January 29, 2025 • 23 mins
While some countries and U.S. states are beginning to reopen businesses and other gathering places, the pandemic is still very much with us. Physical distancing will likely be a way of life until a vaccine for COVID-19 is widely available. So much change, including the threat of illness, and grief of those who have lost loved ones, means that mental health is a great concern.
Fortunately, there are things we can do to support our mental health at this time, especially when caring for young children or other family members. In this episode of The Brain Architects, host Sally Pfitzer speaks with Dr. Karestan Koenen, Professor of Psychiatric Epidemiology at the Harvard T.H. Chan School of Public Health, and Dr. Archana Basu, Research Associate at the Harvard T.H. Chan School of Public Health, and a clinical psychologist at Massachusetts General Hospital. They discuss what supporting your own mental health can look like, as well as ways to support children you care for at this time. They also talk about what mental health professionals all over the world are doing to help take care of our societies in the midst of the pandemic, and how they’re preparing for the challenges that come next.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to The Brain Architects, a podcast from the Center on the Developing Child at
(00:05):
Harvard University.
I'm your host, Sally Fitzer, and since our last podcast series was released, things have
changed drastically as a result of the coronavirus pandemic.
During this unprecedented time, we'd like to share resources and provide guidance that
you may find helpful.
So we're creating a series of podcast episodes that address COVID-19 and child development.
(00:26):
This episode is the fifth in our series, and today's guests are Dr. Karestan Konin, professor
of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, and Dr.
Archana Basu, research associate at the Harvard T.H. Chan School of Public Health and a clinical
psychologist at Massachusetts General Hospital.
Thank you both for being here.
I'm really looking forward to the conversation.
(00:48):
Thanks Sally, it's great to be here.
Thank you so much.
So Karestan, what makes this pandemic different from other traumatic events that many people
have experienced in terms of mental health?
There are a number of characteristics that make the COVID-19 pandemic different than
other traumatic events.
Even than other disasters, I actually lived in New York City during the 9-11 terrorist
(01:12):
attacks and I've seen some similarities in terms of this in that things were shut down,
there was a pervasive feeling of threat, there was loss of life, it was very disruptive and
it was something that people really, in New York anyway, talked about for a long time,
it sort of just really persisted and sort of affected everyone in the city.
(01:33):
What's different about this is the length of time people are being affected, how pervasive
it is in terms of our community, but the state nationally and globally, it's the first time
that I've had experience a traumatic event that my colleagues in Africa are experiencing
some version of it, my colleagues in Mexico.
(01:54):
And then I think because it affects so many different aspects of our lives.
When we talk about trauma, we think of things that are unpredictable and uncontrollable
and overwhelm our ability to cope.
And this has certainly been unpredictable.
It's been a lot of things feel out of our control.
And on top of that, we have other things that can in themselves be traumatic, like unexpected
(02:15):
bereavement, job loss, stigma people are experiencing.
So I think the sheer pervasiveness of it and how it's affected every aspect of our life.
And then finally, I think one of the things we know about disasters is that social support
is so important for resilience and for people's recovery and to offer them from the effects
(02:36):
of disaster.
And in the middle of this, we're being told to physically distance to prevent the spread
of COVID.
And that really cuts into our ability to get social support or to socially support each
other.
So that is something certainly different than I've experienced before anything I've ever
studied actually.
So Archana, I know you work with children and families on all of these issues around
(03:01):
grief, which I know we were just kind of referencing.
I'm wondering if you can talk a little bit more about the different kinds of grief that
families might be experiencing at this time.
I guess I'd like to start by acknowledging that loss is a very common part of human experience.
Even outside of the pandemic, as an example, in the U.S. each year, more than 600,000 people
(03:24):
die of heart disease alone.
And this is not to minimize the losses that we're experiencing now, but only to say that
we as humans are used to experiencing losses and adapt to it on a pretty ongoing basis.
And there's a large body of evidence to suggest that we are adaptive and resilient.
And this is certainly true for children because child development inherently offers many opportunities
(03:49):
for change and positive adaptation with appropriate support.
So that being said, as Kirsten highlighted, there are many unique elements to the pandemic
in terms of the pervasiveness and the unpredictability, as well as the limited or lack of access to
typical support systems or resources, for instance, due to physical distancing requirements.
(04:15):
So that certainly makes it unique and challenging.
So as of today, more than 80,000 fatalities have been reported in the U.S. alone.
So families are certainly very worried about their own health, their loved ones, health
and well-being, or are coping with the death of a loved one.
