Worcester Medicine October 2022

Christina A. Arpin, CAGS, LMHC

It Was the begInnIng Of the sChOOl year In september 2021, and staff already felt as depleted as we would normally experience in June. We were concerned about the students’ academic gaps from the online-learning of the previous year, as well as their overall emotional well-being. The grief, anxiety and depression that the teens experienced during the pandemic have overflowed into the classes and hallways resulting in an increase in conflicts and physical fighting. School provides structure and routine to the lives of students. Expectations for behavior and performance are familiar and understood. When schools closed, students lost that making it more difficult to adjust when they returned full time. This also took an emotional toll on teachers, counselors, nurses and administrators.

Some students need help readjusting to regular classroom routines or tasks such as taking notes, raising their hand to answer questions and remaining in school the whole day. On-line schooling afforded the option to remain in their bedrooms with the camera off still in their pajamas and playing video games or pointing their computers at the ceiling. Teachers corroborated this, saying they observed many ceiling fans as they tried to sustain their students’ attention. Some of the students reported that they hadn’t showered in days. Their reasoning was, “I can’t go anywhere so why bother?” Students who were already struggling with alcohol use and/or marijuana/cigarette use reported that their usage increased during this time. Since returning to in-person learning, a minority of students are having a difficult time completing the school day, and questioned how they ever managed to stay all day prior to the pandemic.

After over a year at home, returning to school was not like a normal year. Staff learned quickly that we couldn’t expect adolescents to adjust to this new normal quickly. They faced many challenges due to ongoing health issues, economics, social and psychological consequences of the pandemic. Households with younger children have been particularly impacted by loss of income and /or food, as well as housing insecurity. Many of our students picked up part-time jobs to contribute to the household income or babysat for their younger siblings while trying to maintain their academics. After being isolated from their peers and away from the consistent structure and routine of school, students appeared more anxious, overwhelmed, irritable and easily fatigued. Increased anxiety also presents in youth with school refusal, tardiness, difficulties with transitions and change, fears of ill- ness for themselves and their families, somatic complaint symptoms (i.e. headaches and stomach aches), panic attacks, avoidance, obsessions and compulsions, self-harm, eating disorders, substance use, fatigue and lack of concentration (1). Instances of aggression and bullying have also increased. In this regard, personally, I have completed more risk assessments (self-harm, suicidal screenings, and threats to harm others), filed more 51A abuse/neglect reports with DCF (Department of Children and Families), and sent more students out for formal risk assessments that resulted in hospitalizations than in any other year in my 32 year career in mental health (including residential, in-home therapy, outpatient counseling and years of school counseling). My counterparts in the Southern Worcester County and Central Western areas report similar concerns.

This year, a substantial increase in counseling referrals came from parents who informed me that the outpatient counseling agencies have a 6 to 8 month wait period, where prior to the pandemic it was only a couple of weeks. School counselors, psychologists and nurses saw their caseloads and responsibilities increase significantly. Although Telehealth services for counseling were offered, most of our students chose to “pause” their outpatient counseling until they could meet with their therapist in person. “Shortly after the pandemic began more than 25% of high-school students reported worsened emotional health. . . . Private insurance data shows that mental health claims for adolescents increased sharply in 2020” (2). Adjustment Counselors are now tasked with trying to fill in the gaps in the mental health system. Many students have had to wait weeks for beds to open up in treatment facilities. I learned that most of my students that I referred for formal risk assessments waited weeks in emergency rooms and hallways for an opening as distressed parents wondered if it was worth the risk as their child was surrounded by physically ill Covid-19 and other mental health patients in crisis.

When the students returned with the Covid-19 protocols, the atmosphere in school was very different. They sat socially distanced, 6 feet apart wearing masks. It was eerily quiet and solemn like a funeral service for the first several weeks. There was no laughter in the halls, very little joking amongst the students or goofing off in their classrooms. Teachers remarked about how quiet their classes were. Our ability to understand and read nonverbal cues was reduced significantly because of the masks. They made it difficult to interpret nuances and lead to miscommunication and misunderstanding. Once the mask mandate lifted and the majority of the students removed their masks, the hustle and bustle, laughter and the noise to which we had been accustomed returned. Teachers also noticed more students glued to their phones, wearing their earbuds constantly and appearing to be more focused on technology than pre-pandemic.

More students remarked to me that they are so tired that afterschool they take a nap for a couple of hours, go to bed by 9:00 p.m. and are still tired the next day. Many of them took naps during virtual schooling. Special needs students were particularly negatively impacted by on-line learning because in-person classrooms allow for teachers to provide more personal attention to each student’s individual needs.

Schools across the country report an increase in anxiety and disruptive behaviors. We are experiencing more verbal, physical and cyber fights following the pandemic (3). Anxiety and stress can trigger a teens “survival brain” turning a look or nudge in the hallway into a physical altercation, causing students to overreact to small issues. The APA reported the most frequently diagnosed mental health conditions in 2020 were depression, anxiety, and adjustment disorder. According to the Centers for Disease Control and Prevention, Emergency Department visits for suspected suicide attempts among adolescents jumped 31% in 2020, compared with 2019. In February and March of 2022, emergency department visits for suspected suicide attempts were 51% higher among girls aged 12-17 than during the same period in 2019 (4). “Girls and boys had similar rates of negative changes in their sleep (24% for girls vs. 21% for boys), withdrawing from family (14% vs. 13%) and aggressive behavior (8% vs. 9%) (5).

Even with the heroic efforts by teachers the continuing ongoing challenges are profound. One teacher remarked to me, “it is like having one foot in one boat (pre-Covid-19) and your other foot in another boat (post Covid-19).” They are feeling stretched and unbalanced on all sides with pressure from parents, administrators, the school community and the State. Teachers are struggling while adapting their curriculum and lesson plans back to in-person teaching.

The pandemic may subside, but its mental health effects will long linger. Although adolescence is a time of great resiliency, the pandemic has shown us that we need to do a better job teaching our students at a young age how to self-soothe, by using positive coping skills, regulating their emotions, resolving conflict, delaying gratification, and self-advocating techniques that will prepare them for future challenges that are bound to arise. Even though this has been the most stressful and exhausting year of my career, I still embrace my calling as a mental health clinician and helper to whoever may need it. +

Christina A. Arpin is a Certified School Adjustment Counselor (CAGS) and Licensed Mental Health Clinician (LMHC). She has worked at Quaboag Regional Middle-High School in Warren, MA for 24 years and has provided outpatient counseling in a community-based setting both full and part time for 15 years. The observations and views expressed are those of the author and are not intended to reflect nor express the opinions of any specific educational entity. Email: carpin@quaboagrsd.org

REFERENCES:

1. APA (2020) Stress in America, 2020 A National Mental Health Crisis. Available at https://www.a-yo.orgnews/press/ releases/stress/2020/report .

2. Fairhealth.org, The Impact of COVID-19 on Pediatric Mental Health, March 2, 2021.

3. Violence Against Educators and School Personnel: Crisis During COVID, APA-Task Force, 2022.

4. CDC, Morbidity and Mortality Weekly report, June 18, 2021/7024, 888-894.

5. Mott Children’s Hospital National Poll on Children’s health at Michigan medicine. Source-University of Michigan, News release, March 15, 2021.