my gosh, they’re having such a great time. How is this so horrible for me?’ There is that constant reflection back.”
Perell agrees that changes in the media landscape have had mixed effects. On the one hand, “The media has brought a huge awareness about mental health issues, which has brought in obviously more people to our attention,” she said. “Episodes like school shootings and school violence obviously get mental health into the media and then all of a sudden people are questioning, ‘Oh, does my child have a mental health issue?’ Social media plays a role in disseminating this information.” At the same time, she said she has “also noticed that people are happy to pathologize themselves persistently. That for me is scary.”
The issue is multilayered and complex, these therapists urged. Talking about issues — and the proliferation of online mental health campaigns and parenting advice — raises awareness, normalizes mental health struggles and reduces stigma in our society, these experts said. But this greater awareness can be a double-edged sword, they say, increasing the anxiety we are at pains to ameliorate. As a result, parents often get trapped in a vicious cycle of too much information and no clear path of what to do with it. And all of this interacts with what tendencies for mental health vulnerabilities we may be born with.
“The psychiatric diagnoses are real,” said Hyman, “And it’s all being exacerbated because of the way we’re running our society and our young children.
She said the question to ask ourselves is, “How does the environment interact with our genes and make things better or worse?”
The next article in the series will explore the perspectives of local schools on the youth mental health crisis.