So right now, with travel restrictions, not being able to come together as families or
(04:39):
with friends, that's definitely a pretty big challenge.
Many families have been unable to engage in typical funeral rituals.
And parents are wondering how to support kids.
And some even wonder whether to say something.
And generally, the research supports the idea that open age-appropriate communication can
(05:01):
be very valuable in helping children.
And there are some specific helpful resources, like really practical tips in terms of what
language or words parents can use to explore how their kids are understanding these experiences,
what worries they might have.
And we can certainly provide links to that in perhaps the website to our podcast.
(05:22):
But briefly, I will just say that open communication really helps to understand what children are
observing and experiencing and can help them not be alone in their worries.
And I would say that would be the number one goal, is to help children recognize what they're
feeling, validate those emotions, and for them to feel that they are not alone in this
(05:45):
experience.
The other element is what you referred to in your question is, outside of bereavement,
all of us are experiencing losses in our everyday lives.
And I think one way in which, as we support each other through tough times, is by reaching
out and connecting with our friends and family, by holding hands, by giving each other a hug.
(06:10):
And we can't do that right now.
Also, I've been hearing from young adults graduating seniors in college that they are
experiencing a pretty tremendous sense of loss around routine rituals that form a sense
of community, like graduation ceremonies.
They don't have that sort of eager anticipation as they're launching into adulthood.
(06:31):
Overall, I guess I would say children can be resilient, but the way forward may not
always look and feel that easy, there'll be moments of frustration and confusion.
We would expect that.
There's nothing normal about what we're experiencing.
So to acknowledge and validate even these everyday experiences of loss would be quite
(06:52):
valuable in supporting kids and families.
I've been thinking so much about how so many different people that I know have been experiencing
this grief in different ways, right?
Like you think, oh, those high school students, that's so hard.
And you think, oh, those college students, that's so hard.
There's so many different traditions and cultural pieces that we are missing right now.
(07:14):
And that just changes how we are in our society for sure.
Karestan, I'm wondering if you could provide some specific examples.
Our listeners have often found it helpful to hear some concrete ideas about how mental
health experts are supporting families now and then also how they're preparing for those
long-term mental health impacts.
(07:35):
So what's been remarkable to me in terms of the pandemic is how the mental health community
and I mean that academics, but frontline practitioners and students and people just interested in
mental health or companies that are interested in mental health have really stepped forward
to offer resources from something like, I know Headspace is offering free services to
(07:57):
health care workers.
And we've been offering these mental health forums at Harvard Chan School of Public Health
and ADAA and CDC are offering all kinds of mental health resources.
So people have really stepped up to put those resources online.
And I think that's been unparalleled.
I've never seen, again, I worked in New York after the 9-11 terrorist attacks and there
was a cooperation among the mental health community, but I didn't even see it at this
(08:19):
scale then.
I guess the other piece is the global collaboration I've never seen before.
So I've been on email chains with colleagues from Italy, China, South Korea, some of whom
I knew before, some of whom I didn't, figuring out what are they seeing and what's helped
in terms of mental health locally.
One center that I'm affiliated with at Harvard decided to have a panel of people from China
(08:43):
and South Korea talk about going back to work.
So using the fact that it is global and that countries are at different stages to problem
solve some of the things that come up, not that it would necessarily, whatever they do
would work here, but at least perhaps give us some ideas.
Another thing has been a sort of rapid move to telehealth, which is something that actually
(09:04):
insurance providers have been quite challenging actually to get reimbursed prior to the pandemic.
And it seemed like within weeks, people had moved their practices to some form of telehealth,
which could mean video or it could mean telephone.
And so that is something that I think has made services to people, especially to people
(09:25):
already had them more accessible.
So those are some things the community has done.
And I think it's a really positive thing going forward.
Absolutely.
I'm wondering if you could help us think about what parents and other caregivers could do
specifically what they could do right now to support children's emotional and mental
(09:46):
well-being.
Foremost readjusting expectations, whatever little that parents can do to support themselves
really matters because they are right now, in fact, the primary support system for kids.
Obviously, parents are the most influential in terms of child development.
But right now, when kids don't have access to other support systems, this, I would say,
(10:09):
is even more important.
As parents, we are not that great at prioritizing our own needs.
It's sort of kids and work and what everybody else needs in a household, maybe their own
parents.
And if you get five hours of sleep, you know, you're lucky.
And I get that this is not an easy thing to focus on.
