We shouldn’t wait until a patient is admitted to the emergency department to treat them for mental health issues like anxiety and depression. 2022 showed the highest number of deaths by suicide on record, with an adjusted suicide rate that increased by 16%. Part of this increase can be attributed to cyberbullying, which, according to the latest Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System results, around 16% of high school students experienced within 12 months before the 2021 survey.
Dr. Chad Rodgers, AFMC’s chief medical officer and member of the American Academy of Pediatrics, discusses social media's impact on child development in a recent episode of AFMC TV.
“The increase that we’re seeing in anxiety, depression, and suicide among 10- to 24-year-olds is likely due to social media,” Dr. Rodgers says. While social media has been a great way to spark new ideas and connect with others around the world, it has also created a fractured look at how the world really works.
“Social media platforms are so anonymous and unprotected that they can cause severe danger to the mental health of a child or young adult,” Dr. Rodgers says.
A snapshot of time
Some people practically live in a “virtual” world. Snapchat, Instagram, Facebook, X, and even TikTok allow a peak into the lives of other people. What some people, especially children, don’t understand is that, when they watch a video of someone else’s life, they’re only seeing a snapshot of time, not someone’s entire life. “You don’t know what’s really going on behind the camera,” Dr. Rodgers explains. “Many times, the video may be an exaggerated version of how life really is.”
That creates a false narrative that someone with a young mind believes is true. “Children scroll through someone else’s posts and believe someone is out there living this great life while they’re wrestling with the thought that what they have in their life, who they are, or what they believe about the world, isn’t good enough. This sense of low self-esteem or feeling lost combined with Adverse Childhood Experiences (ACEs) has detrimental effects on the developing bodies and brains of children.
ACEs increase the likelihood of behavior problems and a higher risk for chronic illness, drug addiction, and mental illness later in life. As healthcare providers, we are responsible for educating our patients on healthy coping skills and resilience strategies that help us overcome our ACEs. AFMC’s annual ACEs & Resilience Summit is a great opportunity for community leaders to get together to discuss challenges and techniques for overcoming ACEs in our lives. This year’s theme is Living in a House of Cards: Dealing with the ACEs in Our Lives. The 2024 summit starts on August 8. Keep an eye out for registration links!
The wrong kind of social interaction
Humans are social. We learn through social interaction. In fact, many studies suggest that children’s interactions with their peers have lasting effects on their occupational status, salary, relationship status, mental health, and even mortality. This longing for social interaction helps explain why social media has become so popular. But is the kind of social interaction children experience on these platforms healthy?
Likes and followers hold more weight in the adolescent community than the humans behind them, often causing some teens to post things about themselves that may not be true just to draw attention. Down the line, children consume “empty calories of social interaction” that temporarily satisfy their biological and psychological needs but do not actually provide any benefits.
Providing support upstream
The first time any healthcare professional interacts or treats a person who has decided to take their own life is in the emergency department after a failed attempt. While there are several intensive emergency protocols that can save a person’s life, if the patient saw a provider sooner, they could have prevented much more harm from occurring.
“In the mental health context, suicide is like the heart attack of the cardiovascular world,” Dr. Rodgers explains. “There are several things that can be done leading up to a heart attack that can prevent it from happening altogether. Similarly, there are several interventions we can take that can prevent a person from taking their own life.”
“Our healthcare system is currently struggling to adapt to the sweeping effects social media has had on adolescence, child development, behavioral health, and mental health,” Dr. Rodgers says. “Mental health has existed in its own silo, but now, we’re making efforts to incorporate it more into primary care and to try to intervene sooner rather than later.
By providing support upstream, we can prevent the crisis from occurring downstream. “Unfortunately, that’s not where resources and funding for mental health have traditionally been placed,” Dr. Rodgers says.
Despite gaps, there are several improvements
In the past, Medicaid did not pay for mental health services, as mental health was often thought to be outside the scope of traditional medicine. Today, Medicaid pays for treatments, therapies, and other mental health services. “Even private insurance companies are now required to cover patients when they seek mental health assistance,” Dr. Rodgers says.
Several medical societies have begun exploring the integration between mental health and primary care to fill the gaps in mental health access and create harmony between the two. “The American Academy of Pediatrics has recognized the importance of early intervention and has provided resources for parents to read that discuss risk factors, warning signs, and tips for how to talk to children about depression and suicide.
Technology has also developed a lot to accommodate online counseling and other virtual mental health services. Apps like BetterHelp and First Stop Health have allowed individuals to consult with counselors via an app, while telehealth has opened a new avenue for rural patients to see providers without leaving their homes.
“If you live in a community that doesn’t have reliable Wi-Fi or broadband connection, you cannot use telehealth, so the gaps to mental health services still exist,” Dr. Rodgers says. “Additionally, while insurance companies do pay for generalized mental health services, specialty care still requires patients to pay out of pocket. Depending on the location of those specialty providers, you’re looking at more costly services overall.”
Value-based care adds hope.
Value-based care models focus on preventive care and reducing unnecessary hospital visits, which are often costly both for the patient and the healthcare system. If we can use the value-based care models to encourage our patients struggling with mental health issues to seek professional help early, we can begin to lower anxiety, depression, and suicide rates, which have been sky-high since after the pandemic.
“With healthcare, we think a lot about encouraging physicals, screenings, and wellness visits that are designed to prevent problems from developing later in life. For mental health, we don’t really think about those things. Performing early screenings, early referrals, and community resources that improve mental health and limit those hospitalizations that can become very expensive,” Dr. Rodgers explains.
Telehealth and online treatments also provide support.
In recent years, telehealth and other virtual healthcare services have become a convenient and effective way for individuals to still see their providers without leaving their homes. For mental health treatment, however, telehealth and online treatment has taken a minute to catch up.
“We were so resistant to telehealth because so much of medicine is relational: being in the room with someone and being able to speak with them face-to-face,” Dr. Rodgers explains. “That’s what people with mental health issues need.” Despite these challenges, Dr. Rodgers says that having an initial visit in person and then utilizing telehealth or virtual visits for follow-up appointments still provides benefits, especially for those who need connection or interaction with a provider more often.
Telehealth also allows patients to visit with a professional more frequently without leaving their homes. This keeps the patient visiting with someone who can provide them with the support and resources they need to avoid a crisis down the road. “Our patients shouldn’t have to go to the ER to receive mental health care,” Dr. Rodgers says. “It should be readily accessible in our community.”
There has also been a recent push for patients struggling with mental health issues to use apps and other online services to connect with others who are going through similar experiences. “We’ve seen different fields emerging like life coaching, which isn’t necessarily counseling, but is a way to provide support for individuals undergoing behavioral health changes,” Dr. Rodgers says. “For people who are struggling with issues that require specialty services, telehealth and online services allow patients to consult with experts in other states who may have more resources that we don’t have here in Arkansas.”
Acknowledging the impact of social media platforms on mental health and child development allows us to create strategies that leverage the benefits of telehealth while encouraging patients to take a mindful approach to digital media. Incorporating mental health into primary care fills gaps and supports the whole-person focus that value-based care has emphasized. Though we are still learning the impacts of social media on our patients’ behavioral health, we can develop plans that help us navigate the intersection of mental health and primary care while ensuring that our patients receive the help they need in both physical and virtual spaces.
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