Risk Insights
May 12, 2020

Addressing the Mental Health Effects of COVID-19

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This article is based on a special edition podcast from RANE entitled, "Addressing the mental health effects of COVID-19" with RANE founder David Lawrence and Harold Koplewicz, the founding president and medical director of the Child Mind Institute. Dr. Koplewicz is one of the nation's leading child and adolescent psychiatrists.

It would likely be hard to find someone in the United States who would argue that the ongoing uncertainty about the coronavirus pandemic is not stressful. In fact, for most of us, the unknown and inconsistent messaging from the federal government to states to cities and even schools is distressing. For many working parents, the complications of working from home and managing students at home has been exhausting. Kids have lost the structure of their lives. There's no more "school." They may be worried because their parents have financial concerns. They may be worried that their grandmother might get ill. There's a real concern that something unusual has happened. Children will need reassurance from their parents that all will be well. For parents, there may be so many stressors from work-life disruptions that reassurances are hard to come by.

Dr. Harold Koplewicz is one of the nation's leading child and adolescent psychiatrists. In a podcast conversation with David Lawrence, the founder and chief collaborative officer of RANE, Koplewicz reminds listeners:

"This pandemic is so unusual, that it has had an effect on the mental health of every person in the United States. That doesn't mean everyone has a mental health disorder, but everyone's mental health is affected."

The anxiety many of us feel right now is normal. Nothing is the same as it was at the end of 2019, or even the beginning of 2020. Kids are learning remotely and they're unable to play with their friends. Perhaps they are spending more time on screens, or eating more sweets. Notice how your children, your family, and you are weathering this storm. Are you able to maintain a schedule? Are you exercising? How about the kids? Are you taking breaks? Have you lost your appetite? Monitor sleep cycles. Yours and theirs. Maintaining a routine — even if it's not the same routine you had before this pandemic — will help. Where you once may have spent an hour a day commuting, perhaps use that time to talk with your kids, or walk together. If you can't go outside, walk around the living room. Blow up a balloon and bounce it back and forth. Even 20 minutes of cardio a day helps alleviate mental stress. Most of all, if you are a parent, pay attention to your kids — and be ready to talk.

"This is one of those conversations that has to be had. You have to talk to your children about coronavirus, whether they're four years old or whether they're 24 years old. The reason for that is they're going to hear about it elsewhere, and kids are very aware when you're not talking about something important or if you're hiding something. I think it's perfectly okay for parents, first of all, to use language that their kids can understand, to make sure that their children know that they can ask questions. If they don't have questions now, the conversation isn't a one-time event. It's an ongoing discussion, and therefore, they can come up with questions again."

Koplewicz says you should not be surprised if you repeatedly have the same conversation or question. Young children want to be reassured that they're going to be okay, that their parents are going to be okay, and that their grandparents are going to be okay. Tell your children what you're doing to keep them safe, whether it's washing their hands, social distancing, wearing a mask, staying in the house or being very careful about the way you interact with other people. Explain that the reason we wear masks is not only to protect ourselves, but to protect our friends and our neighbors and our relatives because we don't want to get them sick.

For older children, empathy is key. Their college or high school experiences will be vastly different from the experiences of those who came of age before this crisis.

"When you talk to a teenager or a college-age student, you have to recognize that their loss is greater than our loss," Koplewicz says. "In other words, they're never getting back their prom. They're never going to get back their graduation. They're never going to get back all that wonderful connecting that you do when you're in high school and in college. They'll get it back later, but these events are sometimes one-time events like graduation, like proms, like rushing for a fraternity. For many, that rite of passage is gone forever. Recognizing and acknowledging that loss is really important. Say, 'I can understand how bad you feel. But remember, we're lucky. We have a house. We have food, but that doesn't minimize your loss.'"

This pandemic is so unusual, that it has had an effect on the mental health of every person in the United States. That doesn't mean everyone has a mental health disorder, but everyone's mental health is affected.

A good rule of thumb in communicating right now is not to compare this situation to other crises. It's not like a blizzard or a flood or a hurricane (those, you can prepare for and communities can "weather"). It's not a catastrophic event such as the terror attacks of Sept. 11, 2001. Those attacks stunned the country and changed our lives. But for the people who lived near Ground Zero in Pennsylvania, New York and Washington, events were exponentially more impactful. Families who lost someone, or who knew someone lost in the attacks, were most affected psychologically. But then came Sept. 12 ... and the country's recovery eventually began.

Being able to share with your kids the things that you're doing to maintain your own mental health is important.

"So that if you get irritable later on, and you snap at them, you can apologize and say, 'You know what? It got to me. I have no excuses. I'm sorry. I guess I need to do more exercise, right? I guess I have to do some more mindfulness and meditation.' I think it's a great time, considering we're stuck in the house. For many of us, we're having more meals with our adult children or even our teenage kids and younger kids than we usually do; three meals a day, some of us, instead of the one meal that we would have once a day or — for some of us — even less frequently than that."

Be honest, and model how to manage anxiety. Continued anxiety can morph into depression, and that, of course, is very serious.

"There's a real difference between the feeling of being depressed or demoralized versus the medical condition called depression. The same goes for an anxiety disorder versus just feeling anxious. People may think, 'It's not that I'm depressed it's because of COVID. I don't want to eat. I can't sleep. I can't concentrate. But it may very well be depression."

Symptoms to watch for include academic difficulties.  

"[Students may] struggle in school. They're more likely to drop out. They're more likely to have an interaction with the juvenile justice system. They're more likely to hurt themselves. The problem had been getting worse before [this pandemic]. For 14- to 24-year-olds, the second leading cause of death is suicide. For girls 15 to 19 worldwide, the leading cause of death is suicide. Think about that: it's not starvation, it's not homicide, it's suicide."

So how are we to ride out this extraordinary crisis being mindful of mental health? Stay engaged.

"Our hope would be that if you know someone who's struggling ... you don't look away. You ask them how they're feeling."

The same advice applies to you, your work colleagues or friends. Listen. Be present. Engage. Individuals and families are not experiencing these challenges in a vacuum. Of course, parents have work lives that may have been disrupted by layoffs, or furloughs or working from home. Proactive companies are seeking guidance for how to help their employees, for instance, so that employees have some place to talk about and learn about the balance between having kids at home being educated and simultaneously working full time. For young adults in the workplace, who may never have been hit by this kind of adversity or uncertainty, Koplewicz says now, more than ever, leadership matters.

"Don't fold up the tent. This is a time to lean in. This is a time to remain more focused because they need you more now than ever. These people rely on you. You are the backbone of this corporation or that organization."

That, Koplewicz reminds us, is a ray of hope.  

"It's amazing to me how many corporations and publicly held companies as well recognize that their employees' mental health is a priority ... It's destigmatizing. When you have a few days of feeling incredibly tense and worried and then it goes away, you have some compassion for what it must be like if you have those kinds of feelings for weeks on end, when there's nothing real to worry about."

Ask, listen, share, communicate. Together, we will get through this. Because when there is hope, everything seems more manageable.  

The Child Mind Institute is an excellent resource for parents and children looking for help navigating these unprecedented times. Find out more here.

If you or anyone you know is suffering from depression, or expressing suicidal thoughts, take it seriously. Don't wait. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK.

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