But it's sometimes just helpful to remind ourselves that every little bit counts, even
(10:34):
if it's 20 extra minutes of sleep, if it's seven minute, quiet cup of coffee in the morning,
maybe that sets the tone for the start of the day.
Simple deep breathing.
Another element could be focusing on what kids and families can control.
So thinking about your own routine, what's helpful for yourself, doing what works, but
(10:56):
keeping it simple.
Basic stuff, managing sleep routines, eating, exercise, maintaining virtual social connections
through technology.
All of those things help.
So just readjusting expectations and taking the time to sort of figure out routines that
can be helpful, help us think about what we can control and talking about it and checking
(11:18):
in to see what's working.
These are all some of the basic things I would highlight.
And of course, one of the biggest advantages right now to telemedicine is that it is more
accessible if you have, you know, a phone or a computer or tablet.
Get in touch with a primary care provider to seek guidance and support if this remains
(11:38):
challenging, which would be quite understandable.
Yeah, outside of COVID providers are being underutilized.
My colleagues who study health care services report that I think it's down to somewhere
like 30 percent of capacity for non-COVID related medical calls.
So thus, people should not hesitate.
(12:01):
Providers actually are available.
And one of the things Archin and I have talked about, because we both have sons, but they're
very different ages, is that kids tend to be most concerned about what directly affects
them.
And so, as adults, we get concerned about all these things that might be more abstract.
One of the examples we've given is, so for my son, when school was canceled, the first
(12:23):
thing he worried about was whether the homework due on Monday was going to be due.
And then is it going to be graded?
And then are they going to have to go to school longer?
These very specific things.
It's not to say he doesn't worry about other things, but there are specific things.
Younger kids at the playground, they usually run up to there's yellow tape around it.
And so, it's these very immediate things.
(12:44):
And I think, at least as a parent myself, I sometimes can trivialize these things.
I find myself being like, you're worried about that?
We're in a pandemic.
Are you worried about that?
But kids do worry about what is most direct and sometimes most concrete.
And so, by acknowledging and responding to those concerns, which may seem kind of silly
(13:06):
in our adult heads, that can provide a lot of comfort to them, too.
Absolutely.
We've both touched quite a bit on some of this, but I think I'll throw this question
to both of you to answer.
So we've been talking a little bit about how, as you're saying, kids are responding to things
that are most direct in their environment.
And we know that the toll of this pandemic hasn't been evenly distributed and will likely
(13:31):
continue to not be evenly distributed.
Some people are at much greater risk for both medical and economic consequences.
And are you seeing that to be true for emotional and mental health consequences as well?
And if so, what could be done about that?
Great question.
So, I mean, some of the groups we are seeing as most at risk for mental health consequences
(13:53):
are one in five people in the U.S., adults in the U.S. live with a mental disorder.
So people who already had a prior mental disorder or mental health condition, the conditions
of the physical distancing for people with a mental disorder removed social supports
and things that also may be access to other care groups, day programs, et cetera.
(14:14):
So those people have been particularly affected and might already have been socially isolated.
The Kaiser Family Foundation came out with some statistics, and some of it's not surprising.
It's families, actually parents.
Parents are reporting more mental health issues and people who experience economic downturn
or job loss.
And we know from the 2008 recession that job loss and foreclosure are associated with increased
(14:40):
risk of mental health issues.
And then, thirdly, low-income and communities of color have been disproportionately affected.
I saw some data from a colleague published in New York, which showed that higher mortality
from COVID was related to income.
We know there's been disproportionate mortality in communities of color.
(15:00):
Also in such communities, there's a greater digital divide.
So we talk about a lot of these resources have been put online, and there's a lot of
virtual support.
But we also know that 15 percent of Massachusetts households, kids don't have computers or
didn't have computers before this.
And those, again, tend to be disproportionately in low-income and communities of color.
(15:21):
So those are some of the people I think disproportionately affected with risk of mental health problems
who are disproportionately experiencing the COVID, as well as the financial consequences.
I think the family-focused care piece is really critical.
And this is, again, very consistent with the center's philosophy around multigeneration
(15:43):
models to support kids and families.
I can't really say this enough.
I think supporting kids also needs to involve a model that supports parents.
So I would say that type of family-focused care as one possible model moving forward
is very key.
The second one I think, you know, Kirsten and I and others have talked about, and maybe
(16:05):
Kirsten can chime in on this, is the aspect that there are many other communities or systems
within which kids and families live and work and develop.
So that includes schools and community-level organizations and faith-based organizations.
And I think part of supporting mental health care would involve partnering with these community-based
(16:26):
organizations.
