On January 29, the Elmo account posted a simple tweet that said, “”Elmo is just checking in! How is everybody doing?” and nobody could have predicted the response this would get.
There was a wide range of responses with people revealing how mental health is very much an issue. “I’m at my lowest. Thanks for asking,” one person replied. “Elmo, I’m depressed and broke” another wrote. “Elmo, I’m suffering from existential dread over here,” another replied.
About 20 hours after Elmo’s initial tweet, the account followed up with this: “Wow! Elmo is glad he asked! Elmo learned that it’s important to ask a friend how they are doing. Elmo will check in again soon, friends! Elmo loves you.”
President Biden chimed in with this response to Elmo’s second tweet: “I know how hard it is some days to sweep the clouds away and get to sunnier days. We have to be there for each other, offer our help to a neighbor in need, and above all else, ask for help when we need it.”
The Elmo tweet that went viral led everyday people to really reveal the issues that they were having. The response echoed what professionals are noticing since the pandemic and other stressors highlight challenges for all people, especially children and families.
Child and adolescent psychiatrist Dr. Ruth Gerson, who is the associate medical director for ambulatory health at the Family Health Centers at NYU Langone was not surprised people were so vulnerable at this time.
The response to the tweet echoed what she has seen in her clinical practice.
“There are real emotional challenges that children and families and really all people are experiencing,” Dr. Gerson said. “As the demand for support around those struggles and as the demand for mental health services increases, it has become increasingly difficult for people to find mental health care and particularly to find effective mental health care.”
Dr. Gerson has found that a lot of people are struggling. When they saw a question like Elmo’s that simply asked how they were doing, the revealing response signified the gap between what is needed and what people can access.
She was not surprised by the range of responses since people are comfortable being open about their emotional struggles about their mental health needs, and thinks it’s wonderful that people could be honest.
This tweet sparked so much of a response since people have been looking for discourse and a forum like this.
“People have been looking for this kind of support and haven’t been able to find it,” Dr. Gerson said. “So when an opportunity comes out to be open about this you see this outpouring of honesty and a real clarity about what they want and what they need.”
She thinks many people could make a very diligent effort to access mental health treatment that would be helpful for them and it still might not be available for them depending on where they live and what their insurance will cover.
There are large parts of the country that don’t have effective mental health treatment easily available, which can lead to families often driving far distances to try to access a mental health provider.
Families struggle to find providers who accept their insurance. They also struggle to find a mental health treatment that doesn’t have a pricey co-pay or another obstacle that would make it financially unrealistic to access that help.
“I am sure people are working hard to fight for and get what they need and it can not just be on the level of the individual,” Dr. Gerson said. “We need to do better in our policy and in our system to make it possible to access the help they need.”
In regards to the Covid pandemic, it placed stress on many families with their anxiety and financial concerns. There is so much with mental health that Americans struggled with due to the pandemic but mental health issues have been happening for many years.
Children’s visits to emergency rooms for mental health concerns have been increasing for many decades.
“There has been a real lack of true parity in mental health funding and mental health access and a real lack of access and reimbursement for specialized effective therapies for specific mental health symptoms and disorders,” Dr. Gerson said. “When people access help it’s often not the help that is going to be curative for their mental health symptoms or the struggles that they are experiencing.”
People of all ages struggle with their mental health but one of the most underserved areas in mental health care is the access to specialists by children. Not enough providers are trained to know how to effectively support children.
“While everyone deserves help and needs help, we know it can be particularly challenging for young people and families to access help from someone who is really qualified and knows what they are doing to provide the care that can get that young person better,” Dr. Gerson said.
The lack of help a child gets can be very impactful. If two years of school are disrupted by a mental illness that was not treated that can have a tremendous impact on one’s life course.
Adults who have stability with their family and career might be more able to take time off to get the help that’s needed.
One way to help ensure mental health services are available to more kids as well as adults is to increase funding. Services for children and families have been historically under resourced.
