Impact of Covid-19 on Pediatric Mental Health Study by FAIR Health 3.2.2021

I have voiced my concerns about the impact on the mental health of our students as a result of the Covid-19 pandemic and our nation’s, state’s and local government’s decision making in reaction to it many times in our public board meetings. This concern above all others is what has kept me and many others awake at night for the last year.

I have been asking for data regarding the mental health decline of RRISD students since my election in Nov 2020. Unfortunately, there are legal barriers (such as HIPPA) that prevent RRISD from having a full picture of the extent of this impact on our own students. Though RRISD has a Behavioral Health Dept that does tremendous work for many of our students, RRISD is not notified when students are admitted to an ER, or when their PCM refers them to a mental health specialist or when they are admitted to local mental health treatment facilities. RRISD does not have access to private health care records. Patient privacy is taken seriously in our country and it should be.

On a weekly, basis I and many others search for data to learn about the impact on the mental health of our youth. Comprehensive, reliable information has been extremely hard to find…until now. Last night a community member sent the trustees a link to a study that has captured this data objectively and meaningfully. It was just published four days ago.

After reviewing this data, I want to express appreciation of RRISD’s e-mailed communication yesterday of our optimism that we will be able to return to fully in-person instruction and activities for the 2021-22 school year. The expectation is that all staff members will have had the opportunity to vaccinated by that time. If the TX legislature authorizes RRISD to offer virtual learning next year, the district is preparing to offer that as a separate platform to better serve students who will need it next school year. This good news comes at a time when many families need and are looking for hope for their children who have suffered terribly in the last year.

Since we are not allowed to post links here on the message board, please know that the study can be found in an internet search by using key words such as, “fair health impact pediatric mental health”.
I want to add that I know there are children who do not show up in these numbers. This study is limited to claims data. We know there are children who for a myriad of reasons lack access to the medical attention and care they need. We don’t see them in these numbers but we know they are there.

The study is 34 pages long and content rich so I encourage all readers to review it and draw their own conclusions. Below are items that stuck out to me.
The study focused on 13-18 year olds and 19-22 year olds and also includes some data on 6-12 year olds.

32 Billion private healthcare records were reviewed

FINDINGS:

Skyrocketing number of overall mental health claims, intentional self-harm claims, overdoses & substance use disorders, and mental health diagnoses. (p2)

“Profound impact on mental health” (p2)

“Young people have proven especially vulnerable to mental health issues related to the COVID-19 pandemic. School closures, having to learn remotely and isolating from friends due to social distancing have been sources of stress and loneliness.” (p3)

Figure 1: Percent change from January-November 2019 to January-November 2020 in mental health claim lines and all medical claim lines, age group 13-18 years (p6)

Figure 5: Intentional self-harm claim lines as percent of all medical claim lines, age group 13-18 years, January-November 2019 versus January-November 2020 (p10)

“Diagnoses of intentional self-harm increased substantially in the 13-18 age group in spring 2020 as compared to spring 2019 (figure 5). These diagnoses included intentional self-harm through such means as drowning, firearms, smoke or fire, sharp objects, blunt objects and crashing of a motor vehicle. Although typically associated with attempted suicide, intentional self-harm can include forms of self-harm without suicidal intent, such as “cutting,” intentional cutting or scratching of the skin. It has been noted that self-harm can serve as a proxy outcome to identify how the pandemic has affected mental health.18 In March 2020, claim lines for intentional self-harm as a percentage of all medical claim lines increased 90.71 percent, from 0.0130 percent of all medical claim lines in March 2019 to 0.0248 percent in the same month the following year. In April 2020, the increase was even larger, nearly doubling (99.83 percent) from 0.0137 percent of all medical claim lines in April 2019 to 0.0274 percent in April 2020. All other months for 2020 stayed above the corresponding months for 2019, with a rise of 89.64 percent in the single month from July to August 2020 (from 0.0121 percent of all medical claim lines to 0.0230 percent).”

Figure 10: Percent change from January-November 2019 to January-November 2020 in overdose claim lines and substance use disorder claim lines, age group 13-18 years

“Although the focus of this report is not substance use disorders, a broad view of overdoses and substance use disorders in January-November 2020 as compared to the same months in 2019 in the age group 13-18 is informative (figure 10). Claim lines for overdoses, which encompass drugs and other substances, including alcohol, and which may include suicide attempts and fatalities, increased 94.91 percent as a percentage of all medical claim lines in March 2020 and 119.31 percent in April 2020 over the same months the year before. April was the peak month, but overdose claim lines continued above 2019 levels throughout the remaining months to November.”

Figure 13: Percent change from January-November 2019 to January-November 2020 in claim lines for top three mental health conditions (major depressive disorder, generalized anxiety disorder adjustment disorders), age group 13-18 years (p19)

Figure 17: Percent change from January-November 2019 to January-November 2020 in top reasons for emergency room visits, age group 13-18 years (p23)

Last page of the study:
“About FAIR Health: FAIR Health is a national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health qualifies as a public charity under section 501(c)(3) of the federal tax code. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 32 billion claim records and is growing at a rate of over 2 billion claim records a year.” (p34)