And this might include formal leaders and key stakeholders, but also potentially developing
collaborations with more informal stakeholders.
You know, there's a lot of evidence that we can provide effective mental health care by
not just working with specialists like psychologists and psychiatrists, which is absolutely necessary,
(16:48):
but also with more community-based health care workers, for example.
And Kirsten can speak to what we can learn in terms of the global context.
Sure.
And something I hope that might come out of this pandemic is the better recognition that
mental health is critical as the foundation of all health and the foundation of a healthy
(17:08):
society, and that rather than treating mental health like a side issue that we deal with
when it's really an apparent big problem, we think of it more proactively.
The burden isn't left on individuals or even on families to seek help when things get to
the crisis point.
And I think one of the things we can learn from our global partners in countries where
(17:30):
there may be 60 psychiatrists in the entire country treating a population and very few
other trained mental health professionals is people have introduced other kinds of models
where community health workers or just leaders in the community, people who the community
would acknowledge they look up to, training them in mental health practices that can then
(17:53):
be disseminated to the community.
I think what Kirsten highlighted in her previous comments is also there is a lot of research
to suggest that longstanding systemic issues can manifest as a mistrust of health systems
and beliefs about mental health that can impact engagement with care.
So engaging in the ways that Kirsten highlighted where people trust, those are really valuable
(18:19):
ways to engage people in just thinking about social and emotional health, engaging and
starting that conversation.
Interesting.
A lot of times at the center when we're talking about stress effects or stress response, we
also like to talk about resilience.
And I'm wondering what you would say in terms of resilience around this pandemic.
(18:42):
One of the themes that has come up for me in terms of resilience is flexibility.
We're being called on to be very flexible.
And we don't always think of that in terms of resilience, but I think in this is particularly
true.
So I give my own example is one of my main coping strategies that works tremendously
well 95% of the time is I'm a planner and I can see my plan backwards.
(19:04):
And I really had to be like, I plan God lapsed right now because so many things change all
the time.
And as a parent now, we don't know what the fall brings.
And so having to be flexible myself, model flexibility for my son who's doing online
school, he doesn't know what the week's going to hold.
(19:25):
The schedule is different every day for his school, etc.
And so learning to roll with it and change your expectations.
And then the other thing is, I've been trying to figure out what are the things that are
most important to me?
What are the priorities for my kid, my family, myself, and keeping them simple and only have
a few of them.
(19:45):
So the normal expectations of everything we're going to get done is not going to happen.
And I also think that as a parent, you have to choose your battles.
Like an example as well if your kids doing all their work and went on all their zoom
calls for school and did all their homework without complaining, doesn't matter if they
got dressed.
(20:05):
Now, maybe it does, maybe it doesn't.
But do you want to fight over what they're wearing?
I don't know.
Maybe you do, maybe you don't.
But there's probably other things about having to really choose what you're going to focus
on and are you going to let go of some of the things some of the time to make it more
manageable?
To follow up on one of the things that Karestan started with was this idea of flexibility.
(20:27):
And it's actually something in our work with kids and families we talk upfront about.
And one of those ideas is this developing kind of a toolbox of things that work for
you as a family and really think about what works for your child.
I will in fact often ask parents and older kids, what has worked for you in the past?
So we may not have been in a pandemic before, but we have certainly experienced transitions
(20:52):
and stressors and challenges in other ways.
And so asking them what has worked for you in the past and then thinking about how we
can adapt those for right now.
And then also recognizing that, especially with kids, what works this morning may not
work at night or the next day.
And so thinking of it as like a toolbox of skills or ideas they can use to cope is very
(21:15):
helpful and certainly along the lines of having a flexible approach and definitely underscore
and readjusting expectations.
I would definitely agree with both of those.
I think the other thing that I would just say is also that individual resilience partially
depends on systemic resilience.
So really thinking about what are ways in which we can support families and schools
(21:42):
and some of the other community based organizations, because those are the contexts in which children
and families and all of us live our lives.
There's a recent study that found that among adolescents who received any mental health
services between 2012 to 2015, that for 35% of the kids, their only point of contact for
(22:02):
getting mental health services was from their schools.
So forming partnerships with schools is actually really important because kids may not even
access care through hospitals or specialists, but for a large portion of kids, schools might
be the only point of service for them.
Excellent.
And I think there's so many listeners who are especially going to relate to that readjusting
(22:26):
expectations piece.
That one resonated with me as well.
Yeah, all of us.
Exactly.
