As Public Health Emergency Ends, Serious Problems Remain

As stated in a recent American Medical Association report, “while the federal government may be declaring an end to the COVID-19 public health emergency, there are still significant, longstanding gaps in the public health infrastructure in the U.S.”

In response to the need for implementing reform and improvements, the AMA has formed the Council on Science and Public Health to study ways to strengthen the nation’s health and public health system. Says Greg A. Adams, CEO of Kaiser Foundation Health Plan Inc., and one of the leaders of this new health care industry coalition, “We have emerged with some wounds and scars from this shared experience and have learned that we must get better at planning for future health crisis events that we know will happen.” It is more than a little ironic that as this statement is being made, real “wounds and scars” are being inflicted on doctors, nurses and care technicians at hospitals around the country.

“We are not protected on our floors,” said one change nurse at a Northeast Georgia Health System facility in recent testimony before the Georgia Senate Study Committee on Violence Against Healthcare Workers. Trained to de-escalate violent situations, the nurse described responding to a call and racing to a hospital room where a patient was assaulting a care technician. Reported by Kaiser Health News, as she tried to intervene, the patient began attacking her, punching, kicking and biting her. By the time a team of security guards and other nurses could free her, the patient had ripped out chunks of her hair.

According to federal data, health care workers today are five times as likely to experience violence as employees in other industries. Says Matt Caseman, CEO of the Georgia Nurses Association, the current level of verbal and physical threats is also exacerbating the current nursing shortage.

In response to a rise in violence against health care workers over the last several years, Georgia, along with nearly 40 other states, is attempting to address the problem by stiffer criminal penalties and enhanced law enforcement. Some, including Georgia, are enacting laws that allow the creation of hospital police forces. Reports Kaiser Health News, according to the International Association for Healthcare Security and Safety, “members of those forces can carry firearms and make arrests. In addition, they have higher training requirements than noncertified officers such as security guards.” Because such interventions are relatively new, little data exists on whether such forces are effective at preventing hospital violence. If anything, these measures show just how desperate this situation has become.

Violence in hospitals is just one of many examples of a serious problem that has emerged that threatens public health and the maintaining of the health and well-being of communities, as the government proclaims an end of the COVID emergency in the country. According to a USA Today report, since the pandemic, more students have become “school-avoidant” leaving parents feeling hopeless to change this behavior, and schools feeling unequipped to find a solution to this perplexing problem. For some parents, a school day can begin with a police car in the driveway in a desperate move to get their child to go to school. “School avoidant behavior, also called school refusal, is when a school-age child refuses to attend school or has difficulty being in school for the entire day,” explains USA Today’s Adrianna Rodriguez. It is described as a mental health issue that has gotten worse since the COVID-19 pandemic.

“There’s no book on this, it’s not spoken about,” says Jayne Demsky, whose teenage son never stole, used illegal substances or physically hurt anyone. He just didn’t go to school. “It’s very scary and parents feel a sense of helplessness.”

“Demsky sought help from educators, doctors and counselors, trying to understand what was stopping her son from going to school for nearly a year,” writes Rodriguez. “Finally, a psychiatrist told Demsky about a condition that affects a growing number of students with severe anxiety: school avoidance.” Mental health experts believe that, for most students, school avoidance is typically a symptom of the bigger problem of anxiety.

“Anxiety may be a common thread, but the basis of that fear varies with each student,” says R. Meredith Elkins, program co-director of the McLean Anxiety Mastery Program at McLean Hospital in Massachusetts. “In younger children, we’re more likely to see school avoidance motivated by separation anxiety. As kids get older and their social environment changes, the way they interact with peers becomes important, and we see social anxiety as a more frequent contributor.”

Half a dozen family members and students told USA Today that school avoidance “has affected not only their mental health, often leading to anxiety and depression, but also their family dynamics, relationships with fellow students, and grades. It has threatened their prospects of graduation and a thriving future,” Rodriguez writes. It is a complicated condition that neither parents nor school systems are fully equipped to handle. A Kaiser Family Foundation analysis found adolescents experiencing anxiety or depression increased by one-third from 2016 to 2020. The same report also found access to mental health services worsened during the pandemic.

“The mental health infrastructure was never designed for this level of need,” says Jonathan Dalton, a licensed psychologist who runs the Center for Anxiety and Behavioral Change in Maryland and Virginia, facilities that offer treatment to those affected by anxiety and other related disorders, including school avoidance. At the time Dalton was contacted, they had a waiting list of approximately 180 families.

“It’s important for students to stop using avoidance as a coping strategy now before it becomes their primary way of dealing with problems for the rest of their lives,” adds Rodriguez.

“I don’t treat anxiety. I don’t have to treat anxiety because anxiety is temporary and harmless. What I treat is avoidance, and avoidance ruins lives,” says Dalton.