The school year has ended on a much better note than the last one did for Mahailya Effee. She studied for her final exams and had been getting good grades on her assignments.
Mahailya is 15 and lives in Roxbury. She says she didn't care at all about her grades early on in the pandemic. She struggled to stay engaged with full-time remote school.
"I would wake up in the morning; I'll have my Chromebook right there in front of me, and would just log in, honestly," Mahailya said. "I would, like, I would do the work. I just wouldn't finish it and turn it in."
Mahailya already had anxiety, and she hated being stuck in her family's apartment. Then the pandemic really hit home in May of last year. Mahailya's grandfather died from COVID-19. She still vividly remembers the moment her mother got the call.
"And I was like, 'Nah, this can't be true," Mahailya recalled. "So then I'm in the bathroom, and all you heard was yelling. I wasn't yelling, but I was just like, 'Why?'"
Her grandfather had been homeless in Boston. She was devastated the family couldn't have a funeral for him because of the risks.
"It was just like, he's gone, I can't say a final goodbye," she said. "And to me, a funeral is when a person might be gone, but their body is there in the casket and you can see them. It was really stressful, and I kind of started overeating."
She also started to fail classes. That's when two advocates from a trauma healing program at Mahailya's Church, Roxbury Presbyterian, stepped in to support and guide her. Her mother had been in the program for some time, and it works to help the whole family.
Trauma healing specialist Shondell Davis says tensions at home during the pandemic could set Mahailya off.
"There was one time that there was something going on at home that she called me and was ... just saying that she had to get out of there," Davis recalled. "She was just crying in her life out, like, I can't do it, I can't stay here no more."
'Kids That Would Have Never Had Mental Health Challenges'
Pediatric clinical psychologist Fatima Watt worries the pandemic has increased inequities for children of color; and those contribute to mental illness. She points out kids in cities, including Boston, were isolated for longer than many of their suburban peers, because the city schools didn't return to in-person learning for a year or more.
"I think that there are kids that would have never had mental health challenges, would have never seen the inside of a hospital if it weren't for the pandemic," Watt said.
Watt directs behavioral health services at Franciscan Children's in Brighton. The hospital saw a 19% increase in children of color in its mental health programs in the year after the pandemic started, compared to the year before.
Two-thirds of the patient base is on MassHealth, the state's Medicaid program.
Demand is so high, patient coordinators have to tell callers it'll be a 6 to 12 month wait to start outpatient therapy. The wait in normal times was about a month — three months, tops.
"It's upsetting for [our staff]. They hate not to be able to provide something for the patient right away," Watt said. "And for families, it can contribute to their despair, like, 'My kid needs help now, and you're saying I can get help in a year?"
Watt says a team at Franciscan does support families who need immediate advice or assistance with resources, and they track kids who are waiting.
She says the crisis seemed to hit a peak recently. As the pandemic settled down, referrals for kids with anxiety, depression and trauma were up.
"They're starting to grieve for loss of grandparents, loss of parents," she said. "We've seen an increase in referrals for children who've lost one or two caregivers."
They grieve for lost milestones, too. Watt describes kids who feel lost — and who've spent a year worried about parents who have to work in jobs that were risky. Meanwhile, many parents have been so stretched, they've put off mental health challenges of their own, which impacts the children.
"If you don't know where your next meal is coming from, if you don't know that you're going to have a roof over your head, how are you supposed to think about your depression and anxiety?" Watt said. "You're like, 'I got to feed my kids. I got to have somewhere to live, so I'm not sleeping in my car. I can't be thinking about depression, anxiety. You want me to do what? You want me to do what behavioral strategies to manage these tantrums? Yeah, I don't have the brain space for that.' "
Brockton — where half the population is Black — had one of the highest COVID infection rates in the state. But pediatricians at Brockton Neighborhood Health Center say most of the issues they identified among kids last fall and winter had to do with mental health. The center's providers work in teams, or "teamlets" as they call them. Each one has a mental health clinician that assesses kids and connects them with therapists at outside partner agencies.
Each teamlet also has a community health worker who helps families address basic needs, from food to transportation. Jessica Miranda is one of them. She says housing insecurity tops the list of issues that have affected parents' — and thereby kids' — mental health.
"They've gotten sick with COVID, or they lost their job because their job closed or something like that," Miranda said. "A lot of the families have lost it, kind of. A lot of stress, a lot of patients not showing up because they're afraid of COVID."
Head pediatrician Janemarie Dolan says she's had families who will not leave the house. That includes kids who live in fear.
"There was so much COVID here. The incidence was so, so high ... that a lot of people still feel like COVID's in the air. They can't go outdoors," said Dolan, who says she tells patients, "You need to be outside. You need to see the fresh air. You need to get some exercise. You know, that overall wellness is going to help your mental health."
On a recent afternoon, Dolan ran from appointment to appointment, barely pausing to catch her breath. One boy revealed he was somewhat depressed, and a girl realized during her visit with Dr. Dolan that she's developed anxiety.
"She's like, 'Yeah, I'm just in my head all the time. Thoughts, thoughts, thoughts, worrying about this, worrying about that,' " Dolan said, "to the point where she doesn't want to sleep, because she's so worried that she's going to be worried about things."
According to Dolan, one of the toughest parts of pediatric care in the pandemic has been when she's had to explain to immigrant families — from cultures that don't really talk about mental health — that their children are depressed, to the point they might be at risk.
For a while, the health center had to involuntarily commit, or "section" about one child per week to a hospital for evaluation. ***Normally that'd happen about once a month.*** Dolan says most families consent to their kids going to the hospital after they hear the risks.
"We might not say suicidal, but we're worried about their safety and explain that some kids are really sad and sometimes want to hurt themselves," she said. "Some parents will get upset with it. But I think all cultures, once you are saying you're really concerned, you start talking about the hospital, I think they see that. They understand that."
But it's still tough to get some of those families to engage in therapy after the hospital.
Dr. Fatima Watt at Franciscan Children's says she knows what would help with that:
"Culturally responsive care that every person of color can walk into any agency and get care that is appropriate for them," Watt said. "The question is, can you get into some into the room and see someone who can actually meet your needs, who can be culturally responsive, who can not perpetuate discrimination and bias that you have on the outside world."
Watt says the pandemic has highlighted the need for more clinicians of color, as well as white clinicians who want to learn how to provide that care. She says research has found families of color are more likely to discontinue therapy after one session. [LINK TO THAT?] She recently had a breakthrough with a Black adolescent who had looked for help for a long time.
"She had seven clinicians before me, and all of the seven clinicians didn't know how to work with her," Watt said. And the mom says, 'I know there's something wrong with my kid and I don't know how to find someone who can help her.' "
Mahailya sought out a new therapist during the pandemic.
"It helps me with, like, just talk about what's going on in my life and my anger, because I struggle with that," she said.
And she's found a different kind of support from the trauma program at Roxbury Presbyterian.
Mahailya's "community companion" from the program, Judelle Cummins, let Mahailya drop by her place to vent and hang out during the pandemic. Cummins checked in with her teachers. And she worked with Mahailya to set goals. The first was just to just attend her remote classes. Then, to take notes. And to call Cummins every day with an update on how she was doing.
"I just wanted to create a space where she can be herself and not feel as though I was trying to make her become something that she wasn't," Cummins said. "But for her to actualize who she really is underneath all the stuff that's going on outside.