Helping Children Thrive: A Conversation With Dr. Linda C. Mayes
“Children are just suffering more,” says Dr. Linda C. Mayes, director of the Yale Child Study Center. A pediatrician by training, Dr. Mayes specializes in child and adolescent psychiatry. Like other health care professionals, she is sounding the alarm about the rise in anxiety and depression in young people. In this episode, Dr. Mayes talks with host Suzanne McCabe about the reasons for this disturbing trend and explores how we, as a society, can address the challenges our children are facing. Dr. Mayes is also the Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology at the Yale Child Study Center and Special Advisor to the Dean at the Yale School of Medicine. She heads the Child Study Center–Scholastic Collaborative, which arose from a shared commitment to exploring how literacy can be used to foster resilience among children and families. → Resources New Mental Health Resource From Scholastic: Check out our new online hub of books and curated, free resources fostering emotional health with insights from leading child development experts. Meet Dr. Linda C. Mayes: The director of the Yale Child Study Center, Dr. Mayes is an expert in developmental psychology, pediatrics, and child psychiatry literature. Kids & Family Reading Report: There’s lots to explore in Scholastic’s biennial national survey of parents’ and children’s reading attitudes and behaviors. Reach Out and Read: Learn how the nonprofit organization partners with pediatric care providers to help families make reading a part of their routines. → The Conversation What trends are you seeing at the Yale Child Study Center in terms of children’s mental health? What types of emotional and behavioral disorders are kids presenting? At the Child Study Center here in New Haven, what we’re seeing is no different than what’s being seen across the country and around the world. The increase in mental health needs among children and adolescents often is framed as a post-COVID phenomenon. But over the past few years, there’s been a steady increase in children’s mental health needs—depression, suicidality, anxiety, increased feelings of stress—that speaks to an overall stress among children and families. COVID and the pandemic added to the mental health crisis. The pandemic also highlighted some of the fragilities in our healthcare system. One might think in the same way, that the pandemic highlighted the mental health needs and vulnerabilities of our youngest citizens, and that we’re seeing an increased volume is important to know. We’re also seeing an increase in severity. Children are just suffering more, and we’re seeing children thinking about suicide at an earlier age. We’re seeing more eating disorders starting at an earlier age. Our children’s distress is also an expression of the increasing distress and fragmentation of our society. Children, in a sense, are like the canaries in the coal mine. They’re experiencing the distress, the increased lack of civility, the increased fragmentation. The lack of civility and lack of empathy among adults is striking. Where did that come from? I think there are multiple causes. We’ve had an economically stressed society. We have the stresses of the pandemic. We have a politically divided society now. Whatever side of the aisle you’re on, to use that metaphor, it’s very hard to cross the aisle. We’ve lost the ability to have a conversation where you see the other person as an individual who may or may not agree with you, but who is still an individual worthy of respect. How to do that is a fundamental skill. It’s the glue that holds society together. When children see and feel and experience that kind of fracturing, it’s not good for their—or anyone’s—mental health. What signs should parents and educators look for if they think a child needs clinical intervention? When children are just not themselves, when they’ve changed, when they might have been the outgoing, playful, always-helping child who now is quiet, maybe even a little bit irritable, when there’s a real change in who they are in their presentation. Typically, people talk about when grades start to go down. That’s another indicator. When kids start to lose their enjoyment for the things they dearly loved. If they love to read, for example, but they stop reading. Or they love to play with friends, but now they just want to stay in the house. Those kinds of changes in behavior are important to notice. It’s not always the child who’s sad and withdrawn. It can be the child who suddenly is acting out or the child who is now afraid of a whole number of things. Those kinds of changes, and especially parents who know their children well, when they see that they’re just not themselves, that’s what to pay attention to. If a child is withdrawn, they may not want to speak. Are there ways to spur conversation without asking repeated questions? One of the most important ways is to be present. Sometimes, it may be taking a walk, or reading a book together, or just doing something together. Silence can be quite deafening. In our busy lives, families don’t often have those moments, those dinner-together moments, or those quiet walk-after-dinner together moments, or those times just sitting on the steps and talking. Those are the kinds of moments that bring people together. A child may not start talking right then. They may need to have a bit of quiet reassurance that, yes, somebody is going to be there, and they’re going to be listening. Many areas in the U.S. have a shortage of mental health professionals. What is being done to make treatment more accessible and more effective? There’s a shortage of healthcare professionals broadly, and there’s a shortage of healthcare professionals around children’s needs broadly. That includes physicians, pediatricians, psychologists, and social workers, because mental health for children is delivered not just by one profession. Before addressing what is being done and what can be done, we need to ask the question of why. Why is there a shortage of healthcare providers, especially post-COVID, but why is there especially a shortage of mental health providers? There are a few reasons that we, as a society, need to look at very deeply. One of them is how we think about mental health. We often think about it as “the other,” that it’s not a part of overall health, that it’s not a part of physical health. The division between physical and mental health is an artificial one. They go together. Another why is the stigma about mental health. As much as we’ve tried to work on it, it’s still alive and well in this country. It still impacts policy and decisions that people make about going into the field. It affects how we reimburse and support mental health, especially children’s mental health. Generally, children’s health is reimbursed less. By reimbursement, I mean by commercial payers and the individuals or institutions that pay for care. Then you take children’s mental health care and it’s not on par with other kinds of care. It’s very hard [for a health care professional] to make a wage that would support themselves and their family after years of training. So, we have a reimbursement structure that also perpetuates the bias. As a country, we need to put that front and center because the other things we can do to improve access or care will be great and are great. During the pandemic, we learned a lot about the delivery of telehealth. We learned how to deliver mental health care across virtual platforms, making it available to children and families across state lines, from rural to urban, extending the capacity of a clinician in an urban area. We still need to increase broadband access in rural areas, and states need to work together so that clinicians can deliver care across state lines. We’ve also learned that some children need just a few sessions with a mental health care provider. Some even respond to one or two sessions. Thinking more creatively about how we deliver services across telehealth platforms will improve access dramatically. We’re in a revolutionary time for mental health care for kids. Can you describe the mechanisms by which literacy can lead to improved physical and mental health outcomes? How does literacy impact health? It opens the world. You learn what a variety of people do. You also learn about your body. You learn how it works, what’s good and not good. Reading—including storytelling—is stress-relieving. Reading has dropped blood pressure to a healthy level in some studies. It’s what we call emotionally organizing. Reading also brings people together. If you’ve read a good book, you tell a friend about it, and soon the two of you are talking about that book. The same is true if a child brings you a book and wants you to read it. Reading builds interpersonal links between parent and child or teacher and child. It’s a very strong glue for building relationships. And we know from research that relationships and social connectedness have as strong an impact on health as good nutrition and not smoking, for example. So, it’s through those areas, and then another, what we would call a meta or proxy variable: If you’re more literate, you’re more educated. If you’re more educated, you know how to access health resources better. You make better choices. Yet we have two systems—our healthcare system and our educational system. The two don’t always work together. What’s good for kids in this country is to bring health and education together. There’s a significant finding in Scholastic’s latest Kids & Family Reading Report that reinforces this notion. Kids who read more reported better mental health overall, with fewer occurrences of anxiety, depression, and loneliness. Yes, and that’s a very important finding. As a researcher, though, I need to w