Well, thank you both so, so much.
Thank you so much.
Thanks, Sally.
I'm your host, Sally Fitzer.
The Brain Architects is a product of the Center on the Developing Child at Harvard University.
You can find us at developingchild.harvard.edu.
(22:48):
We're also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram
at Developing Child Harvard.
Brandy Thomas is our producer and Charlotte Gibney is our producer and audio editor.
Our music is Brain Power by Miele from freemusicarchive.org.
This podcast was recorded at my dining room table.
Welcome to The Brain Architects, a podcast from the Center on the Developing Child at
(00:05):
Harvard University.
I'm your host, Sally Fitzer, and since our last podcast series was released, things have
changed drastically as a result of the coronavirus pandemic.
During this unprecedented time, we'd like to share resources and provide guidance that
you may find helpful.
So we're creating a series of podcast episodes that address COVID-19 and child development.
(00:26):
This episode is the fifth in our series, and today's guests are Dr. Karestan Konin, professor
of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, and Dr.
Archana Basu, research associate at the Harvard T.H. Chan School of Public Health and a clinical
psychologist at Massachusetts General Hospital.
Thank you both for being here.
I'm really looking forward to the conversation.
(00:48):
Thanks Sally, it's great to be here.
Thank you so much.
So Karestan, what makes this pandemic different from other traumatic events that many people
have experienced in terms of mental health?
There are a number of characteristics that make the COVID-19 pandemic different than
other traumatic events.
Even than other disasters, I actually lived in New York City during the 9-11 terrorist
(01:12):
attacks and I've seen some similarities in terms of this in that things were shut down,
there was a pervasive feeling of threat, there was loss of life, it was very disruptive and
it was something that people really, in New York anyway, talked about for a long time,
it sort of just really persisted and sort of affected everyone in the city.
(01:33):
What's different about this is the length of time people are being affected, how pervasive
it is in terms of our community, but the state nationally and globally, it's the first time
that I've had experience a traumatic event that my colleagues in Africa are experiencing
some version of it, my colleagues in Mexico.
(01:54):
And then I think because it affects so many different aspects of our lives.
When we talk about trauma, we think of things that are unpredictable and uncontrollable
and overwhelm our ability to cope.
And this has certainly been unpredictable.
It's been a lot of things feel out of our control.
And on top of that, we have other things that can in themselves be traumatic, like unexpected
(02:15):
bereavement, job loss, stigma people are experiencing.
So I think the sheer pervasiveness of it and how it's affected every aspect of our life.
And then finally, I think one of the things we know about disasters is that social support
is so important for resilience and for people's recovery and to offer them from the effects
(02:36):
of disaster.
And in the middle of this, we're being told to physically distance to prevent the spread
of COVID.
And that really cuts into our ability to get social support or to socially support each
other.
So that is something certainly different than I've experienced before anything I've ever
studied actually.
So Archana, I know you work with children and families on all of these issues around
(03:01):
grief, which I know we were just kind of referencing.
I'm wondering if you can talk a little bit more about the different kinds of grief that
families might be experiencing at this time.
I guess I'd like to start by acknowledging that loss is a very common part of human experience.
Even outside of the pandemic, as an example, in the U.S. each year, more than 600,000 people
(03:24):
die of heart disease alone.
And this is not to minimize the losses that we're experiencing now, but only to say that
we as humans are used to experiencing losses and adapt to it on a pretty ongoing basis.
And there's a large body of evidence to suggest that we are adaptive and resilient.
And this is certainly true for children because child development inherently offers many opportunities
(03:49):
for change and positive adaptation with appropriate support.
So that being said, as Kirsten highlighted, there are many unique elements to the pandemic
in terms of the pervasiveness and the unpredictability, as well as the limited or lack of access to
typical support systems or resources, for instance, due to physical distancing requirements.
(04:15):
So that certainly makes it unique and challenging.
So as of today, more than 80,000 fatalities have been reported in the U.S. alone.
So families are certainly very worried about their own health, their loved ones, health
and well-being, or are coping with the death of a loved one.
So right now, with travel restrictions, not being able to come together as families or
(04:39):
with friends, that's definitely a pretty big challenge.
Many families have been unable to engage in typical funeral rituals.
And parents are wondering how to support kids.
And some even wonder whether to say something.
And generally, the research supports the idea that open age-appropriate communication can
(05:01):
be very valuable in helping children.
And there are some specific helpful resources, like really practical tips in terms of what
language or words parents can use to explore how their kids are understanding these experiences,
what worries they might have.
