Unpacking America’s Mental Health Crisis – CNN One Thing

She has dealt with the pandemic with two different schools. Two grandfathers within a month and a half period to COVID.

This is Mary Norris. She spoke to CNN earlier this month about her 12 year old daughter who’s been having a tough time at school since returning to in-person learning last year. Things have gotten a little better since transferring schools, but only a little.

It is becoming a very difficult situation.

In fact, Mary recently got a call from a staff member who said they discovered her daughter writing about harming herself in her journal. So naturally, Norris wanted to find her daughter, a therapist who she could see outside of school. But that, too, has been a struggle, thanks to insurance issues and just the lack of options.

And now, currently, we still have yet to find a provider due to the fact that now they either want private pay or the numbers that we’re calling are no longer in service.

Here’s the thing, Mary’s story is not uncommon. What actually stands out here is that she’s been willing to talk about it so openly. But many experts say we should be talking way more about mental health now more than ever.

Well, the United States has a mental health problem, according to most Americans.

Mary Norris was one of the thousands of people who responded to a new survey from CNN and the Kaiser Family Foundation, which paints a grim picture of the state of mental health in this country.

More than half of the American people, 55%, think that most children and teenagers are unable to get the mental health services they need.

My guest this week, CNN medical correspondent Dr. Tara Narula. We’re going to dig into the data, the possible solutions and why an influential task force is now saying children eight and older should be screened for anxiety. From CNN, this is One Thing I’m David. Rind.

Dr. Narula, great to see you in person, no less.

Thank you for having me.

Rare thing for podcasters of the last few years. So let’s start here. I want to talk about these new guidelines for anxiety screening watch appearance out there now.

So these were published by the U.S. Preventive Services Task Force, which is basically a body that reviews all the evidence over the last several years and puts out guidelines. In this case, they were for primary care providers and had to do with screening for mental health conditions. And so essentially, one of the big news stories this week had to do with the fact that for the first time, they really published recommendations to screen for anxiety in children. So it’s really a big step forward, and it’s significant for several reasons. There are so many children that are affected by anxiety. Many of them fly under the radar. In fact, the CDC said from 2016 to 2019, there are about 5.8 million children that were diagnosed with anxiety. So that’s a tremendous number. And then unfortunately, while many of these health mental health conditions like anxiety present when kids are young, they fail to get diagnosed for almost on average 11 years.

So they want to catch it early.

Exactly. That’s a really long window of time when kids may be either misdiagnosed. So a lot of kids with anxiety may say, I have a stomachache and then they get sent to a gastrointestinal doctor. Or the teacher may say they’re not concentrating at school and they get diagnosed with ADHD when in fact they have anxiety. So they recommended that primary care providers screen kids who are 8 to 18 who do not have symptoms for anxiety. And then they went on to kind of reinforce their recommendations from 2016 that kids 12 to 18 be screened for major depressive disorder. And also interestingly, even though we know that suicide is a leading cause of death for older kids and teens, they said there’s limited evidence, at least at this time, for screening kids for suicide risk in those who don’t have symptoms. And one of the important thing that they didn’t highlight is also the screening intervals. So how often do you screen kids? And also last month, we should point out that the same task force posted what they call draft recommendations for adults where they again recommended screening for anxiety for the first time in adults younger than 65.

And what does the screening look like? Is it a series of questions.

Yeah. So there’s lots of different screening tools that are out there. a lot of them basically evolved for research purposes. So some of them are really long and not necessarily practically to use in a primary care doctor’s office. There are two that are used very commonly. One is a social phobia screen and one is called SCARED. And the SCARED one is actually 41 questions that are given to parents and kids separately to fill out. And it takes about 10 minutes. And they answer things like, I feel nervous, or I feel uncomfortable separating from my parents. I get headaches. So again, you can see how anxiety can get missed because some of these symptoms or signs may be to many peopl normal.

sounds common.

Right? Common. So if they score over 25, then that’s considered a possible positive screen for anxiety, in which case they would get a real diagnostic evaluation with a mental health provider to confirm that, yes, this is a diagnosis of anxiety. And then in that case, they could potentially go on to get treated with either therapy or medication. There is one FDA approved drug duloxetine for kids over seven for anxiety.

The pandemic has brought a lot more uncertainty and fear in my life, which is affected and given me more anxiety than I think I’ve ever experienced.

There’s a lot of people who are just down. They’re not sure how to get back in the game. They’re not sure whether they want to get back in the game.

My savings is gone. My under the pillow money is gone.

Like so many American students, Spencer struggled with remote learning.

We noticed that he wasn’t working out. He was no longer riding his bike.

Spencer died by suicide December 4th.

As Americans prepare for a third year of pandemic living, therapists say they’re witnessing a nationwide mental health crisis.

We’ve obviously seen a bigger focus on mental health issues over the last several years, particularly in light of COVID. And so our CNN health team wanted to get a bigger picture of the issue. So over the summer, they launched a survey with the Kaiser Family Foundation. And a few weeks ago, we actually got the results.

So what did the survey find? How do Americans feel about mental health in this country?

It’s not a pretty picture. This was a survey of about 2000 adults. And essentially nine out of ten adults said that there is a mental health crisis in this country and they went on.

Nine out of ten. 90 percent.

