PANDEMIC PROVIDES OPPORTUNITY FOR FAMILIES' MENTAL HEALTH

The enforced familial closeness of COVID19 can lead to reconnection and change

These past three months, we’ve all had a crash course in social isolation and physical distancing. As the initial shock and adrenaline surge that accompanied the first phase of the pandemic pass, leaving us depleted, we are coming to terms with a new reality: COVID19 has changed life as we know it and there is no clear end date in sight. Most families are now looking at the loss of usual summer activities – camps, extended visits with family, travel, cottage vacations.

As child and adolescent psychiatrists—and parents ourselves—we know that this time has brought new fears about our children’s physical health, but also increasingly as time passes about their mental health. Before COVID19, you may have been concerned whether your child was doing well in school or hanging out with the right friends; now you are likely focused on how this interruption to their lives will impact their academic future and psychological wellbeing. For parents with children already suffering from a mental illness, you have probably anticipated – or possibly experienced – pandemic disruption worsening symptoms or triggering a relapse.

You are not alone in these worries. Studies of previous pandemics show that self-isolation can impact our mental health in a variety of ways: anxiety and fear for ourselves and others, loneliness, frustration, anger, increased substance use, and exacerbation of abusive behaviours within households. We already know from our collective decades of experience working with families facing a child’s mental health crisis that social isolation and stigma are two of the greatest contributors to mental health burden ; however, we also know that a child’s mental illness, while potentially devastating in the short term, brings opportunities for change and reconnection in families that persist long after the child recovers or adapts to their new reality. The enforced familial closeness of COVID19 provides similar opportunities.

We describe below how families can build their mental health supports even during times of apparent isolation:

Don’t look away

In our book, Start Here: A Parent’s Guide to Helping Children Through Mental Health Challenges, a central message for parents is to not look away from potential signs that their child is in distress, but in fact to move closer. We know from personal experience, as well as from our patients’ parents, that there can be many drivers for parents’ distancing themselves from their instinct that something is wrong – busy lives, demanding work schedules, angry denials by one’s child, difficulty teasing out developmental changes (for example, entering the teen years) from mental health symptoms, and most painfully, parental shame that we may be correct - our child is not OK and it’s our fault. The closeness enforced by pandemic advisories slices through our tendency to avoid, shedding light on a child’s symptoms. A child struggling with eating issues, using substances excessively or experiencing depression can no longer hide their experience from family members. A child’s anxiety that was partially managed by a clear structure and predictability has the potential to become a wildfire, sparked by the virus. As a result of this increased visibility of a child’s struggles, this is a time when parents can share honestly with their child what they are seeing, and offer help and resources, without having to second guess their perceptions or meet with denials. A number of online resources hosted by hospitals and community mental health agencies, have recommendations and scripts available for parents on how to raise these difficult subjects.*

Draw on multigenerational supports.

We’ve learned from our work in children’s mental health that the best approach to any crisis is a unified one where all family members – biological and found – of all generations come together to support each other. When a child is suffering, parents need the strength provided by their own support networks to provide the steadiness that their child needs from them. Often - we recognize not always - trusted extended family members, friends, and mentors can step in to have supportive conversations and share wisdom, albeit now virtually, with parents, children, and siblings.

Spend time together.

Your children have very few places to hide from you these days. As the summer draws near, use this time to draw everyone in to shared activities that - particularly if your children are teens or university age - your family may not have engaged in for some time: movie nights, puzzles, board games, walks, bike rides, baking, crafts, making music together. Not only will this provide healthy distraction and companionship to a child who is grappling with mental health issues but it will weave them back into the family connections that are essential to their wellbeing.

Find shared meaning.

A global upheaval like this pandemic forces all of us to engage with life’s existential questions – illness, death, our obligations to one another, what family and community mean, the role of governments, private citizens, and the inequities in our societies that have differentially shaped the burden of illness for certain members of our communities. It provides opportunities to share your values with your children and to explore theirs. Ask older family members who have lived through tough times to share how they coped and what lessons these times left them that have shaped their lives subsequently. Find a volunteer activity that your family can engage in together. Even if children choose not to participate in these conversations or activities, you can be sure they are listening and learning.

