Coping as the COVID-19 crisis wears on

Isolation, uncertainty and anxiety related to the pandemic is contributing to mental health issues

BY KRYSTEN GODFREY MADDOCKS

COVID-19 has prompted a new epidemic among Americans — increased anxiety and depression.

This new reality has pushed mental health concerns to the limit for families who may already be struggling with juggling remote learning schedules, unemployment and the stresses of being home most of the time. In fact, more than a third of those surveyed by the U.S. Census Bureau and the National Center for Health Statistics in July 2020 reported having symptoms of anxiety or depression. Data from The National Center for Health Statistics shows that in late August 2020, 31% of New Hampshire residents surveyed reported either an anxiety or depressive disorder.

A NEW, VIRTUAL REALITY

At the beginning of the COVID-19 pandemic, Nikki Pike, 13, of Exeter, had to adjust to living in a mostly virtual reality.

The eighth-grader was attending Exeter Cooperative Middle School remotely last fall because her school was not offering in-person instruction, and she socialized with a limited number of friends.

Even if her classes had been held at school, Nikki was practicing social distancing to protect her 81-year-old grandmother, who lives in nearby elderly housing, according to her mother, Teddie Pike, who works from home. If Nikki wanted to hang out with her best friend, she had to be extra vigilant about who she came into contact with, because her friend’s mother works in the health care field, Teddie said.

Nikki also had to navigate a pandemic through the lens of living with ADHD, which ramped up as the months went on.

She was reluctant to go outside because groups of people congregating without wearing masks further triggered her anxiety. Nikki worked with her therapist on practicing healthy coping strategies, but still spent much of her time inside, drawing on her iPhone and connecting with friends on social media. Her sleep was also affected, according to her mother.

“She can sleep 16 hours a day and be up all night and all day as well. It’s a catch-22. Her screen time has increased 1,000%. I have talked to her therapist about putting limits on it, but it’s the only way she can talk to every single one of her friends and see their faces,” Teddie said. Nikki talked to her therapist on Zoom every other week. Teddie said she worked to stay engaged with Nikki to make sure she was doing OK emotionally. While she remains concerned about Nikki’s screen time, she has access to all of her daughter’s social media accounts and enjoys an open, trusting relationship with her daughter.

ANXIETY AND DEPRESSION IN CHILDREN AND TEENS

Jodie Lubarksy, LCMHC, and Child, Adolescent and Family Services director for Seacoast Mental Health Center, said by October of 2020 she

was beginning to see an increase in service requests for youth who are feeling increased anxiety, depression and an overwhelming sense of isolation due to the pandemic.

“The majority of kids we are seeing report symptoms of anxiety and depression, and their caregivers report struggling with managing behaviors or maintaining a structure within the home environment,” Lubarsky said last fall.

“Parents/caregivers have been acting as parents, caretakers, spouses, educators and employees. They’ve also had to make the difficult choices about cutting their work hours, leaving their jobs, or being laid off due to remote learning and the pandemic.”

Different families have established different ground rules about how they are navigating the pandemic as well, which further may confuse children.

For example, everyone has their own comfort levels about their degree of exposure to other people, who they are going to include in their social circles and who they choose to have contact with, Lubarsky said. It’s important for parents to discuss with children that they have to be respectful and mindful that every family is in a different place when it comes to protecting themselves from the coronavirus.

But most of all, parents need to have conversations with their children and approach them from a place of hope. She also urges parents to think about what they are modeling to their children. Some conversations should be kept between adults, and parents should refrain from messaging to their children that “the sky is falling,” Lubarsky said.

“If we don’t have hope, it feels like there will never be any end to this. We need to tell kids this is just what is happening right now, and it’s not going to be forever,” Lubarsky said.

RECOGNIZE THE SIGNS

While it’s normal to feel anxious during a pandemic amid fluctuating schedules, parents do need to be cognizant of behaviors that might indicate their children are experiencing mental health concerns. Lubarsky said parents know their children best, and should they notice any major changes in their child’s behavior, that could be an indicator that their child or teen is struggling.

While younger children may become clingier or have a harder time detaching from their caregivers or show signs of regression; teens may exhibit increased anger or aggression, which could be misconstrued as an anger management issue instead of a projection of anxiety or depression.

The Centers for Disease Control in July 2020 issued a report, “Helping Children Cope,” that outlined behavior changes parents should watch for in their children. These included:

• Excessive crying or irritation in younger children

• Returning to behaviors they’ve outgrown (including toilet accidents, bedwetting)

• Excessive worry or sadness

• Unhealthy eating or sleeping habits

• Irritability or “acting out” in teens

• Poor school performance or avoiding school

• Difficulties with attention or concentration

• Avoidance of activities enjoyed in the past

• Unexplained headaches or body pain

• Use of alcohol, tobacco, or other drugs

Physical self-harm or statements about inflicting self-harm need to be taken seriously at any age and should be evaluated by a professional, Lubarsky said.

MANAGE UNCERTAINTY

Sandy Norton, LICSW, director of Child, Adolescent, and Family Clinical Services at the Center for Life Management in Derry, said that her center, too, has seen an increase in children suffering from anxiety and depression.

