As schools across the country reopen, mental health professionals are anticipating a surge in the number of kids seeking help in the coming weeks.

That's not unlike previous years.

"Historically, our busiest times of the year are a couple of weeks into the school year, perhaps the end of September, beginning of October," says Dr. Richard Martini, a child and adolescent psychiatrist at the University of Utah and Primary Children's Hospital in Salt Lake City. "These are times where you really begin to identify kids that are struggling — the schools begin to identify them."

But what's different this year is that the pandemic has already increased the number of kids struggling with mental illness. Another surge this fall might mean a further worsening of an ongoing crisis.

"It was about this time last year that hospitals started raising red flags, like 'we are being overrun in the [emergency department],' " says Amy Knight, president of the Children's Hospital Association.

According to the CDC, between March and May, 2020, hospitals across the country saw a 24% increase in the proportion of mental health emergency visits by kids aged 5 to 11 years old, and a 31% increase for kids 12 to 17.

"And it hasn't really subsided," says Knight.

This year, the number of kids coming to hospitals for mental health needs in 2021 is 15% higher than two years ago, says Knight, referring to data collected by the Children's Hospital Association.

While many kids are excited to go back to school, mental health care providers around the country are already seeing signs of growing anxiety among students.

"We have already been seeing a lot of pick up in pre-existing anxiety in anticipation of school starting," says child and adolescent psychiatrist Dr. Ujjwal Ramtekkar at Nationwide Children's Hospital. The hospital has a school-based mental health program in 70 schools in the area. (It also provides financial support to NPR.)

The causes for anxiety differ for different age groups. "The younger school-age kids are more anxious about separation from their parents and caregivers," he says. "They're worried about getting sick," or their parents getting sick.

On the other hand, most teenagers are struggling with social and academic anxiety, he adds. They are worried about socializing with their peers again and adapting to full-time in-person learning.

"As the [Covid-19 case] numbers were improving, there was a significant amount of hope that, oh, great, now I can play basketball, or I can hug my friends when I see them," says Dr. Nicole Christian-Brathwaite, a child and adolescent psychiatrist in Boston.

With cases rising again, she says, there's a lot of disappointment especially among older students. Many of her patients are angry, frustrated and stressed by the uncertainty of what this school year will look like.

"That uncertainty increases anxiety," says Christian-Brathwaite.

Kids most vulnerable to feeling anxious right now, or to having other mental health problems are those with certain risk factors, say child and adolescent psychiatrists.

"This is more for kids who already are prone to anxiety or they already had pre-existing depression, anxiety, separation related issues, trauma or things like that," says Ramtekkar.

And kids in communities of color have been disproportionately affected by trauma during the pandemic, says Dr. Warren Ng, president-elect for the American Academy of Child and Adolescent Psychiatry. That's because their communities have been disproportionately affected by the health and economic impacts of the pandemic.

"What we've experienced over the past 18 months is that there's been a lot of stress and anxiety experienced by our children and adolescents and families," says Ng, who also directs outpatient behavioral health at Columbia University, which primarily serves Latino and African American families in Manhattan and the Bronx.

"Many of these children also live in households where there are more multigenerational family members, where you're more likely to experience a loss," he says

They are also more likely to have fallen behind with school work, he adds, because many don't have a private space at home for attending school online.

"What we've seen with the youth has been much more anxiety related to preparedness," says Ng. "They're concerned about how far they've fallen in terms of their schooling and their education and their progress. They've worried that they've lost a year of schooling."

Fortunately, schools and teachers are aware of all these issues. And many have been proactively reaching out to mental health experts for guidance and advice, says Christian-Brathwaite.

"I am getting a significant number of calls from schools requesting education and professional development for teachers around how to support kids with trauma," she says. "They're looking for tools to help support students."

Children's hospitals, too, have been preparing, some adding more resources in anticipation of a fall surge in mental health visits.

"This summer allowed us at the children's hospital and at the psychiatric hospital to catch up a little bit with recruitment and expanding services and capacity," says Dr. Vera Feuer, a child and adolescent psychiatrist at Cohen's Children's Medical Center in Long Island, N.Y., and the associate vice president for school mental health at Northwell Health.

She hopes more kids and families will have access to care if and when kids struggle with mental health problems. For now, she says, her team is just watching and waiting. "It's the quiet before the storm phase."

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