UCLA Health interview: Dr. Melissa Brymer


Dr. Melissa Brymer - Expert in Children's response to disasters

For more than two years, the COVID-19 pandemic has caused significant disruption to our lives. Recently, research and headlines warn of a youth mental health crisis. In December 2021, the U.S. Surgeon General issued an advisory about this youth mental health crisis and in March 2022, the CDC published data further demonstrating this growing issue.

To help put this all in perspective, we sat down with a UCLA Health expert in children’s response to trauma, Dr. Melissa Brymer.

Matt: Thank you for meeting with us today, Dr. Brymer. Can you tell us a little bit about who you are, where you're involved at UCLA, and your background?

Dr. Brymer: My name is Dr. Melissa Brymer and I have a unique role at UCLA. We are the coordinating body for the National Child Traumatic Stress Network, which is funded by SAMHSA (Substance Abuse Mental Health Services Administration) and UCLA, along with Duke University, serves as the national center. We coordinate this network that includes 140 centers across the country. Our mission is to improve the access and quality of care for all types of traumas that kids might experience in their lives, whether it's domestic violence, community violence, or physical abuse. And so my work addresses when there are large scale disasters such as mass violence, or in this case, COVID, how does that impact on different communities that were affected by that disaster and what are strategies that we can put into place to help that community and to help those families and those kids heal from what they experienced.

Matt: We are hearing more and more that there is a youth mental health crisis being brought on by the pandemic. Can you help us better understand what is being said when we hear that? What is contributing to this?

Dr. Brymer: When we use terms like 'there's a mental health crisis' as you stated, no one knows what that means. It's anxiety provoking. First and foremost, we need to understand that the pandemic hasn't impacted kids all in the same way. We know that some kids actually did better. They enjoyed spending more time with their family and appreciated not having some of the social pressures at school. But not all kids are having that experience. We have many kids who have had a parent or a secondary caregiver who has died because of COVID or from a subsequent adversity related to COVID (e.g., reduced access to medical care, opioid crisis). These kids have suffered a permanent loss – their loved ones aren't coming back. For many, they weren't able to say goodbye to their loved ones, because of visitor restrictions at the hospital or not being able to hold goodbye rituals that we know are so important to those bereaved. The other area that I think that we need to be thoughtful about is that some youth in our community were experiencing abuse during this time. We are hearing about verbal abuse, and we're also hearing that some of that abuse turned physical. Some of our youth may also have been with family members that may not be supportive of their different identities. They were isolated from those that supported them. Usually schools are the place where we hear about child abuse and where reporting happen, but since schools were remote, people were thinking that abuse wasn't happening. We know that when kids have experienced something traumatic like abuse or if they have experienced something else during the pandemic, like racism, or have experienced a stigma or other hate, or violence, we know that they can be prone to more risky behaviors. We are seeing an increase of substance use and in overdoses and we're seeing that some of our kids have been lonely and depressed, and we're seeing an increase of suicidal risk.

Matt: What can our teachers and administrators look out for in their classrooms and with their children and what can they do?

Dr. Brymer: I want to first make sure we acknowledge that our educators have also experienced COVID and have been part of this pandemic themselves. They've had to make huge adjustments to how they work. So it's important that our educators take care of themselves. It is important for us to make sure that our educators stay well. But, if you noticed a kid has been absent, if there has been a death recently or some kind of other traumatic experience, if there has been a change in grades, if there is a change in attendance, if there are writing assignments where a child is showing that they're struggling, we need to check in with that student. Teachers know their students now and starting that initial check in can go a long way. Sometimes for some of our kids that might be the first check in they've had for the last two years. On the otherhand, educators can't help a student if they don't know if there's been something that's recently happened. And so having a communication between the parents and educators is one first step that that can really be helpful.

Matt: Do children and students have a role to play in addressing this mental health crisis?

Dr. Brymer: We're hearing from many kids that their own friends are having these types of struggles and they are talking together. We can help them to have the conversation, give that support in the moment when their friend is reaching out, and then help their peers to seek the supports necessary, whether that's a trusted teacher, sharing with a parent, or another trusted adult. Having that conversation with a friend can be so stressful and overwhelming. We need to actually teach youth how to support their fellow friends right now. They're doing it already. We need to empower the youth, but we also need to listen to them.

Matt: What are some immediate questions we can ask from a systems or operations perspective to address this crisis? Where do we need to see change happen?

Dr. Brymer: We need to make sure that we have services in place at schools, which are the best place, because that's where we have the most access to kids. We need to make sure that our schools have trauma and grief treatments. We need to train our educators, for example, on Mental Health First Aid that talks about giving us awareness on mental health issues and on Psychological First Aid so our educators know how to support students after a crisis. These trainings need to include what to say and how to give a referral. We also need to equip educators with relevant resources so that if a parent comes to them and says, ‘I'm worried about my child,’ they know what referrals are in the community or can hand them a resource to empower them. It's important for us to identify those kids with safety concerns and get them immediate help. We also need to continue to monitor the long term impacts, and make sure we have the appropriate treatments to address these concerns – treatments that are culturally and developmentally appropriate. These services need to be equitable across all our schools and communities.

Matt: I’d love for you to share some of the resources you have worked or know about that might be valuable for our readers to better help them navigate conversations with youth and how to help address some of the mental health issues we discussed above.

Dr. Brymer

Matt: Thank you so much for sharing those resources, they look wonderful. We know this is a complex and difficult topic – thank you for sharing your insight with us today.