Children look to their parents for guidance on how to react during stressful situations, transitions and change. She suggests that parents help their children prepare for what a school day will look like and be aware of any changes in policies, rules, regulations and directives issued by their child’s school — whether or not they are returning to in-person learning.

“Walk your child through the day and talk about the schools’ COVID rules so they can be familiar,” she said. “Children respond well to routine and structure and with so much uncertainty in the world today, maintaining a routine schedule at home is important for children to feel safe and secure.”

Lubarsky also suggests limiting children’s’ exposure to the news and social media. Setting a firm bedtime and instituting screen limits provides additional structure, too.

“Let them know we wake up at this time in the morning, eat a healthy breakfast and put on clothes that are presentable in person. If you are doing remote learning, incorporate breaks,” she said. “If the day ends early, ask your kids to engage in 30 minutes of quiet time or reading rather than screen time.”

Building in that kind of routine is important, Lubarsky said, because kids don’t have strong executive functioning skills before age 25. Hanging up their daily schedule can be helpful, too. She also suggests that parents limit their child or teen’s exposure to excessive social media and/or TV.

For those children and teens who do need treatment, the earlier they receive it, the better.

“Things to watch out for include if children start to say they don’t want to live anymore or begin hurting themselves on purpose,” Norton said. “Additionally, seek treatment when children are experiencing symptoms causing an interference with their daily functioning for more than two weeks.”

GET HELP

Parents may choose to work with their school guidance counselor or their child’s pediatrician for advice regarding mental health care and coping strategies. However, anytime a child or teen verbalizes or acts out to harm herself or another, parents are urged to contact a mental health professional, Lubarsky said.

Once you determine your child might need professional help, you will need to first check with your insurance company to determine if you need a referral to seek services, Norton said. Insurance providers can direct you to a list of providers contracted with your insurance who can offer services.

Both the Seacoast Mental Health Center and The Center for Life Management are members of the New Hampshire Community Behavioral Health Association, which represents a group of 10 mental health centers in New Hampshire.

These community mental health centers cover more than 40 locations throughout New Hampshire and serve individuals and families in their respective communities, regardless of their ability to pay.

Centers contract with insurance companies, and also accept Medicaid and Medicare plans. All provide both in-person and telehealth services to further reduce barriers to mental health care.

For example, to meet the needs of families in the Seacoast area, the Seacoast Mental Health Center last spring began offering talk therapy through telehealth services. So far, youth and families have adapted well to the platform and have been able to maintain their engagement in mental health care, Lubarsky said.

She called telehealth services a “silver lining,” because it allowed more clients to seek treatment when they couldn’t physically travel to an appointment.

For families who could benefit from peer assistance and referral services, the National Alliance on Mental Illness of New Hampshire (NAMI NH) may provide support as well.

NAMI NH is a grassroots organization comprised of a network of affiliate chapters and support groups, staff and volunteers. NAMI NH provides information, education and support to all families and communities affected by mental illness and suicide.

The nonprofit guides families through the mental health continuum without cost or judgment, said Brian Huckins, director of Children and Youth Programs.

This could mean helping families understand how to support children after an emergency room hospitalization to how to obtain financial resources for mental health treatment.

NAMI NH services have been virtual since March, but families can call their information and resources line at 1-800-242- 6264 and leave a confidential message — a NAMI New Hampshire team member will return your call within 48 business hours.

Although it’s not a hotline, the information and resources line connects callers with trained NAMI NH staff who can help answer questions and provide information on NAMI NH programs and supports. They can also provide contact information for local and national resources.

“We’ve seen a 30% increase in calls since March, and our actual contact is up significantly,” Huckins said. “Parents are questioning what they should do now that they have been forced to go back home and educate their children.”

Not only is kids’ anxiety up, but family anxiety is up significantly, too, Huckins said. NAMI NH will work with a child’s school district, mental health agencies, wraparound support services and family members in virtual meetings to help families navigate mental health concerns.

One of the advantages of NAMI is that you will work with staff and volunteers who have had their own experiences with child mental health challenges, Huckins said.

“We aren’t here to judge any family member — we try to support them with whatever we can through information and self-care ideas,” he said. “Nobody’s decision right now (about how to deal with the coronavirus) is perfect. We are hopeful that it’s all going to work out and get back to normal at some point.” ✪

Information and resources

• NH Community Behavioral Health Association. The NH Community Behavioral Health Association is an organization comprised of the 10 community mental health centers throughout New Hampshire. https://nhcbha.org/nhcbha-member-locations

• National Alliance on Mental Illness — New Hampshire (NAMI NH). Tips and advice for parents and caregivers. www.naminh.org

• The State of New Hampshire’s list of Mental Health, Stress and Anxiety Supports during COVID-19. www.nh.gov/covid19/support/index.htm

• New Futures’ list of Early childhood COVID-19 resources. www.new-futures.org

• American Academy of Child & Adolescent Psychiatry. Resources for helping kids and parents cope with COVID-19. www.aacap.org

• Catholic Charities of NH, COVID-19 & Your Mental Health. www.cc-nh.org/covid-19-and-your-mental-health

• American Academy of Pediatrics, Returning to school during COVID-19. www.healthychildren.org

• Healthy UNH, COVID-19 resources for families. www.unh.edu/healthyunh/covid-19-resources