“Mental health services have been underfunded and under reimbursed compared to medical services,” Dr. Gerson said. “I think there needs to be recognition that evidence based treatments have a real value over a one sized fits all approach.”
She added that the expensive cost of treatment for cancer and expensive treatments that have been approved for diabetes are provided since it is what people deserve and it should be the same for mental health.
The only way for people to live healthy lives is for people to actually get treatments for the illness they are experiencing.
“Funding needs to be focused on how we get people truly well, not just what is simple to fund, easy to fund or what has been historically covered by health insurance.,” Dr Gerson said.
At the NYU Langone Family Health Centers, they focus on at first identifying kids who are struggling and identifying signs of kids’ mental illness.
To help identify any kids who are struggling, they have clinicians imbedded in local schools and they have partnership with pediatricians to make sure kids who are struggling can get identified and connected to services as quickly as possible.
“Identification is really important so that we can get the right services to a young person before a major disruption to their school or a major disruption to their social or emotional development,” Dr. Gerson said.
It’s necessary that families have access to treatments that are right and that match what their child is going through and treatments that are accessible for them.
“Whether that’s an issue of insurance reimbursement, whether that’s an issue of the language in which they feel most comfortable engaging in treatment or whether that’s an issue of scheduling,” Dr. Gerson said. “All of those things are really important to ensure that the right treatment can be given at the right time.”
A critical way of helping people who have experienced trauma issues is recognizing that trauma and stress can directly lead to symptoms of mental illness. Society might miss the underlying causes that make somebody vulnerable to mental health struggles.
It’s important to look at why someone has depression or why someone has anxiety and to go beyond surface level intervention to help provide treatment to process what they have experienced as part of their recovery.
“There are particular therapies that are effective for people who have experienced trauma who are now feeling anxious or depressed,” Dr. Gerson said. “It’s about ensuring that people who have experienced trauma, who have experienced stress and adversity, have access to treatments and the kinds of clinicians who are specialized to provide those treatments.”
Dr. Gerson believes that it’s important to address ones holistic wellbeing, which means going beyond just the treatment of the illness to helping people achieve the fullest potential and internal wellness.
It’s important for people to be resilient and to be able to cope with obstacles that might come their way.
“One of the things that stress and trauma can do is it can stay with us in ways that make it hard for us to cope when things get challenging,” Dr. Gerson said. “To be able to feel sturdy and well in coping with ups and downs means processing the stuff that has happened to us before, and having the skills that help us be resilient in the face of stresses that might otherwise trigger something like anxiety or an episode of depression.”
The goal is to treat people until they aren’t ill but also to provide them support and skill so they can be resilient if other things may arise in the future.
Dr. Gerson added that it’s about people feeling confident that they will be able to adapt instead of having a feeling that the next stress or obstacle could push them over the edge.
Dr. Gerson believes that social media has had positive and negative effects on peoples mental health. There has been a lot of research on this and the surgeon general has concerns about social media.
“I think there are ways in which being able to connect with people virtually can be really helpful to be able find others who have shared experiences,” Dr. Gerson said.
On the negative side, she added that when used in excess social media can impact peoples sleep and it can negatively impact people having time and energy to find connections in real life.
“The other piece that is key is that while social media and online support can be helpful as a support, it’s not a mental health treatment,” Dr. Gerson said.
We saw how many people reached out for help after the response to Elmo’s tweet, and the platform that the tweet provided, but that isn’t sufficient.
“We need to make sure that people have access to high quality mental health care, high quality medical care, and support in their communities to feel connected and well,” Dr. Gerson said.
It’s important that parents are thoughtful about what children can access online and that rules and structures are provided so kids can be safe in the online world.
There is a NYU Langone Family Health Center in Red Hook at 168 Van Brunt St. that makes sure families are able to access mental health and school based health services.
There is a school based clinic at PS 15 as well as others across Brooklyn.
