Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 53

Corners of the PCSO

Practice Management

A Child Psychiatrist Reflects on COVID
and How You Can Support Child
Mental Health

Dr. Michael Swetye
San Francisco, CA
PCSO Bulletin Contributor

The COVID " Footprint "
Imagine the footprint of a toddler's little sneaker in the snow. Then imagine an adult snowshoe placed over it. This footprint metaphor
captures an essential concept from disaster
psychiatry research that is applicable to our
current COVID pandemic.1 The toddler print
represents the initial disaster trauma: lost lives,
frightened people, and disrupted resources.
The snowshoe print, like a penumbra around
the toddler's print, represents the much larger
mental health toll that results from a cascade of
disturbances that unfold over months and years
during and after the disaster. Unfortunately,
as the pandemic surges, each disturbance is
like a mini-disaster, and rates of mental health
disorders will rise significantly. This has already
happened: between April and October 2020, the
proportion of all emergency department pediatric visits for mental health issues increased by
approximately 30%.2
How Is the Mental Health Footprint Relevant to
Orthodontists?
I believe that orthodontists are in a special
position within the community to support child
mental health. The relationships that you build
with children and families over many months
gives you a unique window into their lives and a
powerful opportunity for positive influence. By
considering how your practice does or does not
address mental health concerns, you can make
a few small changes that could have a positive
impact on the welfare of many children, which is
increasingly relevant as the mental health footprint takes hold.
Given That Psychiatry Is Not Your Expertise,
Where Do You Start?
Start with developing a general awareness.
If you are aware of mental health problems
generally, then you can start reflecting on how
to address them in your practice and when to
pursue more information. To give you a sense of
the scale of mental health problems, here are a
few pre-pandemic facts based on United States

Spring 2021    PCSO Bulletin	

statistics: 1 in 5 of the children in your practice
had a mental disorder over the prior 12 months;3
1 in 14 had an anxiety disorder;4 1 in 10 had
attention-deficit hyperactivity disorder;5 1 in 10
of the parents in your practice had a personality
disorder;6,7 1 in 5 of your high schoolers seriously
contemplated suicide in the past 12 months;8
and 1 in 11 of your high schoolers reported at
least 1 prior lifetime suicide attempt.8 With the
pandemic, these numbers are getting worse.
To bring these statistics alive, do the following
exercise: close your eyes and bring to mind five
of your high school patients. Next, realize that
one of them has thought about suicide in the
past year. As you become more informed about
psychiatric issues, you can brainstorm ways for
your practice to support child mental health.
Below are some suggestions for getting started.
Put It on the Table
Do you have a system in place for how you and
your staff should handle mental health issues?
This is important to address up front with new
patients as part of your standard process; otherwise, you will run into awkward conversations
later. By opening the door and setting expectations, you will not feel so stuck when you notice
cuts on a teenager's wrist or when you are
facing yet another inappropriate outburst from
a 10-year-old. You will also be able to plan for
challenges, such as if you discover a history of
panic disorder or oppositional defiant disorder,
rather than reacting unprepared. Perhaps you
can touch on the topic of mental health during
treatment planning as part of a broader discussion about referrals to other dental and medical
professionals. You could ask, " Does the patient
have a therapist or psychiatrist, or a psychiatric
diagnosis? " If a behavioral or emotional issue
raises your concern (since many kids struggle
with things such as anxiety or disruptive behavior), are the parents agreeable to you bringing it
up with them and/or the pediatrician to see how
best to find support? You could include such
questions in a check-list as part of your standard
intake paperwork.

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Pacific Coast Society of Orthodontists Bulletin Spring 2021

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