During a typical year, the pediatric emergency room staff at Joe DiMaggio Children’s Hospital in Hollywood would be preparing for a summer lull. But like last year, this one hasn’t been typical.

Amid a surge in behavioral health issues that has overwhelmed children’s hospitals across the country, South Florida has been no exception.

Dr. David Rube, the medical director of child and adolescent psychology at Joe DiMaggio, told the Miami Herald that kids and young adults in the emergency department are more frequently complaining of mental health issues like depression, anxiety and suicidal ideations when showing up for other medical conditions. They’re also more commonly presenting with conditions that are psychosomatic.

After a year of social isolation and school disruption, the effects of the pandemic on young people’s mental health has begun to worsen, and the medical community is taking notice. Rube said he is preparing for a wave of demand on an already strained mental health system for adolescents when school returns in August.

“They’ve gotten used to this reality, and now we’re asking them to rearrange their reality once again.” he said.

To that end, the hospital is scrambling to add more social work therapists to its emergency department. But there aren’t many candidates available.

The situation is no less dire in Miami-Dade, where the inpatient psychiatry unit at Nicklaus Children’s Hospital has been running full throughout the year, according to vice president and chief medical officer Dr. Marcos Mestre. The pressure has been such that the hospital has been forced to transfer patients to other hospitals to get them mental health services.

“Unfortunately, sometimes it needs to be out of county to do that,” Mestre said. “It’s challenging.”

A ‘state of emergency’

What’s happening in South Florida is part of a national crisis that has begun to bubble over, with a children’s hospital CEO in Colorado last month declaring that the demand for behavioral health services and a coinciding lack of specialists had reached a “state of emergency.”

Emergency-room visits for suspected suicide attempts for adolescents aged 12-17 rose during the pandemic and spiked over the winter, rising 51% in girls and 4 percent in boys in that age group from Feb. 21 to March 20 of this year, compared with the same period in 2019, according to a study by the U.S. Centers for Disease Control and Prevention.

The doctors at children’s hospitals know that what they’re seeing in their emergency departments are the mental health issues that went unaddressed until they turned into crises. Ideally, mental health needs could be addressed early, but South Florida families are facing lengthy wait times to get an appointment with a child psychiatrist.

Clinics and private practices alike are backed up in South Florida, and the appointment shortage cuts across the socioeconomic spectrum, Rube said. Mestre, the Nicklaus CMO, cited a similar lack of appointments and specialists.

There hasn’t yet been a surge of students with behavioral health needs at Miami-Dade Public School’s mental health department, said Sally Alayon, the assistant superintendent of mental health services there, but she said that could be because there haven’t been full rosters of students in schools.

Alayon said the staff in her department were expecting to see a sharp increase this fall.

“The research indicates that we haven’t seen it all yet,” she said. “…When the kids were at home, a lot of that pressure fell on the parents.”

To that end, Alayon stressed that parents with children who need support should reach out to the school’s mental health department early, as the staff there works 12 months a year. “We are here to help now,” she said.

Getting help early

Sara Ruiz, who is going into her junior year of college, is a patient of Dr. Rube’s who started seeing him when she was a junior in high school. She said she wished she had gotten help sooner.

As early as fifth grade, Ruiz obsessed over getting perfect grades, even staying up until 3 a.m. to work on her homework. Her younger sister started seeing Rube for her own mental health issues, and with some gentle nudging from her mom, Sara was convinced, if not reluctant.

Ruiz, who was eventually diagnosed with ADHD, remembered thinking: “What? I’m not crazy …. how dare you? …. No, people have it a lot worse than I do. I’m perfectly fine.”

It wasn’t easy for her to open up, but once she did, Ruiz said she realized Rube was just trying to help her.

“That changed my mindset,” she said. “I realized that what I put in is what I get out. I think that if there were more resources, and less stigma surrounding seeking treatment and mental health, it would have been a lot easier for me to cope with my brand new diagnosis at that time.”

Rube said that a good way to reduce that stigma would be for primary care providers to talk to their pediatric patients about mental health more, and to further increase staffing of behavioral health specialists wherever there are children.

“That would be a very significant move in the right direction, and it would make significant societal progress, but it’s tough, “Rube said. “The number one complaint from school principals is that there’s never enough space, and behavioral health takes up space. It’s a struggle all the way around.”

Ben Conarck is a reporter covering the coronavirus pandemic for the Miami Herald. He joined as a healthcare reporter in August 2019. Previously, Conarck was an investigative reporter covering criminal justice at The Florida Times-Union.