They had to write an obituary for their 16-year-old son. This is what Saul’s parents want you to know about the pandemic’s effect on youth mental health
WARNING: This story contains sensitive subject matter, including suicide and self-harm, that could be triggering for some readers.
The public notice announcing the death of Saul Ignacio Arias leaves no mystery about how the 16-year-old's life ended in January.
He died by suicide," reads the memorial posted online by his parents alongside a photo of a smiling teen. Saul was a victim of these difficult times."
The Toronto teen's parents, Saul Arias Sr. and Marcela Lopez, included the heartbreaking detail about their son's death to flag what they call systemic failures in addressing teen isolation and academic anxiety during a pandemic entering its second year.
Something made his cup overfill," said Lopez in a recent interview. If (teens) are an at-risk group in a normal time, why aren't there mechanisms, more true concrete actions during this situation?"
As the second wave of the pandemic reinstituted social restrictions and shuttered schools in many places this winter, three of Ontario's largest children's hospitals have seen spikes in youth suicidal ideation, self harm and suicide attempts, according to new data obtained by the Toronto Star and Investigative Journalism Bureau.
While overall traffic at children's emergency departments has dropped dramatically during the pandemic, the number of child and youth mental health visits has increased - as much as nearly quadrupled since pre-pandemic times - over the winter.
The number of children that are presenting to acute care services in mental health crisis...is unlike anything I've seen in 15 years," said Dr. Charlotte Moore Hepburn, a Toronto pediatrician and director of medical affairs with the Canadian Paediatric Society who is based at the Hospital for Sick Children.
It's heartbreaking."
Perhaps more troubling than the number of young patients arriving at emergency room doors with suicidal ideation is the unusual severity of their symptoms, said physicians across the province.
We have a much greater percentage, 30 per cent more, presenting with actual action - that is, they have hurt themselves," said Dr. Kathleen Pajer, chief of psychiatry at Ottawa's Children's Hospital Eastern Ontario.
One key factor, she said, is isolation.
This is an isolation that is really different than anything these kids have ever experienced before," she said. The world can feel very uncertain and unsafe."
A dozen medical experts across the province - including psychiatrists, emergency room physicians, pediatricians and clinical psychologists - repeated many of the same words when asked to describe what they are seeing in emergency rooms and private counselling sessions: Isolation. Loneliness. Anxiety. Boredom. Missed milestones. Increased substance use. And a growing sense of doom.
Dr. Michael Peer has noticed fraying resilience among young patients.
That group has really been hit the hardest with the pandemic," he said. If something goes wrong, they just can't seem to pick themselves up and shake it off."
Just before the winter holidays, five of Peer's young patients were admitted to hospitals in the GTA with suicidality, he says.
It normally takes two or three years to have five of my patients admitted to hospital. Five within a week really struck me as, Wow, what's going on here?' That's a really big number."
The Star and IJB obtained data from three children's hospitals comparing youth mental health visits over the past few months with the same time period last year.
The emergency department at Toronto's Sick Kids hospital has seen visits drop by nearly half during the pandemic. But the numbers of youth arriving for help with depression, suicidal ideation and self-harm have risen 25 per cent between September 2020 and January 2021 compared to the same time frame a year before.
In December, 60 Sick Kids patients arrived seeking help for mental health symptoms, a 36-per-cent increase over the previous December. In January, 65 arrived, up 16 per cent from the previous January.
Children and teens are in more serious trouble than in years past," said Dr. Peter Szatmari, chief of the child and youth mental health collaborative between Sick Kids and Centre for Addiction and Mental Health at the University of Toronto. And what about those who don't come in for help, who don't have the wherewithal to seek out services (which takes skill)...Their mental health is seriously suffering."
At McMaster Children's Hospital in Hamilton, 26 youth were admitted after a suicide attempt between October 2020 and January 2021 - nearly four times the number for the same time period in the previous year.
Dr. Olabode Akintan, a child and adolescent psychiatrist at McMaster, said youth are not just being admitted to the psychiatry ward; they are being admitted to the pediatric floor or intensive care unit, suggesting medical intervention is required.
It reflects that these attempts are much more severe," he said.
At Ottawa's Children's Hospital Eastern Ontario (CHEO), the number of children and teens seeking care for self-harm had fallen during the first wave of the pandemic. But between September 2020 and January 2021, there was an increase compared to similar months the year before. This uptick was most notable in December and January 2021 with a 79-per-cent increase from the same period a year earlier.
**
Following the winter school break, classes moved online for Saul Arias.
