Honolulu psychiatrist Sonia Patel tells the story of a teen who was confined to a college dorm room most hours of each day while classes were being taught remotely. He started vaping marijuana to manage his escalating anxiety — even though he was taking a medication that doesn’t mix well with marijuana.

On one occasion, the teen spiraled into a dangerous state of cannabis-induced psychosis.

The coronavirus pandemic stripped adolescents of healthy coping mechanisms, such as socializing with friends. Some of her patients adopted detrimental new strategies to manage their stress, anxiety or trauma.

Almost two years into the pandemic, classroom doors have reopened to students who spent roughly an entire academic year attending virtual school. Although many kids have enthusiastically embraced a return to the normalcy of lunch rooms, sports and classrooms, others are struggling to reclaim their pre-pandemic lives amid intensifying psychological symptoms and a stark regression in their ability to cope.

For some teens, the very thought of going to school in the morning can elicit physical symptoms of anxiety, depression and gut stress, Patel said.

“I’ve had to write a lot of doctor’s notes,” the psychiatrist said. “It’s this fear of their little teenage world — seeing people, having to bump into people, having to talk to teachers. A lot of these kids can’t ask their teacher for help on assignments. They can’t even talk to their teacher.”

A powerful call for action to address a rampant youth mental health crisis arrived this week in the form of a public health advisory issued by U.S. Surgeon General Vivek Murthy. It spotlights escalating psychological symptoms among children, teens and young adults who’ve lost out on so many social and developmental milestones during the pandemic.

Depression and anxiety have doubled during the pandemic, according to the advisory, while negative emotions and behaviors, such as impulsivity and irritability associated with ADHD, have moderately increased. In early 2021, emergency room visits for suicide attempts shot up 51% for adolescent girls and 4% for adolescent boys compared to the same time period in early 2019.

“I don’t think we, as a society, paid sufficient attention to youth and how they were experiencing the pandemic,” said Mental Health America of Hawaii Executive Director Bryan Talisayan.

Since the onset of the pandemic in early 2020, mental health providers statewide have reported heightened levels of anxiety, loneliness, depression and stress in their patients, both youth and adults.

As a result, some psychiatrists say they’ve increased their patients’ medication dosages or now see them more often. People with no history of psychiatric symptoms are also struggling.

In June, a national analysis of data collected from people seeking help with their mental health during the COVID-19 pandemic ranked Hawaii as having the highest percentage of survey participants who reported thinking about or planning suicide.

The finding is based on data collected by Mental Health America from nearly 750,000 people — of which more than 40% are adolescents ages 11 to 17 — who volunteered to take an online depression screening aimed at discovering mental health hotspots across the country.

Schools Are Starting To Ask For Help

Since schools reopened for in-person learning, Talisayan said there’s been a surge in interest from public and private schools in the nonprofit’s youth suicide and bullying prevention training program, as well as its suicide prevention course for faculty and staff. To keep up with rising demand, Mental Health America of Hawaii hired a new full-time mental health educator to lead in-school training programs in the spring.

“I think we’ve all been hearing throughout the pandemic that the mental health crisis will be the second pandemic, for both youth and adults,” Talisayan said. “But seemingly, throughout the pandemic, the priority has been on adults, and youth were kind of just there in the background, waiting for decisions to be made while simultaneously experiencing the pandemic, missing out on sentinel events (and) important social development activities.”

“Even when the decision was made to send kids back to in-person learning this fall, what seemed to be missing from the discussion and decision-making process was the youth voice,” he said.

A number of teens Patel treats who suffer from anxiety started exhibiting signs of depression and suicidal thoughts for the first time following months of pandemic-induced isolation, she said.

One high school student, who was hospitalized after becoming suicidal, probably wouldn’t have experienced such a dangerous deterioration in her mental health if she hadn’t been cooped up at home during the worst months of the pandemic, Patel said.

“This entire generation of teens missed out on almost two years of development and I’m just now seeing the fallout of what the last year and a half has done to some of the youth,” Patel said. “They’re at the most vulnerable developmental point in their life, their brains are more fragile, and they’re supposed to be going out and developing their identities but they are completely not able to do that.”

When it comes to technology, the pandemic presented parents with another conundrum: How do you limit a child’s screen time when virtual school requires them to be glued to their devices?

Some of Patel’s teenage patients passed the long, lonely hours of a computer-based school year on social media, which can reinforce preexisting problems with negative body image, insomnia or cyberbullying.

Like schools, the public health threat posed by the coronavirus prompted many mental health providers to supplant face-to-face programs and services with those conducted online. A benefit of this new availability of virtual help, however, is that it’s engaging new populations, including adolescents who may tend to be more at ease communicating over a phone, tablet or computer screen.

The behavioral health staff at Kokua Kalihi Valley continues to conduct many patient appointments remotely as the pandemic has rapidly expanded the use of telemedicine for psychotherapy, according to KKV Medical Director Dr. Laura DeVilbiss. Before the pandemic, the community health center only offered mental health services in person.

“That has been really good because people can access it from home or even on a work break,” DeVilbiss said.

This increased accessibility could be one reason why patient demand for mental health services remains abnormally high nearly two years into the pandemic, she said.

Now that classroom doors have reopened, DeVilbiss said in many cases the younger children who had been grappling with loneliness and isolation appear to be doing better psychologically than when their schools first shifted to remote learning.

“It’s been helpful for them to be face-to-face again at school but there are still repercussions from last year,” she said.

Especially among teens and young adults, the doctor said elevated symptoms of anxiety and depression appear to be a looming repercussion of the pandemic’s hardest days.

“A lot of our patients work in the service industry, whether it’s in the hotels or in transportation or as greeters at the airport, so if their hours are backed up they’re just not making enough to get by,” she said. “So a lot of people move in with each other and then there’s more stress because of crowding in the house. That affects everyone in the family.”