Worcester Medicine October 2022

Sonia Nagy Chimienti, MD FIDSA

In th I s I ssue O f the W O r C ester D I str IC t m e DIC al Society magazine, we bring attention to the profound negative impact of the COVID-19 pandemic on the mental health of children across our nation. Amidst the sobering data presented in this issue, it is easy to despair and wonder what one person can do to combat such a significant challenge. Those of us who are not directly involved in caring for children with mental health issues feel the urgency of the situation and may wish to help. Fortunately, there is a great deal that we can do. Building awareness of mental health challenges and needs, reducing stigma through conversations and education, and advocating for resources are just a few ways in which we can contribute, regardless of our primary areas of professional focus. I recently caught up with one New England physician who is doing what he can to try to raise awareness regarding the mental health needs of children in crisis.

Dr. Dominick Tammaro, a colleague and adult medicine physician is hiking the Appalachian Trail (AT) this summer to raise awareness and funding for pediatric mental health care. As a physician and educator, Dr. Tammaro has been aware, as many of us have, of the toll that the pandemic has taken on our children and youth. Dr. Tammaro is hiking the Appalachian Trail to raise awareness of this crisis and support the work of Bradley Hospital. The first children’s psychiatric hospital in the United States, Bradley Hospital opened in 1931 through the bequest of George and Helen Bradley, whose daughter Emma who suffered from complications of encephalitis at the age of 7. The Bradley Hospital provides a variety of mental health services for children not only in New England, but nationally and internationally. It also invests in advocacy and training for members of the community. I had the opportunity to ask Dr. Tammaro about his motivation to hike the AT and to share why pediatric mental health rose to his awareness.

SNC: Dr. Tammaro, why were you compelled to raise funds for and bring awareness to this particular problem?

DT: I think that there are many areas where people are especially vulnerable, especially after two years of uncertainty, social isolation, health concerns and disruption of the social safety net. I have seen an increase in patients admitted to hospital with mental health problems as well as medical conditions complicated by the co-existence of psychiatric comorbidities. This has been front and center in my work and that of my colleagues so, when I undertook planning for my hike, I thought it a worthwhile and relevant cause.

SNC: In an ideal world, what do you hope will be an outcome from your efforts?

DT: It’s all about access in my view. That means those in need of mental health care should have the ability to (a) find and access a provider, (b) [ ensure that the provider] has the skillset and training to provide the specific post-traumatic care necessary in the current mental health crisis and (c) to do so without fear of patient stigma. That last item is a tall order based on long-standing societal prejudices, but the first two elements would make the care of individuals affected by post-COVID mental illness more effective.

SNC: Are there personal narratives or stories that your patients or friends have shared that impacted your decision to support mental health services for children?

DT: I have several friends who are involved in K-12 education as teachers, administrators, and healthcare staff. The teachers especially are uniformly observing students with high levels of anxiety and depression with the simultaneous loss of social anchors and coping skills. This is evident in classroom behaviors and loss of grade-level preparation in subject matter. Many students have lost family members or spent time with restricted contact with loved ones and are feeling disconnected from their routines and support systems. During the peak and recovery periods of the COVID pandemic, my hospital’s daily operational preparedness meetings reflected an unprecedented increase in hospitalizations of children for mental illness. In the adult wards, we likewise saw evidence of unaddressed mental health needs in young adults. I think this is a chronic issue in our country made much worse by COVID, which had major health and social impacts.

SNC: As you have made this hike on the Appalachian Trail, have you talked about this mission with people you’ve encountered, and if so, what feedback and stories have your co-hikers shared?

DT: Yes indeed. I’m not the only person utilizing a hike of this nature as a vehicle to raise awareness and funds for worthwhile causes. Several of my hiking buddies are Veterans who are raising funds to help the extraordinary rise in mental health conditions and suicide among Veterans. Like hikers, Veterans have a close-knit community of support and recognize the mental health needs of this group. Similarly, many hike the AT at a transition point in their lives, often after some traumatic event or personal crisis. I’ve spoken to hikers who have experienced loss and personal mental health challenges who are walking through their pain and seeking restoration through nature and fellowship in the woods.

SNC: Anything else you might wish to share?

DT: Yes – my donation and YouTube pages, both listed below! Seriously, mental health conditions are often hidden just beneath the surface of our daily experiences. We should remain mindful of their existence and of the fact that many suffer in silence. Together we can assist in their proper care and recovery. +

HELPFUL RESOURCES:

My YouTube Channel (a phrase which I NEVER thought I would ever type in my life...): https://www.youtube.com/channel/UCF7PNmFf9y6a39LPYtQ3Gow

*To learn more about Bradley Hospital, please visit https://www.lifespan.org/locations/ bradley-hospital/about-bradley-hospital/ our-history.

*Dr. Tammaro’s Donation Page - Appalachian Challenge: Meeting the Mental Health Needs of Our Youth: https://giving.lifespan.org/ Bradley/appalachian-trail-fundraiser

Dr. Sonia Nagy Chimienti is Senior Associate Dean for Medical Education at the Geisel School of Medicine at Dartmouth, and former Vice Provost for Student Life at the TH Chan School of Medicine at the University of Massachusetts Medical School.

Dr. Dominick Tammaro is Vice-Chair for Education in the Department of Medicine at Rhode Island Hospital in Providence, RI. He is formerly the Internal Medicine Residency Director at the Warren Alpert Medical School at Brown University.