And we can certainly provide links to that in perhaps the website to our podcast.
(05:22):
But briefly, I will just say that open communication really helps to understand what children are
observing and experiencing and can help them not be alone in their worries.
And I would say that would be the number one goal, is to help children recognize what they're
feeling, validate those emotions, and for them to feel that they are not alone in this
(05:45):
experience.
The other element is what you referred to in your question is, outside of bereavement,
all of us are experiencing losses in our everyday lives.
And I think one way in which, as we support each other through tough times, is by reaching
out and connecting with our friends and family, by holding hands, by giving each other a hug.
(06:10):
And we can't do that right now.
Also, I've been hearing from young adults graduating seniors in college that they are
experiencing a pretty tremendous sense of loss around routine rituals that form a sense
of community, like graduation ceremonies.
They don't have that sort of eager anticipation as they're launching into adulthood.
(06:31):
Overall, I guess I would say children can be resilient, but the way forward may not
always look and feel that easy, there'll be moments of frustration and confusion.
We would expect that.
There's nothing normal about what we're experiencing.
So to acknowledge and validate even these everyday experiences of loss would be quite
(06:52):
valuable in supporting kids and families.
I've been thinking so much about how so many different people that I know have been experiencing
this grief in different ways, right?
Like you think, oh, those high school students, that's so hard.
And you think, oh, those college students, that's so hard.
There's so many different traditions and cultural pieces that we are missing right now.
(07:14):
And that just changes how we are in our society for sure.
Karestan, I'm wondering if you could provide some specific examples.
Our listeners have often found it helpful to hear some concrete ideas about how mental
health experts are supporting families now and then also how they're preparing for those
long-term mental health impacts.
(07:35):
So what's been remarkable to me in terms of the pandemic is how the mental health community
and I mean that academics, but frontline practitioners and students and people just interested in
mental health or companies that are interested in mental health have really stepped forward
to offer resources from something like, I know Headspace is offering free services to
(07:57):
health care workers.
And we've been offering these mental health forums at Harvard Chan School of Public Health
and ADAA and CDC are offering all kinds of mental health resources.
So people have really stepped up to put those resources online.
And I think that's been unparalleled.
I've never seen, again, I worked in New York after the 9-11 terrorist attacks and there
was a cooperation among the mental health community, but I didn't even see it at this
(08:19):
scale then.
I guess the other piece is the global collaboration I've never seen before.
So I've been on email chains with colleagues from Italy, China, South Korea, some of whom
I knew before, some of whom I didn't, figuring out what are they seeing and what's helped
in terms of mental health locally.
One center that I'm affiliated with at Harvard decided to have a panel of people from China
(08:43):
and South Korea talk about going back to work.
So using the fact that it is global and that countries are at different stages to problem
solve some of the things that come up, not that it would necessarily, whatever they do
would work here, but at least perhaps give us some ideas.
Another thing has been a sort of rapid move to telehealth, which is something that actually
(09:04):
insurance providers have been quite challenging actually to get reimbursed prior to the pandemic.
And it seemed like within weeks, people had moved their practices to some form of telehealth,
which could mean video or it could mean telephone.
And so that is something that I think has made services to people, especially to people
(09:25):
already had them more accessible.
So those are some things the community has done.
And I think it's a really positive thing going forward.
Absolutely.
I'm wondering if you could help us think about what parents and other caregivers could do
specifically what they could do right now to support children's emotional and mental
(09:46):
well-being.
Foremost readjusting expectations, whatever little that parents can do to support themselves
really matters because they are right now, in fact, the primary support system for kids.
Obviously, parents are the most influential in terms of child development.
But right now, when kids don't have access to other support systems, this, I would say,
(10:09):
is even more important.
As parents, we are not that great at prioritizing our own needs.
It's sort of kids and work and what everybody else needs in a household, maybe their own
parents.
And if you get five hours of sleep, you know, you're lucky.
And I get that this is not an easy thing to focus on.
But it's sometimes just helpful to remind ourselves that every little bit counts, even
(10:34):
if it's 20 extra minutes of sleep, if it's seven minute, quiet cup of coffee in the morning,
maybe that sets the tone for the start of the day.
Simple deep breathing.
Another element could be focusing on what kids and families can control.
So thinking about your own routine, what's helpful for yourself, doing what works, but
(10:56):
keeping it simple.
Basic stuff, managing sleep routines, eating, exercise, maintaining virtual social connections
through technology.
All of those things help.
