Doctors keep a close eye on kids' mental health as school resumes during pandemic

Six months after COVID-19 forced Alberta schools to close their doors, thousands of children are settling back into classrooms and many are struggling with issues ranging from pandemic-related stress to full-blown mental health disorders.

Kids Help Phone, a national service providing supports by phone and text, says demand is up 44 per cent in Alberta over this time last year.

"Stressors like returning to school, violence in the home and abuse are really percolating and concerning us at this time," said Katherine Hay, president and CEO of the organization.

Loneliness is the number one reason children and youth are calling and texting right now, Hay said, followed by mental health concerns including anxiety and depression and stress about returning to school.

Distress versus mental health disorder

Mental health experts say there is a key distinction between acute stress — which many people are experiencing due to COVID-19 — and a mental health disorder.

Distress, while unwelcome, is to be expected during a crisis, according to Dr. Chris Wilkes, head of child and adolescent psychiatry at the University of Calgary's Cumming School of Medicine.

"We can all have acute distress when there's a threat or a perceived threat," he said.

When children get support from parents or a teacher — and learn to cope — they can calm down.

"So the fast breathing, the fast pulse rate settles down and the perceived threat in your mind is also decreased," he said. "However, if that stress continues hourly and then daily and then continually, then you get into a situation where you are eliciting what we call a generalized anxiety disorder or prolonged stress reaction."

If that continues for a long period of time, Wilkes said, it can be damaging.

"It can cause you to lose sleep, have problems with your concentration and you're in a fear, fight, flight reaction all the time."

Delayed reaction to pandemic

Some children — including those in homes where parents are struggling financially, don't have support or are dealing with their own mental health concerns — can be more vulnerable.

"The long term implications are very worrying and concerning," said Wilkes.

That's because mental health problems can take six months to a year to manifest in children after a crisis.

"So we are anticipating long-term consequences in terms of increased demands for treating children with anxiety or mental health disorders such as depression."

Wilkes and others at the University of Calgary have been working with school boards to provide increased support through a website which includes mental health information and videos offering parents and children ways to cope.

Returning to school will be helpful for many children, according to Wilkes, because they'll be able to see their friends again and those who are really struggling can get extra support from teachers and school counsellors.

Ways children cope

"In my own practice, I saw a little bit of increased visits about concerns and anxieties, but not diagnosed anxiety disorders necessarily," said Dr. Christine Luelo, a Calgary-based family physician and medical director for the South Calgary Primary Care Network.

She spends a lot of time coaching parents and children about positive coping strategies including getting enough sleep, exercising, eating well, reducing social media use and spending time talking.

But during the pandemic, she said some people have developed problematic coping mechanisms.

For adults it can be alcohol consumption. In kids you could see more self-harm, known as non-suicidal self-injury. A very serious form of that is cutting.

Kids Help Phone said calls related to self-harm have increased dramatically during the pandemic.

"It can be even just … twisting their hands and twisting their skin and pinching themselves — things that where you can't actually see the effect after," said Luelo.

"It could be things like pulling on their hair or fidgeting. It may be pacing behaviours. It could be … not eating properly because you want to feel that hunger."

According to Luelo, parents shouldn't panic if they see this behaviour in their children.

"It's not a suicidal attempt. It's a physical feeling that helps to overcome a mental feeling."

At another time, when everyone is calm, she said it's important to ask children about this behaviour.

"And then the most important next step is to close your mouth and just listen.… For teenagers, that can often be the best time to have that conversation is in the car where they can't leave and also where you're not actually looking straight at them."

 Paying attention to how children perceive a situation is a key step in helping them cope, according to Luelo.

"Recognizing that your child is framing this in a way that's very negative.… We've lost a lot. There's a grieving that has to occur around things that we will never have again the same way," she said.

 "But we'll also have new things in a way that we didn't have before. And so if that means parents don't commute to work anymore so that we have actually more family time, that's a good thing."

Talk about the positives, she says.

"Parents … can think about how am I framing this and 'am I actually being a good role model for my kids? Or am I putting my negative outlook on them?' Check in with them about where they actually are around COVID-19 and how they're framing it, and then help them find resources to be able to do that differently if you don't feel capable of doing that."

Luelo said parents who are worried for any reason can access help through their family doctor, Kids Help Phone and school counsellors.

If you're struggling or know someone who is, you can call the Canada Suicide Prevention Service hotline 24/7 at 1-833-456-4566, or text "CONNECT" to the Kids Help Phone (which also serves adults) at 686868.

For a list of 24-hour crisis centres in your area, visit the Canadian Association for Suicide Prevention's website.

If you feel your mental health or the mental health of a loved one is at risk of an immediate crisis, call 911.