Prioritize sleep, nutrition, and exercise...as a family.

These are the pillars of good mental health even in the best of times, but in times of crisis, it’s easy to lose a sense of routine. As we move to a maintenance phase with the pandemic, try to find the balance between building some type of summer schedule for the family as a whole – not just your children – and not feeling like a failure when you need to be flexible or recognize that what you initially tried may not be sustainable. Placing a limit on everyone’s screen time – parents included – leaves more time for meals, sleep, exercise, and other activities. Take the opportunity to have some one-on-one time with your child by going for a walk outside. Let each child choose a favourite meal and try family cooking classes to encourage them to build cooperation skills. Try a new virtual exercise program together. By modelling a balance between structure and flexibility, and approaching these goals as a family, you are also modelling coping, problem solving, and using relationship supports for your children.

Pick your battles.

While we all benefit from daily structure and tasks, this is an unusual time and it’s a family survival strategy to be flexible. Parents who are working at home with small children will likely need to accept more screen time than is usually recommended in order to preserve their own sanity. Remind your family that these exceptions are temporary, but as much as you can, try to improve the quality of their shows and games and engage with them by joining in and asking how to play along. Being involved with and aware of your child’s on screen activities is an important safety net and something that you will want to continue, at least for younger children, after the pandemic ends. Using this time to build connection with your children rather than focusing on their shortcomings will support your family’s wellbeing long after COVID19 is behind us.

Be honest and listen.

Ask your children how they are managing and validate any feelings of anxiety, frustration, and loss. If this is not something you have done before, share with your child that while the reason for your asking now may be the pandemic, you are learning yourself that talking and sharing difficult emotions is something that is an important part of relationships that you want to continue in less challenging times. Remember to talk to the other adults in your life about your own fears and frustrations and not bottle them up inside—and tell your child that you are doing so. This serves two purposes, role modelling for them that you are following your own advice and supporting your own mental health, which is essential to your family’s wellbeing.

Adapt goals.

For all parents, recognizing that your goals for child’s academic, athletic, and social development need to accommodate the restrictions imposed by COVID19, will also model for your child the important skill of adapting to life events. Talking about your own adjustments to your expectations for your work productivity will authenticate this message. For children with mental health challenges, it’s natural to worry your kids’ symptoms may relapse or worsen, but focus on consolidating any recent gains your child has made in treatment and acknowledge that the pace of recovery may slow temporarily. This adaptation will relieve unhelpful pressure for all of you.

Help is still available.

Know that, as a result of the pandemic, there has been an explosion of virtual mental health care to replace in-person therapies and supports. And now, in most jurisdictions, workplaces and healthcare institutions are starting to re-open gradually.

Don’t be afraid to contact your primary care physician and/or mental health caregiver to ask them what they offer virtually. Many mental health centres are rushing to collate resources on their websites.

For families in crisis where safety is an issue, in addition to first responders, child protection services, women’s shelters are all still open and can be contacted by phone or virtually.

And if you are concerned about your child’s mental health and that they are in danger, don’t hesitate to bring them into the hospital. Parents may be concerned about overloading the healthcare system or exposing their child to COVID19, but rest assured that hospitals have taken strong measures to protect patients. What’s more important is mitigating the risk of a mental health emergency.

While we don’t claim to be experts on COVID19, we have learned from our years in practice how families can come together to address crises effectively but more importantly change in positive ways that are lasting. We’ve seen repeatedly that families that enlist everyone and work together; communicate openly about difficult emotions and experiences; share fears, goals, jokes, and coping strategies; and seek external help, are stronger over the long term. While the COVID 19 storm brings inevitable mental health challenges, it also provides opportunities for lasting changes that will support families’ mental health when better weather returns.