The youth mental health crisis is here, and it’s worse than you thought.


Photo by Pixabay

By Sarah Gayden and Fran Havard

In honor of Mental Health Awareness Month, The North Salem Post is bringing you stories about mental health and its impact on our community.

In March 2020, when the COVID-19 pandemic brought the world to a halt, one North Salem mom felt that she was facing the situation with eyes wide open. Sure, things would be tough for a time, but her family was together and safe at home. Her teenager, D (The North Salem Post is withholding her name to protect her identity), was spending more time in her room, but wasn’t that typical for her age?

In the ensuing year, D went from being a high honor roll student to nearly failing all of her classes, being assessed for suicidality and ultimately leaving the school district. D’s story is heartbreaking and severe. Sadly, it is not unique.

In the 2020-2021 academic school year, the North Salem Central School District conducted 19 suicide assessments, a staggering figure for a district with just over 1,000 students across grades K-12. The year prior, the district conducted six suicide assessments between September and March (data was not available for the Apr - June period due to the pandemic). During the 2018-2019 academic year, the district conducted 10 suicide assessments.  

Adam VanDerStuyf, assistant superintendent of pupil personnel services for the North Salem Central School District, acknowledged that the pandemic significantly impacted the student population. “How they left us and how they came back were very different,” he said.

Conversations with D, her parents, district administrators and mental health professionals reveal the complex and varied factors that came together to create the perfect storm for youth mental health-a crisis that continues to affect teens across the country-and reveal a system that was ill-equipped to help.

“It was happening right under our nose.”

“When the pandemic happened, it was like a switch flipped. Like gravity was reversed,” D recalled. The tight group of friends D had grown up with since Kindergarten were no longer people she could socialize with in the hallways at school. Instead, they were text bubbles in a group chat, or faces on a screen. And all around them, the world no longer resembled anything that D and her friends recognized.

D and her friends began struggling: as a group but also individually, siloed in their immediate family structures without one another to lean on. They struggled to adapt to online learning and to stay connected with one another virtually.

“All of us were having trouble in school and that would affect our moods,” D said. “We’d be irritable and get into fights with each other. We just didn’t click together anymore.” The friendships D had relied on since she first entered school were fraying. Some ended altogether.

Meanwhile, D was beginning to discover her sexual identity. “I had this slow realization of me looking at girls the same way I would look at boys,” she said. “I realized that I was more attracted to girls than I would be to boys.”

It wasn’t long before D was ‘outed’ by her classmates. She had told a few close friends, who told other friends, and soon everyone knew. “I knew they were going to be mean and it was inevitable,” D said with resignation.

D shared little to none of her struggles with her parents. “I’m kind of private when it comes to my own ordeals but quarantine definitely increased that,” she said. There were so many horrible things happening in the world; D felt that talking with her parents about what was going on with her would just place an additional burden on them. “I just stayed quiet. Like the less they knew, the better,” she said.

From bad to worse

As the months wore on, D fell deeper and deeper into her own isolation. She grew increasingly irritable. She stopped showering or brushing her teeth with any regularity.

“I’d ask, ‘why didn’t you take a shower?’ and she would explode at me,” D’s mom recalled. “She was really angry.”

D struggled to connect with learning in the hybrid format. Her teachers were trying to balance those students who were physically in the school building with those who were learning remotely from home. D, who stayed remote through most of the 2020-2021 school year, felt like she could never get her teachers’ attention.

D’s mom, who has always considered herself an attentive and involved parent, didn’t realize the extent to which D was growing disengaged. “I literally was in the room right next to her, with the doors open,” she said. “I could hear the teachers, and I just assumed D was in there participating.”

D wasn’t participating. She was coming dangerously close to failing all of her classes. “I felt like I was kind of aware but I was outside my own body watching myself go through the motions. Like all I could do was let it happen,” D said.

By the time D’s grades came out, she was at best withdrawn and at worst aggressive. “She wouldn’t even come out of her room very much,” her mom said. “Even if we did come in for anything, it was met with a lot of irritability.”

“I was really irrational,” D said.

Looking for help when there’s no help

By the spring of 2021, D’s parents decided they would send her back to in-person school. D had been attending school remotely for 13 months. She was now vaccinated and her parents felt that she needed to be back in a social circle. There was this sense that if they just returned to school all of this would go away and things would be normal.

D’s mom planned a day of ‘back to school’ shopping. She looked forward to spending time with her daughter doing something that felt as close to normal as they had had in over a year. It ended up being anything but.

“I didn’t realize how much anxiety she had being around other people,” D’s mom confessed. “We went to one store and we had to come home. She was shaking, and picking at her fingers.”

