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Proem recently hosted "The Second Pandemic of Mental Health: An Expert Panel Discussion." This webinar, which is now available as an on-demand recording, brought together behavioral health experts for a discussion about the current challenges and opportunities around mental health. The panelists were Dr. Hansa Bhargava, Dr. Josh Spitalnick, and Sherry Farrugia.

The program was hosted by Proem Health and moderated by Dr. Tom Young, a board-certified family physician, and chief medical officer and founder of nView.

The following is an excerpt from the webinar that provides the panelists' responses to the first four questions asked by Dr. Young. It has been edited for length and clarity.

   Q: What have you personally experienced with the pandemic's impact on your patients and your co-workers?

hansa bhargavaHansa Bhargava (HB): Unfortunately, what we are all experiencing right now in pediatrics is a tremendous surge of mental health illness. That is happening across the board, with increases in presentations of mental health-related issues in the emergency room, our primary care offices, and elsewhere. In addition, healthcare workers are also experiencing the surge in mental health illness. It's an unfortunate time, and that's why I agree with experts who call what we're experiencing the "second pandemic."

Josh Spitalnick (JS): I'm seeing very similar things as Hansa. As a director of an outpatient clinic, we are seeing a significant number of patients we've seen in the past coming back for treatment, a significant number of people who have never sought treatment before coming in for treatment, and we're seeing people more in acute crises seeking out treatment. Given that mental health providers and other providers are now more available through teleplatforms, we are more available to the general public, which is good in certain ways and challenging in others because now we can essentially be accessed almost anytime, anywhere.

It's wonderful to see how many people are reaching out to get their needs met. I like to talk about that. We all know that we have medical health. Finally, people are admitting that we all have mental health. Good, bad, or indifferent, we all have it. But as Hansa mentioned, the surge we're experiencing is overwhelming. I'm in touch with clinicians around the country who run practices like ours and am hearing that waitlists are growing and clinicians are struggling to get these patients support and care. The trickle effect is that clinics are doing their best to support these needs, sometimes with approaches that they've never used before.

Sherry Farrugia (SF): From a co-worker's perspective, we have been up to our neck in delivering personal protective equipment and it has been very eye-opening to see the stress that our clinicians are under, where they literally are not leaving the hospital for days at a time. They're exhausted, they're showing signs of depression. I've never really seen this so rampant before in our clinicians. As someone who is a Georgia Tech employee, we're seeing it with faculty and with students. It just seems to be that in today's world, in this second pandemic, we're all susceptible to the mental health crisis that we're experiencing. No one is exempt.


Q: How is the pandemic affecting children and adolescents from a mental health perspective?

HB: We are seeing elevated numbers. We have been through a year and a half of radical changes and social isolation. Unfortunately, we have needed to pivot so many times, and appropriately so with public health measures. We know socialization is a buffer against social isolation and pivotal in the prevention of mental health issues brought on by sadness or feeling depressed. The constant pivoting because of all the waves of the pandemic hitting us together with that constant sea of change, the drumbeat of social isolation, and all the bad news has been really difficult for all people.

temp-Jun-28-2021-09-09-14-89-PMJS: It's difficult for me to think about this. My clinic and clinics like ours treat kids, teens, and adults. We see all ages, starting as young as three. It's impossible for me to think about kids without thinking about the system that he or she is operating in. Hansa nailed it. Socialization is a buffer, whether in organizational systems or the extracurricular activities we have our kids in. They're all mitigating institutions that help our kids have other touchpoints and give them opportunities to learn social skills and emotional regulation skills.

For the last 18 months, we have asked parents, single parents, blended families, parents where both are working in the home or out of the home — every type of parent — to become therapists, medical providers, teachers, educators, counselors, speech-language pathologists, and physical trainers. We have asked parents who are the core of the family to do the lion's share of the work. My heart goes out to teachers. People have seen just how much teachers are the backbone of this country in supporting our children no matter what their needs.

Children's needs are serious right now. The lack of socialization for certain kids and opportunities to go out because they're wearing masks or because people are afraid of pandemic spread is significant. What's happening in the home, whether you're homeschooling, virtual schooling, or doing in-person school, the stress on the parents and families is trickling down to the kids, and they're all feeling it. How kids are struggling really speaks about how the family unit is struggling and our need for more services to support parents, grandparents, and caregivers. We need to be getting families on board with getting their needs met as a unit — not just the individual kid, teen, or adult.

Q: What are the specific challenges that you perceive that face underserved communities as a result of this pandemic?

