When school buildings closed last March, Tara Brown’s then-12-year-old daughter stopped turning in assignments. Most of her classmates in Southeast Washington didn’t show up to their virtual classes that spring, so she wasn’t socializing online. Sleepovers and trips to the roller rink stopped, and she drifted away from her close group of friends.

She had been treated for depression and anxiety before the pandemic, and Brown worried when her daughter started to withdraw from school.

In May, the seventh-grader attempted suicide and was admitted to Children’s National Hospital for four days.

“These are hard circumstances, and as hard as it has been for adults to adjust, you have to take that and multiply it by 10,000 when you think about children,” Brown said.

There is no data showing that suicides among adults and teens have increased in the country during the pandemic, but mental health workers in the city say they are seeing a notable increase in children who are experiencing anxiety, depression and loneliness.

Children’s National doctors told D.C. Council members last month at an education hearing that its emergency rooms are experiencing an uptick of children with self-harm-related injuries. They are seeing children experiencing panic attacks and admitting more patients with eating disorders, the doctors said.

The youth mental health crisis started before the pandemic, and the suicide rate nationally among Black children — who account for a majority of public school students in the District — has dramatically increased over the past decade, according to a 2019 report from the Congressional Black Caucus.

Students, parents and teachers were pushing the city to invest in more school mental health workers long before the pandemic. And everyone — on all sides of the debate about reopening schools — seems to agree that the pandemic has taken a psychological toll on students.

Children’s National said it is seeing slightly fewer emergency psychiatry visits this year — an average of about 200 a month — and doctors suspect that is because they are getting fewer referrals from schools. (Currently in the District, less than a quarter of public school students are regularly attending school in person.) But the hospital said it is admitting a far greater percentage of children who come to the emergency room in crisis, suggesting the cases are more severe, according to Ariana Ahmadi Perez, a spokeswoman for the hospital.

The hospital typically admits about 25 percent of children who visit with psychiatric complaints, Perez said. In the first 2 1/2 months of 2021, the hospital admitted upward of 50 percent of the children brought in. Sixty percent of all the children screened positive for suicidal ideation, and 40 percent were assessed to be at high risk of suicide.

“A lot of kids access mental health services in school, and not being in school has been a barrier to that,” said Joanna Cohen, associate professor of pediatrics and emergency medicine at Children’s National.

Last summer, when city leaders thought school buildings could reopen in the fall of 2020, D.C. Public Schools Chancellor Lewis D. Ferebee said that students were experiencing trauma during the pandemic and that when they returned to school buildings the focus would be on their mental health.

But advocates say they do not feel the initial school budget proposals reflect the trauma that students experienced. Overall, the school system is adding 31.5 mental health positions — including psychologists, social workers and counselors — to its payroll, though some of the school system’s 118 campuses may be losing mental health staffers because of declining enrollment. Thirty-six campuses are facing budget cuts.

The city also contracts with mental health workers through community-based organizations and is anticipating the number of staffers through those partnerships to increase from 84 to 88. In all, the school system says it has more than 600 trained mental health professionals providing services to the school system’s more than 52,000 students.

Ferebee has said that he would not use the infusion of federal pandemic aid to hire permanent staffers. So while that money will not go toward employing more mental health workers, he has allocated $5 million of it to train teachers to better support the mental health needs of their students.

“This is not a pandemic budget,” said Mary Levy, an independent local school budget expert who has previously been hired in the city to analyze school spending.

At a rally this month outside the Office of the State Superintendent of Education, a couple dozen students and advocates called for the city to remove police from schools and spend more on services such as mental health. Students in the Black Swan Academy, an after-school program that teaches community activism, have been calling for more resources since long before the pandemic.

It has not been easy to deliver mental health services virtually, according to Marisa Parrella, director of the school-based mental health program at Mary’s Center, a community health provider in 26 of D.C.’s traditional public and charter schools.

Last spring and summer, many students did not have computers or Internet access, so telehealth was not really an option. Mary’s Health focused on getting cash aid to their families so they could have food and essentials.

Most families are now connected, but it is still difficult to reach students. Mental health workers rely on schools to talk to students. Students will stop by a clinician whose office door may be open or can leave class to meet with them.

Teachers would often refer students to clinicians, though in virtual learning it is harder for them to identify which youths may be upset or stressed. Without these interventions, Parrella said she is not surprised that so many more students are experiencing crises and need to be admitted to the hospital.

“It is very challenging to get the kids you really want to engage to engage,” Parrella said. “The ones that are really at risk and depressed, who are disconnected, who live in a one-bedroom apartment and don’t have privacy, they are the hardest to get to come.” 

Even the children who have comfortable housing and parents with steady incomes are experiencing significant stress and anxiety, according to Joshua Corbin, professor of pediatrics at the Center for Neuroscience Research at Children’s National.

Corbin said that socializing is key to childhood brain development and that virtual schooling and activities cannot replace that. Without these interactions with peers, it is normal that children would feel depressed and anxious.

“Humans are social animals and a good part of our brains are wired for social interaction, and these interactions start from intimacy,” Corbin said. “If you remove this, you are removing one of the basic stimuli you are wired for. It’s a necessary thing for social brain development.” 

Nathan Luecking, a social worker at Anacostia High, said that the school has lost multiple students and recent alumni to gun violence during the pandemic and that his sessions with students are still dominated by gun violence and safety fears.

Some students are stressed about having to take extra jobs to make up for lost family incomes, but he said others have talked about how the federal stimulus checks have relieved family stresses. And he has noticed fewer teenagers talking about unexpectedly needing to move homes, something he suspects can be attributed to the eviction moratorium in place.

Brown said she realizes her daughter has had more support than many children during the pandemic. Brown, a secretary for the federal government, has been working remotely, and her daughter receives mental health care outside of school.

Her daughter’s mental health has improved this academic year, and she is laughing and smiling around their home more. Brown said this academic year she moved her to a different school, one she felt would be better for virtual learning.

Now, she is planning an outdoor 14th-birthday party in May since she missed a celebration last year during the early months of the pandemic.

“She has it all planned out, and she has given me a list and she has organized it based on one of her favorite anime games,” Brown said. “Even though she understood, she told me she wasn’t happy about her 13th birthday. I think she would have appreciated fewer gifts and more friends.”