He stared at his computer screen all day, every day, his parents said. He read online news stories about the insurrection at the U.S. Capitol, he played video games, chatted with friends online and played guitar.
One factor that triggered his desperation in January was the isolation that physicians are seeing in growing numbers at hospital emergency rooms, his parents said.
The biggest determinant was the lack of seeing his friends," said Saul Arias Sr. We are convinced that the whole pandemic situation, on and off school, even when he was going to school, he couldn't see a lot of his friends because they were in different cohorts."
Arias's death by suicide blindsided and devastated his parents.
An only child, raised in what they call a privileged" environment, he was quiet and curious, had good friends and was successful in school. He had no known history or diagnosis of mental health challenges.
In retrospect, the couple sees he might have been faltering under the weight of virtual classes, at-home confinement and isolation from friends. In November, he almost failed a course for the first time and in an area he had always commanded. He stopped handing in assignments.
This is a kid who memorized the periodic table in Grade 5," said Arias's father. We are in a pandemic, we are in an emergency. Plenty of people have died in the country and we are still worried about grades...The people in charge of this are not taking it seriously."
**
It's hard to know how many young people feel the despair that overtook Arias.
Youth mental health data is nuanced and sometimes contradictory.
A recent study published by Sick Kids researchers found some adolescents between the ages of 6 and 18, especially those with social anxiety or learning disorders, showed improvement in mental health under COVID-19 emergency measures.
The stay-at-home directives may have provided relief from sources of stress or anxiety, thereby improving their symptoms of anxiety or irritability," the paper concludes.
But more broadly, the study showed emergency measures during the initial lockdown in Ontario between March and June 2020 - including shutdowns of schools, playgrounds, extracurriculars and heavy restrictions on social gatherings - resulted in more than two-thirds of children and adolescents experiencing mental health deterioration from stress related to social isolation." This included children with no pre-COVID mental health conditions.
School closures have fuelled a politically charged debate.
Ontario announced a province-wide lockdown on Dec. 26 that shut down in-person classes well into February in some regions, including Toronto, due to mounting COVID cases and the rise of more transmissible variants.
Research suggests restrictions have unintended consequences for youth, including reduced physical activity, loss of routine, potential for abuse and neglect, further isolation and loss of social interaction.
In January, a surge in suicides in the Las Vegas area triggered a push for schools to open despite rising COVID cases. Suicides in Clark County doubled over nine months of school closure compared to the year prior.
The same month, Toronto's Sick Kids experts issued updated advice for school operation during the pandemic citing significant negative impact" of school closures. This should be a last resort for pandemic control," and, when adopted, should be as time-limited as possible. Additional delays will inevitably further exacerbate the harms to children and the inequities caused by school closures."
Taking kids out of school can remove access to mental health supports - peers, teachers, guidance counsellors and social workers who can often detect subtle signs of youth in distress.
A 2014 Ontario study found that the most common source of contact for children and teens with mental health disorders was through someone at school. Referral through guidance counsellors or social workers was more common than through their family doctor or other sources such as the emergency department.
With school closures, the most common way of getting into the mental health-care system has been closed off.
Dr. Kate Strasburg, a psychiatrist at St. Joseph's hospital on the Queensway in west Toronto, said pandemic disruptions have placed traditional school-based mental health services beyond the reach of many youth.
In a normal year, we have this whole population of youth who are referred in because schools, guidance counsellors or some community agency are identifying and flagging these youth in the school," she said. That has gone silent....We have not gotten a single call from a social worker or from a school. Not one."
The adults who are seeing troubled young people - parents and caregivers - often aren't equipped to notice subtle changes in youth mental health, she said.
They don't know what to look for and they are not trained to identify signs."
Saul Arias Sr. and Marcela Lopez said they've chosen to speak about their son with the hope of preventing similar tragedies for other parents and families.
We adored him, we told him that we loved him every day," said his mother. He was the light in our life...If he was pushed to that edge, with all the good things in life around him, we worry...it could happen to anyone."
This story is part of a cross-border investigation into youth mental health involving the Toronto Star and the Investigative Journalism Bureau (University of Toronto's Dalla Lana School of Public Health), the National Observer and NBC News in partnership with journalism faculty and students from the following universities: Stanford University, Temple University, University of Missouri, Syracuse University, City University of New York, University of British Columbia, Ryerson University, Carleton University and the University of King's College.
Robert Cribb is a Toronto-based investigative reporter for the Star. Reach him via email: rcribb@thestar.ca