Sherry-FarrugiaSF: I'll give you a classic example right now. My internet is a little unstable and it's probably because I literally have 38 connected devices in my home. But guess what? The underserved community does not, and so not only did they not have internet, not only did they not have 10 computers or iPads that they could connect to, but both parents, assuming there were two parents, were working outside the home. I had friends who set up a classroom in their house. The underserved community wasn't doing that. How were they going to eat? There was one meal a day that they got and that was the one at school. What about the child who was in an abusive situation? The teacher no longer had eyes on that child. It goes on and on. The stories that I hear of teenagers who were at home during the pandemic and when the teachers would approach them, they'd say, "I'm home now. I'm having to go to work with my dad. He owns his own business, and if I'm home, I'm working."

Kids had to grow up in the underserved community so quickly during this pandemic. They went from maybe being a 14-year-old to a full-blown adult taking care of either their younger children, trying to find food for the family, going to work and working 10–12 hours, and then trying to do their schoolwork. Inequities became not only more apparent but blaring during the pandemic. I think that as we move forward, it's important that we learn from this and that we do not leave any child behind — whether it's in pandemic one, pandemic two, or just our day-to-day lives.

HB: I echo Sherry's comments. I think the inequities are exponential. These pandemics — the mental health pandemic and the pandemic itself — have absolutely made the inequities giant. I would point to what Sherry said as well: We forget that one in four kids are food insecure in this nation, and that was before the pandemic. Then there's the digital divide, which means that they don't have the internet. Even if you give them a laptop from school, they may not have the internet to use it at home, so how are they supposed to do online school?

Then there's the other issue of increased strain. There were hundreds of thousands of women who left the workforce last year (2020). A lot of those were mothers because somebody had to oversee the education, somebody had to oversee what was happening at home. What kind of strain did that put on the entire family, whether it's a single parent, blended, or two-parent family? I think the children have suffered. If I could yell from the rooftops about the children, I'd yell that the children are not all right. The kids are not all right, and I feel as a pediatrician and a mom and a parent that they have paid the price for all of what has happened. That's what makes me really sad.

Q: Why is addressing mental health such a challenge for healthcare professionals specifically?

JS: Besides the stigma, which has been around forever, we still, unfortunately, use pejorative terms like "OCD." We don't say that someone is "so diabetic" or they're being "so cancer." But we still say someone's being "so crazy," someone's being "so schizophrenic," someone's being "so OCD." Somewhere in the last 50 years, we all agreed that these psychiatric labels or terms were acceptable descriptors of people, but we haven't shed that yet.

We still look at people who have mental health struggles, emotional problems, behavioral issues, people who are autistic, and people who have neurodevelopmental issues as if it's their fault. That hasn't changed much despite a lot of compassion work done and a lot of good work supporting advocacy for various populations. Unfortunately, in my clinic and clinics around the country, we still see people talking about mental health like "it's your fault, you've caused it, you're not doing enough about it." I think a lot of us now view alcoholism and disorders like it in a much more medicalized kind of way, but we still view things like depression and anxiety, two of the most diagnosed disorders in the country, differently.

Anxiety disorders, which cover eight specific disorders, are the largest class of psychiatric problems in the country and yet we still blame people for having panic attacks, for avoiding social events. I think the biggest challenge of mental health providers, in general, is just helping people open up and talk about mental health just like medical health. We all have experience with it. No one's immune to it.

If we can get over that hurdle, get over that reticence, and begin talking about this on a national platform, it would really fix a lot of the issues we have here. I'd love to see someone next to Dr. Anthony Fauci, who is talking about the medical side of the pandemic, talking about the mental health side, with that person saying, "Let's talk about people's emotional needs on a national level." I'd love to see that equal person next to the medical providers out there.

HB: Families have taken on a huge burden with children being affected. Let's not forget about that, and let's not forget about the parental anxiety and depression that exists and how much they have had to take with the online schools. I'm going to refer to equity here because I have spoken to some pediatricians, the AP school committees for example, who have pointed out that in some communities, 90% of kids were not learning during that time of online school and also point out that there was, unfortunately, increased substance abuse, domestic violence, and child abuse. There's a lot of ramifications, those kinds of arms from the mental health crisis.

We just need to continue to increase awareness. I do feel like one of the silver linings of COVID and the pandemic is that I think that we are talking about this more, and I'm very hopeful that this conversation will continue so we can actually address access and all the issues that come along with this crisis.


Watch the recording of "The Second Pandemic of Mental Health:
An Expert Panel Discussion" webinar.

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