So just readjusting expectations and taking the time to sort of figure out routines that
can be helpful, help us think about what we can control and talking about it and checking
(11:18):
in to see what's working.
These are all some of the basic things I would highlight.
And of course, one of the biggest advantages right now to telemedicine is that it is more
accessible if you have, you know, a phone or a computer or tablet.
Get in touch with a primary care provider to seek guidance and support if this remains
(11:38):
challenging, which would be quite understandable.
Yeah, outside of COVID providers are being underutilized.
My colleagues who study health care services report that I think it's down to somewhere
like 30 percent of capacity for non-COVID related medical calls.
So thus, people should not hesitate.
(12:01):
Providers actually are available.
And one of the things Archin and I have talked about, because we both have sons, but they're
very different ages, is that kids tend to be most concerned about what directly affects
them.
And so, as adults, we get concerned about all these things that might be more abstract.
One of the examples we've given is, so for my son, when school was canceled, the first
(12:23):
thing he worried about was whether the homework due on Monday was going to be due.
And then is it going to be graded?
And then are they going to have to go to school longer?
These very specific things.
It's not to say he doesn't worry about other things, but there are specific things.
Younger kids at the playground, they usually run up to there's yellow tape around it.
And so, it's these very immediate things.
(12:44):
And I think, at least as a parent myself, I sometimes can trivialize these things.
I find myself being like, you're worried about that?
We're in a pandemic.
Are you worried about that?
But kids do worry about what is most direct and sometimes most concrete.
And so, by acknowledging and responding to those concerns, which may seem kind of silly
(13:06):
in our adult heads, that can provide a lot of comfort to them, too.
Absolutely.
We've both touched quite a bit on some of this, but I think I'll throw this question
to both of you to answer.
So we've been talking a little bit about how, as you're saying, kids are responding to things
that are most direct in their environment.
And we know that the toll of this pandemic hasn't been evenly distributed and will likely
(13:31):
continue to not be evenly distributed.
Some people are at much greater risk for both medical and economic consequences.
And are you seeing that to be true for emotional and mental health consequences as well?
And if so, what could be done about that?
Great question.
So, I mean, some of the groups we are seeing as most at risk for mental health consequences
(13:53):
are one in five people in the U.S., adults in the U.S. live with a mental disorder.
So people who already had a prior mental disorder or mental health condition, the conditions
of the physical distancing for people with a mental disorder removed social supports
and things that also may be access to other care groups, day programs, et cetera.
(14:14):
So those people have been particularly affected and might already have been socially isolated.
The Kaiser Family Foundation came out with some statistics, and some of it's not surprising.
It's families, actually parents.
Parents are reporting more mental health issues and people who experience economic downturn
or job loss.
And we know from the 2008 recession that job loss and foreclosure are associated with increased
(14:40):
risk of mental health issues.
And then, thirdly, low-income and communities of color have been disproportionately affected.
I saw some data from a colleague published in New York, which showed that higher mortality
from COVID was related to income.
We know there's been disproportionate mortality in communities of color.
(15:00):
Also in such communities, there's a greater digital divide.
So we talk about a lot of these resources have been put online, and there's a lot of
virtual support.
But we also know that 15 percent of Massachusetts households, kids don't have computers or
didn't have computers before this.
And those, again, tend to be disproportionately in low-income and communities of color.
(15:21):
So those are some of the people I think disproportionately affected with risk of mental health problems
who are disproportionately experiencing the COVID, as well as the financial consequences.
I think the family-focused care piece is really critical.
And this is, again, very consistent with the center's philosophy around multigeneration
(15:43):
models to support kids and families.
I can't really say this enough.
I think supporting kids also needs to involve a model that supports parents.
So I would say that type of family-focused care as one possible model moving forward
is very key.
The second one I think, you know, Kirsten and I and others have talked about, and maybe
(16:05):
Kirsten can chime in on this, is the aspect that there are many other communities or systems
within which kids and families live and work and develop.
So that includes schools and community-level organizations and faith-based organizations.
And I think part of supporting mental health care would involve partnering with these community-based
(16:26):
organizations.
And this might include formal leaders and key stakeholders, but also potentially developing
collaborations with more informal stakeholders.
You know, there's a lot of evidence that we can provide effective mental health care by
not just working with specialists like psychologists and psychiatrists, which is absolutely necessary,
(16:48):
but also with more community-based health care workers, for example.
And Kirsten can speak to what we can learn in terms of the global context.
Sure.
