Protecting Youth Mental Health During the COVID-19 Pandemic: A Challenging Engagement and Learning Process
Globally, the COVID-19 pandemic [ruckus] is causing
extensive morbidity and mortality and is fueling
psychological distress across populations. Early
evidence has shown an increase in anxiety, depression and
sleep problems in the general population. Although
pandemics shatter the functioning of communities and
families globally, there is a paucity of studies targeting the
effects of pandemics on youth mental health.
As mental health professionals, our fields have become
aware of how the COVID-19 outbreak represents an
extraordinarily stressful experience for youths, including how
necessary public health measures may also threaten personal
and collective meaning-making, and disrupt family dynamics
and youths’ usual social environment. Because of the
COVID-19-related school closures and social distancing
measures, millions of children have been confined at home.
Although families, communities, and schools have attempted to adapt, at times successfully, many children and youth have
been deprived of structured support, trapped in dysfunctional
family settings, and are relying largely on peer relations through the unsupervised use of social media.
In the absence of much-needed evidence, clinical experience and available evidence on stress-related disorders in emergency settings is provisionally informing clinical
practice and define the role of child mental health services
during a pandemic. Although it is impossible and premature
to address all aspects of pediatric mental health during the
COVID-19 pandemic, it is important to begin conceptualizing what this pandemic has meant for our practice and where and how we can promote pediatric mental health during a global emergency that is not currently remitting.
INDIVIDUAL YOUTH MENTAL HEALTH DURING
The mental health consequences of the COVID-19 pandemic in youth have been diverse, ranging from the onset of stress-related disorders to the exacerbation of preexisting disorders, including a flare-up in cyber dependence, and also, in rare cases, the alleviation of disorders (eg, school phobia for some).
During the pandemic, a primary role for mental health expertise is distinguishing normative responses to pandemic
adversities, that are not associated with severe psychological
distress or with significant impairment, from pathological
responses that require a specialized intervention.
Nevertheless, the fear of illness and death and the many
stressors of the pandemic can result in symptoms that correspond to adjustment disorders and to post-traumatic stress disorder (PTSD), diagnoses that can be made during ongoing dangers (such as pandemics, wars, domestic violence).
Some populations may be especially vulnerable, such as those for whom the stresses reactivate personal or trans-generational traumas. This reactivation may be associated
with the severity of the exposure, such as if youth or their
loved ones have become sick or family members or friends
have died. In addition, children of essential workers,
homeless children, children with uncertain immigration status, and children whose supports (particularly intensive
psychiatric and psychosocial supports) have suddenly diminished or disappeared may be at increased risk for
developing mental health difficulties.
As the death toll rises, numerous children are grieving a loved one in a context that is often highly traumatic because
of frightening aspects of the death—witnessing shortness of
breath, ambulances, videos of intubated relatives—as well as
associated helplessness, not being permitted to say goodbye,
and guilt associated with the impression of having abandoned the deceased. The confinement rules also interfere with culturally accepted mourning processes, which may further aggravate unresolved and complicated grief. Adopting a developmentally informed trauma perspective that acknowledges individual and family capacity in the face of adversity may assist in assessing and, to some extent, addressing the traumatic consequences of a pandemic for youth.
As one example, some refugee families told us that they used
the stories about the ways in which they survived war, deprivation, and a cholera epidemic to reassure their children, conveying the idea that they had the collective
strengths to overcome this new challenge.
A key challenge has been how to safely provide mental health services to individuals and families during an infectious disease pandemic. Available evidence suggests that telepsychiatry has been a promising tool for children and adolescents in emergency situations. Indeed, telepsychiatry
has rapidly become a vital component in the efforts to
reduce safety risks related to coronavirus exposure.
However, its applicability to each case needs to be carefully evaluated, and, though it provides a measure of safety
during an infectious pandemic for all involved, its risks and
inadequacies must be further understood. The availability
of the technology, the quality of Internet connections, the
level of computer skills required, the security of the technology, and the level of confidentiality possible at home
during the assessment and therapy sessions, as well as the
risks of eliciting disclosure of violence or abuse in an unsafe environment, are potential drawbacks to telepsychiatry
The high levels of distress observed among mental health staff, ranging from emergency departments to outpatient departments, reflect our real fears as well as our uncertainty in facing a crisis which is shattering our world and challenging individual, familial, and collective notions
of safety and security, while exposing individual, familial,
and social vulnerabilities. In the present context, the
governmental and institutional responses to mental health
professionals’ legitimate concerns about their own safety as well as that of their loved ones is based on the reiteration of security measures, although data on casualties among
healthcare staff demonstrate that these measures only
partially protect against the risk.
Indeed, the danger of contagion for ourselves and our families is real, and our capacity to confront it without being paralyzed requires acknowledging the risk and nonjudgmental sharing our fears within our teams, while collectively assuming our responsibilities as mental health professionals in the midst of adversity. Support and solidarity within mental health teams is an essential first step to support courage and hope in an emergency context. Some preliminary take-home messages for professionals working in child mental health units are reported in Table 1 [seen here]:
As we look forward, we need to consider how we must
rethink educational, community, and family support in a
pandemic that is not going away. For example, what community systems can we put into place to support vulnerable
children during school closures? What can we do to protect
children in their homes, when their homes may not be safe,
while youth protection agencies are in total disarray? What
are the strengths and limitations of a virtual clinical approach?
Answering these questions is crucial in order to develop
effective strategies in response to youth mental health needs
during a major health crisis such as this one.
Mindfulness-based approaches appear well-suited to deal with the challenges presented by the time of unrepresented uncertainty, change, and loss, which can take many forms in the context of COVID-19 pandemic. Mindfulness practice facilitates acceptance of the uncomfortable, difficult, and painful experiences, allowing them to simply be, feeling them as they are without judgement, being present with them until we are ready to let go, and thereby opening ourselves to new experiential and behavioral possibilities. Mindfulness as a way of being exemplifies an approach to life captured by the American poet Robert Frost: “The best way out is always through.”
__Antonova, E., Schlosser, K., Pandey, R., & Kumari, V. (2021). Coping with COVID-19: Mindfulness-based approaches for mitigating mental health crisis. Frontiers in Psychiatry, 12, 563417.
__Rousseau, C., & Miconi, D. (2020). Protecting youth mental health during the COVID-19 pandemic: A challenging engagement and learning process. Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1203-7.