Back at school, things got worse. D couldn’t function, and often spent more time at the counselor’s office than in the classroom. The North Salem High School counseling department was gravely concerned; they felt that D was becoming a danger to herself. But D wasn’t the only one. All day long, the counselors sought to help what seemed like a never-ending stream of troubled students.

“They were swamped; they were drowning,” D’s mom said of the school clinical team. North Salem Middle School/High School has two school psychologists and four guidance counselors on staff (district-wide, there are four psychologists, two of whom are trained on the Suicide Safety curriculum published by the NYS Suicide Prevention Center of NY and have disseminated that knowledge to the staff). The National Association of School Psychologists recommends a ratio of one school psychologist per 500 students. With two psychologists for 355 students enrolled at North Salem MSHS, the school more than meets the quota. Still, North Salem High School psychologist Dr. Katia Castelli acknowledged in an email to The North Salem Post, “our offices have been very busy.” VanDerStuyf said that the intensity of demand has “remained fairly steady since the students returned full time.”

“I put myself in her position,” D’s mom said. “You go to school and you’re going to try to talk to somebody and they say their schedule is full. There’s nobody, and you start to drown.”

“Now we’re in crisis mode”

At school, D began exhibiting “red flag” behaviors and actions. She was saying worrisome things, drawing disturbing imagery on her body, and posting things on social media that caused concern among her friends and teachers. D says she doesn’t remember much about that time, but she does recall being pulled out of class and sent to the guidance office.

“They asked if I knew why I was there, and they said that my friends were worried about me,” D said. “I don’t think I was trying to send signals; I think it was subconscious.”

D confided in the school counselor that she would sometimes have suicidal dreams or feelings. “I wasn’t going to act on them, but still, they followed protocol,” she said. Dr. Castelli said that the state's Suicide Safety training outlines warning signs and provides adults in the school building with a step-by-step guide on what to do and who to call if they have a student they are worried about.

D’s counselor advised D’s parents to take her to Northern Westchester Hospital for an evaluation. The school had intended to help make appointments for D with various specialists beyond the psychologist that she had seen weekly since early adolescence, but provider caseloads were full, and an extended wait was highly likely. “They said by the time she’d be able to see anybody, she’d be in danger,” D’s mom said.

At Northern Westchester Hospital, doctors recommended inpatient treatment, but the closest available facility was a five-hour drive away, in Buffalo. D’s parents asked themselves how they could help their kid when it seemed that there was no help available. 

The number of residential treatment facilities for people under the age of 18 declined by 30% between 2012 and 2020, according to reporting from the New York Times. That number decreased further since the pandemic, due to social distancing and labor shortages.

Ultimately, doctors recommended that D return home with her family, but that she meet with her psychologist twice per week, a psychiatrist once per week, and that she enroll in Dialectical Behavioral Therapy (DBT), an evidence-based psychotherapy that can be useful in treating suicidal ideation. North Salem Central School District’s clinical team, which is currently trained in Cognitive Behavioral Therapy, is considering adding DBT to their skillset, according to VanDerStuyf.

“We are continuously looking for ways to enhance our clinical repertoire and learn the latest research-based interventions,” Castelli told The Post, though she noted that the team is not charged with providing therapy in school.

A slow climb

Photo by NEOSiAM 2021

The day D left Northern Westchester Hospital, things felt “easier,” she said. “It was eye opening to see that there were people who cared about me and my well-being.” In the year since D was discharged, she has been seen regularly by a team of professionals, including her longtime psychologist, her psychiatrist, and a guidance counselor, school psychologist and a case worker at the new high school she attends (D and her family moved out of the area last summer).

“It’s a complete support system,” D’s mom said. “I think it’s a three-pronged situation. She’s in school six to eight hours a day; she needs a support system there as well, which she has.”

At school, D now also has a 504 Plan, which provides her with accommodations to complete her schoolwork, due to her diagnosed anxiety. “She’s capable, she makes good grades, but she gets anxiety and needs more time,” her mom said.

D acknowledged that while life has improved overall, there have been ups and downs. “I need to find a way to be okay when I lose control of things,” she said.

Medication in combination with therapy has helped, though D’s mom noted that it took a while to tweak the medication to meet D’s needs. “In the last six months we’ve gotten to a good point where she feels comfortable that these are the meds for her.”

D is hardly alone in her peer group, coping with depression and anxiety. She has several friends who are experiencing mental health issues. A 2020 survey showed that 30% of young people have more often been feeling unhappy or depressed. It’s painful for D to see her friends struggle. “She cares about them,” her mom said. “Some of them result to self-medicating or self-harming. I just don’t want any child to be in pain.”

Elizabeth Malvino contributed additional reporting to this article.

We chose to keep D and her family anonymous for this article to protect the privacy of a young, vulnerable adolescent. Both D and her parents gave their consent to share their story for this article. Her parents were present for interviews with her.

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