And something I hope that might come out of this pandemic is the better recognition that
mental health is critical as the foundation of all health and the foundation of a healthy
(17:08):
society, and that rather than treating mental health like a side issue that we deal with
when it's really an apparent big problem, we think of it more proactively.
The burden isn't left on individuals or even on families to seek help when things get to
the crisis point.
And I think one of the things we can learn from our global partners in countries where
(17:30):
there may be 60 psychiatrists in the entire country treating a population and very few
other trained mental health professionals is people have introduced other kinds of models
where community health workers or just leaders in the community, people who the community
would acknowledge they look up to, training them in mental health practices that can then
(17:53):
be disseminated to the community.
I think what Kirsten highlighted in her previous comments is also there is a lot of research
to suggest that longstanding systemic issues can manifest as a mistrust of health systems
and beliefs about mental health that can impact engagement with care.
So engaging in the ways that Kirsten highlighted where people trust, those are really valuable
(18:19):
ways to engage people in just thinking about social and emotional health, engaging and
starting that conversation.
Interesting.
A lot of times at the center when we're talking about stress effects or stress response, we
also like to talk about resilience.
And I'm wondering what you would say in terms of resilience around this pandemic.
(18:42):
One of the themes that has come up for me in terms of resilience is flexibility.
We're being called on to be very flexible.
And we don't always think of that in terms of resilience, but I think in this is particularly
true.
So I give my own example is one of my main coping strategies that works tremendously
well 95% of the time is I'm a planner and I can see my plan backwards.
(19:04):
And I really had to be like, I plan God lapsed right now because so many things change all
the time.
And as a parent now, we don't know what the fall brings.
And so having to be flexible myself, model flexibility for my son who's doing online
school, he doesn't know what the week's going to hold.
(19:25):
The schedule is different every day for his school, etc.
And so learning to roll with it and change your expectations.
And then the other thing is, I've been trying to figure out what are the things that are
most important to me?
What are the priorities for my kid, my family, myself, and keeping them simple and only have
a few of them.
(19:45):
So the normal expectations of everything we're going to get done is not going to happen.
And I also think that as a parent, you have to choose your battles.
Like an example as well if your kids doing all their work and went on all their zoom
calls for school and did all their homework without complaining, doesn't matter if they
got dressed.
(20:05):
Now, maybe it does, maybe it doesn't.
But do you want to fight over what they're wearing?
I don't know.
Maybe you do, maybe you don't.
But there's probably other things about having to really choose what you're going to focus
on and are you going to let go of some of the things some of the time to make it more
manageable?
To follow up on one of the things that Karestan started with was this idea of flexibility.
(20:27):
And it's actually something in our work with kids and families we talk upfront about.
And one of those ideas is this developing kind of a toolbox of things that work for
you as a family and really think about what works for your child.
I will in fact often ask parents and older kids, what has worked for you in the past?
So we may not have been in a pandemic before, but we have certainly experienced transitions
(20:52):
and stressors and challenges in other ways.
And so asking them what has worked for you in the past and then thinking about how we
can adapt those for right now.
And then also recognizing that, especially with kids, what works this morning may not
work at night or the next day.
And so thinking of it as like a toolbox of skills or ideas they can use to cope is very
(21:15):
helpful and certainly along the lines of having a flexible approach and definitely underscore
and readjusting expectations.
I would definitely agree with both of those.
I think the other thing that I would just say is also that individual resilience partially
depends on systemic resilience.
So really thinking about what are ways in which we can support families and schools
(21:42):
and some of the other community based organizations, because those are the contexts in which children
and families and all of us live our lives.
There's a recent study that found that among adolescents who received any mental health
services between 2012 to 2015, that for 35% of the kids, their only point of contact for
(22:02):
getting mental health services was from their schools.
So forming partnerships with schools is actually really important because kids may not even
access care through hospitals or specialists, but for a large portion of kids, schools might
be the only point of service for them.
Excellent.
And I think there's so many listeners who are especially going to relate to that readjusting
(22:26):
expectations piece.
That one resonated with me as well.
Yeah, all of us.
Exactly.
Well, thank you both so, so much.
Thank you so much.
Thanks, Sally.
I'm your host, Sally Fitzer.
The Brain Architects is a product of the Center on the Developing Child at Harvard University.
You can find us at developingchild.harvard.edu.
(22:48):
We're also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram
at Developing Child Harvard.
Brandy Thomas is our producer and Charlotte Gibney is our producer and audio editor.
Our music is Brain Power by Miele from freemusicarchive.org.
This podcast was recorded at my dining room table.
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