90 percent. They then went on to really identify and list what they felt were not problems, but crises. And so over two thirds identified the opioid epidemic as a crisis. Over 50% identified mental health issues in kids and teens, which you just talked about, and severe mental illness in adults, 45% anxiety and depression in adults, 39%. This one’s so interesting to me. Stress and anxiety around politics and 25% identified loneliness. So this is really what Americans in the survey felt were crises. But then they also just answered questions about their own levels of anxiety and depression. And it was interesting to see that about one in five or 20% described their own mental health as only fair or poor. One out of three said they felt anxious always or over the course of the past year, and one in five said they were often or always depressed or lonely in the past year. The poll also showed some interesting findings in terms of which groups reported poor mental health. So first, younger adults ages 18 to 29 reported the most concerns with their mental health and also were the more likely to report that they seeking mental health services but not able to access them. Other groups LGBT, those in poor physical health, those with economic uncertainty, or who made less than $40,000 a year. So these are groups that specifically seem to report poor mental health in the survey. And then when asked about specific sources of stress, again, 39% identified personal finances, 32% politics. And then relationships and work both around 24%.

So this was over the summer, you said obviously the past few years have been pandemic years. And, you know, it’s still very much with us. But those early years were rough, you know, for a lot of people, obviously. How much did the pandemic show up in these results?

Yeah, I mean, there’s no question that the pandemic exacerbated a mental health crisis that was already there, both for adults and for kids. And I think when you look at the barriers to getting care that, again, were exacerbating the pandemic, there were a couple of things that really showed up again and again in this survey. One was cost being a real big problem. It’s just for so many people, it’s prohibitive. The costs of paying for therapy are so high, as well as insurance issues. So many providers don’t take insurance. And then there’s still this issue with stigma. So no matter how much we continue to shine a light on this and talk about it, a lot of people identified that they felt uncomfortable talking to people they cared about and loved, family and friends because they were worried they would be judged or they would be a burden to them or they wouldn’t be met with compassion. So. So that’s a real issue. And then there’s an issue with lack of providers just available. So people are waiting months to get an appointment.

It’s just pure staffing issues.

Exactly.

In some areas.

In some areas, correct. 80% of counties in the U.S. don’t have child psychologists, which is an alarming statistic.

So what are the solutions then? Because it isn’t the way you say, it’s just such a multifaceted problem, like it kind of goes off in all these directions. So what are some of the bigger picture ideas to kind of help this?

Well, exactly what you said, because it is such a multifaceted problem it needs a multifaceted approach. Right. You got to hit it from all different angles. So I think first and foremost, parents need to be involved. Parents need to take care of their own mental health. We know that when parents have issues with their mental health, it trickles down to affect their kids. I think we need to do a better job with kids telling them it’s okay to talk about these things and also to prioritize their mental health. So you want to start young. Certainly equipping teachers and schools with programs to identify kids early and get kids help is important. Increased federal funding for telehealth and also more providers to be educated. And then one of the other interesting things that the poll identified was that only 27% of Americans say they wouldn’t know who to call or how to seek help if they themselves or a loved one were having a mental health crisis. You know, many people don’t want to turn to 911. They’re afraid that that’s actually going to exacerbate the situation, that it may end up causing more problems.

We’ve seen that time and time again with people having mental health episodes and police get involved and it ends horribly.

Exactly. And so I think one of the things that we’re trying as a country to educate people about is the nine, eight, eight crisis line. Basically, the National Suicide Prevention Lifeline transitioned to that three digit code this summer, and early data suggests that there’s been success with that, with calls really jumping about 45% in the first month compared to the same time last year. But but once again, with our survey, we know there’s more work to be done because more than half of the adults in the poll said they hadn’t heard anything at all about the new nine eight, eight hotline.

Huh. So finally, I’m curious to get your perspective here as as a health provider, I know you’re a cardiologist, but does the survey and the stories we’ve been hearing from parents and family members, does it track with what you’re seeing and what you’re hearing from your colleagues in the field?

Absolutely. I mean, as you said, I’m a cardiologist. So when I walk in an exam room, people, you know, you would expect them to say, I’ve been taking my blood pressure medicine or I have chest pain. And I can tell you 70% of the time when I walk in the room and I say to someone, how’s it going? You know, how are you doing as the first question? The answer is, Oh, I’m really stressed out. I’ve been really anxious, I’ve been feeling depressed, I’ve been feeling lonely. I’m hearing about their mental health issues at the top of the conversation because that’s what’s really, you know, foremost in their mind. And of course, you know, that trickles down to effects on their physical health.

Right, can it manifest physically?

Absolutely. And, you know, as a cardiologist, we try to educate that what happens up here mentally has an impact on your cardiovascular well-being and that you need to control those mental health issues, whether it’s anxiety, depression, PTSD, the better control those are, the lower your risk of cardiovascular disease. So there’s no question that, you know, this is just everywhere and everyone’s feeling it. And I see it in my practice and my colleagues as well.

For Spencer Smith’s family thinks they will never take for granted again. Is endless.

Check on them. No matter how old they are and always give them a hug and let them know how proud you really are of them.

And just, you know, I just want to put one last line in there, which is for people to just be there for each other. Right. I think so often we think this is a problem that has to be solved in some other way. But so many times it’s just being there for the people that we love and creating that space for them to open up to us. That can be so helpful.

Hmm. Right.

And I think it bears repeating for our listeners, if you or anyone you know is struggling right now, the number to call or text is nine, eight, eight. That’s the suicide and crisis lifeline. We’ll put that number in our show notes as well. It’s really important reporting. Thanks for your perspective Dr. Narula.

Thanks so much for having me.

One thing is a production of CNN audio. This episode was produced by Paola Ortiz and Me David Rind. Matt Dempsey is our production manager. Faiz Jamil is our senior producer and Greg Peppers is our supervising producer. Special thanks this week to Ben Tinker, Katherine Dillinger and Brenda Goodman. A lot more coverage from our health team over at CNN.com or the CNN app. And thank you as always, for listening. We appreciate it. We’ll be back next Sunday. Talk to you then.