Toward the end of his first year teaching seventh graders in Indianola, Mississippi, Hal Kronsberg had an epiphany: “I became increasingly interested in why so many kids were struggling,” he says. More than a few of his students had returned from a psychiatric hospital several hours away, and they were taking antipsychotic medications and other drugs that made them too sleepy to focus in class. “My feeling was, if I wanted to work with these kids, I needed to know about their meds,” he says. “How could they succeed, if they couldn’t keep their eyes open?”
And so began Kronsberg’s career pivot to child and adolescent psychiatry. “We must have every tool available to help kids manage their feelings and become their best selves,” he says.
Now, as program director for the Johns Hopkins Child and Adolescent Psychiatry Fellowship Program and as a psychiatrist for Johns Hopkins Bayview Medical Center’s School-Based Mental Health Program, Kronsberg supports children grappling with mental health issues. He also acts as psychiatrist for the Child Mobile Treatment Program team. The team consists of seven therapists or case managers, as well as a nurse practitioner. Members travel to schools and homes in Baltimore City to address students’ mental health crises.
The mobile team sees about 80 children in their homes, says Kronsberg. “Many of these families experience poverty and trauma on a regular basis, such as community violence.” The COVID-19 pandemic exacerbated their struggles, he notes, forcing these children to attend school virtually. “Our main area of concern is to provide support for these kids and help them figure out who they are.”
Some children managed to learn by computers during the pandemic, says Kronsberg, but mental health issues intensified: “ED visits for suicide attempts rose 50% among girls ages 12 to 17 at the start of the pandemic, and there was less supervision and more troubles for families trying to hold things together.”
Kronsberg has resumed traveling to Baltimore City public schools to meet with students, families and school personnel. He also serves on the Maryland Behavioral Health Integration in Pediatric Primary Care program ECHO (Extension for Community Healthcare Outcomes), a model that aims to educate pediatricians across Maryland on topics and practices related to child and adolescent mental health.
There’s further cause for concern, he says: “In the wake of the pandemic, we’re seeing more severe psychiatric illness, including catatonia and psychotic illnesses. And there will never be enough child psychiatrists, so we must tap into our expertise to help others provide expert care and services to help children thrive.”
Perhaps the most important lesson Kronsberg has learned as a child psychiatrist, he observes, is how badly kids actually want limits when they’re struggling — even when they keep that wish to themselves. “Clear limits can help kids feel safe and contained, even when they push against them. Kids are smart, and when we catch them breaking a rule, we need to be curious about why it happened.”
Demand for these services continues to soar, says Jimmy Potash, director of the Department of Psychiatry and Behavioral Sciences. “We are looking for physicians who bring a sense of compassion, dedication and clinical curiosity to the work they do with children and their families. The top priority here at Johns Hopkins is to provide outstanding medical care to the youngsters and families who come through our doors. We believe that creating a friendly and supportive learning environment, where colleagues can combine strengths and learn from one another, is absolutely vital toward this end.”