While there are disadvantages to increased screen time and internet use, there are efforts underway to use these tools to help improve MH.  A silver lining of the COVID-19 pandemic is the increased utilization of telepsychiatry.  Georgia suffers from a shortage of child and adolescent psychiatrists, with many rural areas having no child and adolescent psychiatrists available for miles. With telepsychiatry, psychiatrists and psychologists are able to reach patients from a broader catchment area. For patients who require assistance with mental wellness, but not specialized MH treatment, there are many apps available to promote mood monitoring, meditation, and mindfulness. In 2017, a systematic review on the use of mobile apps and SMS messaging as a physical and MH intervention showed improved medication adherence and reduced stress, depression and anxiety in users.⁸ In Georgia, the Georgia Crisis and Access Line (GCAL 1-800-715-4225,  or myGCAL app) can provide telephone or mobile crisis services, assist in finding open crisis or detox beds across the state, and help arrange for urgent appointments. Patients can access these services simply by calling GCAL, or by using their app (myGCAL). It can be helpful to familiarize yourself with the various apps and services available nationally and locally. AACAP has a list: 

As to be expected, with the increase in MH concerns in the community, we have seen an increase in psychiatric emergencies. For pediatric patients experiencing a MH emergency (for example, active suicidal or homicidal thoughts), online evaluations are not sufficient. These patients require an immediate face to face evaluation. If they do not have a psychiatrist or therapist who can provide urgent evaluation, they should be referred directly to a psychiatric hospital (a psychiatric emergency receiving facility) or to the nearest emergency department (ED).  An ED psychiatric evaluation focuses on safety and connecting the patient with the appropriate level of care.  It is not a thorough diagnostic interview and should be not utilized as an alternative to routine psychiatry referrals. Families and physicians should be aware that this process can be time consuming, but that the focus is on getting the patient to a safe level of care.  

As we help children, teens and parents navigate the changes in their lives arising this year, it is important to recognize that the effects of COVID-19 are not just limited to direct effects on the body by the virus. Children and teens are not immune to the complex emotional and social stressors accompanying this period, and our approach to supporting them will need to adjust in kind.  ED and primary care physicians are essential allies in identifying these emerging MH symptoms and connecting patients with services, whether through telepsychiatry or face-to-face psychiatric evaluation.  

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References:

1. Cziesler ME, Lane RI, Petrosky E, Wiley JF, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – United States, June 24-30, 2020. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. 14 Aug 2020; 69(32):1049-57.
2. Fegert JM, Vitiello B, Plenel P. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health. (2020) 14:20
3. Aacap.org. Facts for Families: News and Children. No 67. January 2019
4. Schønning V, Hjetland GJ, Aarø LE, Skogen JC. Social media use and mental health and well-being among adolescents – a scoping review. Front Psychol. 2020;11:1949. Published 2020 Aug 14. doi:10.3389/fpsyg.2020.01949
5. 2020 Tweens, Teens, Tech, and Mental Health. Coming of age in an increasingly digital, uncertain, and unequal world. https://www.commonsensemedia.org/sites/default/files/uploads/pdfs/tweens-teens-tech-and-mental-health-full-report-final-for-web1.pdf.  Accessed 11.19.2020.
6. O’Reilly M, Dogra N, Whiteman N, Hughes J, et al. Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents. Clin Child Psychol Psychiatry. 2018 Oct; 23(4):601-13.
7. Tynes BM, Willis HA, Stewart Am, Hamilton MW. Race-Related traumatic events online and mental health among adolescents of color.  Journal Of Adolescent Health. Sept 2019; 65(3): 371-377. 
8. Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: systematic review. J Med Internet Res. Aug 2017; 19(8):e295.