Mental Health Help for Families

As the Bay Area’s shelter-in-place order moves past the one-month mark, with no end in sight, many families here and throughout the country are suffering from strains brought on by the new coronavirus. Parents and children may be worried about getting sick, job losses and financial security, the impacts of school shutdowns and other factors that are increasing stress on families. There are news reports of an increase in both domestic violence and calls to suicide prevention and other helplines.
 
“Families are coping differently and handling the situation differently, and it’s changing as the time passes,” says Lauren Haack, Ph.D., an assistant clinical professor and attending psychologist at the UCSF Department of Psychiatry’s child and adolescent services division. “For some families, there was almost this honeymoon period: We may have less stress without as many school and commuting pressures. There definitely seems to be an increase in stressors, some related to the uncertainty: How long is this going to last? How will this impact our jobs and livelihood? When can we see friends and go back to school?”
 
Bay Area Parent spoke with Haack about how families can handle the stress and when and how to seek help.
 
How can parents tell what’s normal stress and anxiety vs. a serious problem?
Everyone is going to be experiencing some ups and down. Everyone is going to have some bad days when they’re feeling less effective or more emotional. What you want to look for is a consistently different mood, how the child or adolescent is functioning and an inability to bounce back – not being able to get any routines or schoolwork done, not being able to sleep or participate in any family activities. That’s more of an area for concern.
 
How can families find help?
Luckily, there are a lot of therapeutic and mental health resources that have very quickly moved to telehealth. There is also seemingly an increase in insurance for telehealth. If you have insurance, contact your insurance carrier and see what options there are for speaking to a mental health professional.
 
Another option might be to reach out to your child’s school and ask if there is a mental health specialist that the child can connect to virtually.
 
If there’s a real immediate concern about the child’s safety, then child crisis resources (such as the Edgewood Center for Children and Families in San Francisco and any pediatric emergency department) are continuing to operate during the shelter in place.
 
Is the current situation increasing suicide risk?
It’s too early to say. We don’t have the data. But it’s logical to say it could be exacerbating underlying conditions like depression. One of the main mechanisms for depression is that when we feel sad and irritated, we withdraw and isolate. … 
 
We (doctors) are working as a group to get creative in brainstorming ways youth and teens can still be active and engaged while staying safe and following shelter-in-place guidelines. We can encourage virtual get-togethers. There are also a lot of exercise apps and activities that have been made free during the shelter in place. There are a lot of cultural things like museum tours and streaming concerts. Families can spend time together playing games, cooking or going on walks in their area.
 
One of the most helpful strategies is something that we call building mastery, which is doing an activity where you’re working toward a goal and growing, like playing an instrument or learning a new language. Those can be really impactful activities to work on and feel that sense of accomplishment.
 
It seems like it can be hard for some parents to deal with their own emotions when they’re trying to stay positive for their kids.
I’ve really been recommending that parents do schedule time for their own self-care. And also try to focus on helpful, rather than unhelpful, thinking.
 
There are the adages that you can’t pour from an empty glass or you should always put on your own oxygen mask before helping others. Those concepts are even more important in uncertain times. 
 
Research shows that even a 90-second break to do deep breathing or meditate can be really restorative. It’s also good modeling for their children to take care of themselves and check in with themselves.
 
For helpful thinking tips, when you notice yourself getting stuck on things we can’t control or predict, try to refocus on something you can control, like implementing a daily routine for the family or scheduling one activity for everyone.
 
It’s also important to adjust your expectations and focus on little victories. I’ve heard from a lot of parents self-doubt about whether they are doing enough, whether their children are getting enough done, maybe comparing themselves to others who seem to have it all together. That’s just not going to be helpful.
 
Try to set really realistic expectations day by day. Acknowledging any step in the right direction can be much more helpful.
 
Just as it’s important to seek help for your child if things are consistently getting in the way of functioning, I would say the same for parents, particularly if they’re healthcare providers or essential workers. UCSF has a program to help healthcare providers with peer support, and many other agencies have similar programs. There are also a lot of support groups that meet virtually or have tips they share online. And sometimes it might be helpful for a parent to have their own mental health provider.
 
What about reports of increases in domestic violence?
It’s a very serious issue. It makes sense when we’re not able to get space from one another that it can exacerbate (any) underlying issues. It’s fanning the flames.
 
There are very good resources for domestic violence right now in the Bay Area. Our website has a page we put together specifically for shelter in place
 
Working with a mental health professional can be very helpful, and it can be helpful to develop a safe word with your provider since you probably can’t go to their office and may be having your session in the house with someone who is listening.
 
How about for parents or children who were already struggling with their mental health?
We’re seeing an interesting phenomenon where some folks are actually feeling better, especially folks with social anxiety who are not having to go out to go to school or events. But … after the shelter in place, it’s going to be easier to adjust if they continue to maintain some sort of interactions during this time.
 
Some people are having a harder time, which is expected. In addition to some of the strategies like helpful thinking and scheduling activities, we talk about basic self-care – having some sort of routine where you’re getting up, taking a shower, getting dressed, being active.
 
Even for families not in crisis, there seems to be a seesawing in how to deal with this situation: Is it an extended vacation or a traumatic event on an international scale?
That matches what I’m seeing as well. When we focus on what we can’t predict, it becomes very overwhelming. The more we can focus on what we’re in control of right now, that makes us feel happy and healthy. That’s going to be more effective than trying to guess what’s going to happen four months down the line.
 
One piece of consistent advice is to really limit exposure to the media. Maybe one time a day I get my update for 20 minutes and then I can turn it off for the rest of the day.
 
I think children need even less exposure to the media. There are some really helpful guides, some of them on our web page, on how to talk to your children about COVID-19.
 
When we’re talking to our children, what’s more important than giving them information is soliciting how they’re feeling and what questions they have. And just letting them know it’s OK to have these feelings and having a safe space where they can express their feelings of uncertainty or sadness. If we don’t check in with them, they could be having really big worry thoughts that they feel aren’t OK to share.
 
Resources
 National Suicide Prevention Lifeline. 1-800-273-8255. 
 National Domestic Violence Hotline. 800-799-7233, chat online at thehotline.org or text “LOVEIS” to 22522.
 Crisis Textline. Text “TALK” to 741741. 
 UCSF Department of Psychiatry Resources to Support your Mental Health During the COVID-19 Outbreak 
 Stanford Children’s Health COVID-19 Resources 
 CHC. Bay Area-based mental health services for children, teens and young adults, including 24-hour crisis lines and telehealth.
211.org. A free and confidential national hotline that connects callers with resources and support in their area. 
The Coronavirus Grief Cycle. Heather Valentine, a licensed family and marriage therapist who is a counseler at Notre Dame High School in San Jose, has created this video and others to help kids and families dealing with the coronavirus.
Child Mind Institute’s Anxiety and Coping With the Coronavirus.
 Also offers telehealth appointments. 
 The National Child Traumatic Stress Network Supporting Children During Coronavirus 
 Lyf. A new, free app that provides a self-care community and bills itself as the world’s largest virtual support group. The platform has a team of licensed psychologists available 24/7 to answer questions and provide feedback for free.
 7 Cups. Offers free 24/7 chat and affordable online therapy. 
 Anxiety – What Every Young Person Should Know. From the creators of the documentary Screenagers.
Shadow’s Edge. A free mobile game, based on positive psychology and narrative therapy, that allows teens to explore feelings through journaling and street art. 
 

Janine DeFao is an associate editor at Bay Area Parent.

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