IWK chief of psychiatry: Distress calls, eating disorders up, but no overall changes in admission rates

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With the exception of a consistent number of patients presenting with eating disorders, the region’s largest children’s hospital isn’t seeing any alarming pandemic-related mental health trends despite a 15% increase in “distress visits” so far this year.

“The beginning of 2021 looks like a slight increase in visits, and definitely that’s felt most in our emergency department but also in people reaching out for help through our central referral,” Dr. Alexa Bagnell, chief of psychiatry at the IWK Health Centre, said in a recent interview.

Bagnell said the number of people wanting to connect with services means they’ve had to shuffle resources to support the need.

“There is more distress, but that doesn’t equate to mental illness. However, mental distress is still in need of support and service,” she said. “We know that the pandemic has been challenging for everyone, some more than others, for different reasons.”

While the numbers tend to fluctuate month to month, Bagnell said they’ve seen no increase in the number of patients coming into the IWK who’ve attempted suicide or who are struggling with suicidal ideation.

Although they tend to examine their data on a yearly basis, and then compare it month-to-month based on previous years, Bagnell said those numbers are so far consistent with past years.

From January until the end of April, however, Bagnell said the IWK had seen a 15% increase in the number of mental health-related visits to the emergency department. Despite this, there has been no overall change in admission rates.

Bagnell said that tells them a few things about the young people showing up to the emergency department and not being admitted to hospital: their visits are due to distress; the IWK team is helping support that distress; and people are reaching out for help and getting support when it’s needed.

“I don’t want to make an overall global report, but when we see a trend of three months, we need to pay attention to that and at least temporarily move resources,” she said. “We won’t really know honestly until the end of the year and then we can really compare the data year by year, but that’s where we are right now.”

Increase in eating disorders

When looking at their data, eating disorders are the one area of mental illness where the IWK has noted a consistent increase throughout the pandemic.

“I really do trust our data and it is real,” Bagnell said.

“Looking across all our categories of why people are seeking service that’s the one that I can say ‘Yeah, that’s a real change with the start of the pandemic.’”

Bagnell said from the first few months of the pandemic, centres across the country were reporting similar trends. The Halifax Examiner reported on the increase in eating disorders amid the pandemic last year here and here. While there are many theories, Bagnell said no one knows for certain why it’s happening.

“It’s been consistent. It’s real. In referrals, presentations, admissions … We’ve had to move more resources into eating disorder treatment and that’s been helpful,” she said. “It hasn’t been a steady increase, it just increased and it stayed persistent. It’s really the only area.”

‘We are going to get through this’

Bagnell said while it’s important to consider our situation contextually in that Nova Scotia’s experience with COVID-19 was different from many parts of the country, the pandemic has still taken a toll.

“We do know that people are under more stress and that as time goes on, that stress is harder and harder to manage,” she said. “And then some things that may happen that you could have coped with well before are harder to cope with because your reserves are down.”

It’s unsurprising that the ongoing uncertainty caused by the virus, the disruption in school schedules, and a loss or restriction of many coping mechanisms — things like seeing friends and participating in activities — have significantly impacted adolescents.

“The most common things we hear about are mood being lower and more anxiety, and often the two are together when we hear about it,” Bagnell said

“Those two things can make it harder to cope and also harder to create structure in your day, so they lose the structure and then the connections and they end up being more isolated and it just kind of snowballs because then they feel worse and they’re less motivated to do things.”

Bagnell said much of their work revolves around crisis management and supporting children who, while they may not have a mental illness, are in distress and “not coping well.”

Working with them and their families, she said they help them build coping strategies that do exist despite ongoing public health restrictions. Bagnell said that usually means focusing on things they have control over, like structure and daily routines, limiting screen time, ensuring they’re interacting with people in their family, and getting outside.

That piece becomes even more important when children are in online learning mode because outdoor time isn’t always top of mind.

“It’s so easy sometimes to realize, oh, my gosh, it’s seven o’clock and I haven’t left my room,” Bagnell explained. “From a biological basis, it’s really hard on your brain,.”

“There’s stuff about being outside, but also sunlight and other things that activate important chemicals in our brain. If we’re deprived of those for too long, it’s not so good for us.”

Bagnell said it’s important for parents and guardians to be kind to themselves and to their children, understanding that no one is functioning as efficiently right now. If we can’t be as ‘on’ all the time amid the pandemic, she asks, how can we expect that of our children?

“I think the prolonged nature of the pandemic is making this even harder because for adults, we can think a little bit further ahead and it’s still hard for us,” she said. “But for most of our young people, they don’t project out that far and so this has been really, really prolonged for them.”

While no one can predict the long term implications of the pandemic on mental health, Bagnell is certain this globally shared experience that changed lives, resulted in terrible losses, and forced many of us to do things we wouldn’t have otherwise, is going to have a long lasting impact. She remains hopeful that it won’t be “all bad” news.

“As human beings, we are incredibly adaptable and resilient and our experiences do shape us, and sometimes challenges that we’ve all shared actually shape us in a positive way in the future,” Bagnell said.

“We are going to get through this, and I think that on the other side there could be things that we have developed and that our young people have developed that will actually stand us in very good stead for the future.”

Make a big deal of important milestones

Despite how different things might look, Bagnell stresses the importance of parents marking important milestones like birthdays and graduations. She said recognizing and making “a big deal” of these events is very important, even if the pandemic has robbed them of celebrating those time-honoured traditions in ways they would have in a pre-pandemic world.

“Don’t let important milestones go by without making a big deal of them,” she urged.

If parents or guardians are concerned their child might not be coping well, Bagnell encourages them to “check in” with their child and start a non-judgmental conversation. She suggests opening by sharing that what’s going on can be tough on people, you’re concerned about them, and wondering how they’re doing. She said if a child doesn’t want to talk or open up, parents are encouraged to reach out.

“Our IWK system is a self-referral and we do want to talk to young people about it,” she advised.

“But parents can call and express what they’re seeing and worrying about as a first step — even if the young person isn’t quite ready — and then get some ideas about how to engage them in getting help.”

Family physicians and nurse practitioners can also be helpful because oftentimes young people will feel more comfortable opening up to them rather than a parent or guardian.

Bagnell said it’s important for everyone to recognize that pandemic distress is real, and they’re encouraged to reach out for help and support.

“It is helpful for people to realize that yes, what I’m feeling is real but at this point, it’s not a mental-health crisis,” Bagnell said.

“And we do have help available, that’s the biggest thing I want young people and families to know. We are here if they need us.”

Resources for Nova Scotians seeking help:

The province’s mental health and addictions team takes calls from people struggling with mental health or addiction concerns Monday to Friday from 8:30am to 4:30pm at 1-855-922-1122.

The provincial mental health and addictions crisis line is available 24/7 at 1-888-429-8167.

Kids Help Phone offers help for children and youth seeking mental health support. They can get more information about texting, calling or online chats by visiting kidshelphone.ca.