The Unseen Effects of Mental Illness, Trauma & Covid-19

This informative interview was conducted with Helen Boukos. Helen is the Clinical Lead of the Trauma Treatment Service at Alberta Health Services in partnership with the Zebra Child Protection Centre. The following interview highlights Helen’s insights on mental illness and trauma in children and youth. She also expands on how the pandemic has played a role in impacting mental health and how you can help children and youth navigate through these challenges.

1. What is the difference between mental health and mental illness?

Mental health, like physical health, is something everyone has. Physical health has to do with the state of our bodies while mental health refers to the state of our feelings, thoughts, motivations, and attitudes. Mental health, like physical health, is always present. Similarly, to physical health, it can fluctuate up and down.

Our mental health is influenced by our level of social connectedness, our capacity to cope with challenges, and how we generally relate to the world around us. Mental illness is identified when a person experiences a set of symptoms that make up a diagnosis and these categories are generally agreed upon within the field of mental health. Both mental health and mental illness exist on a continuum, however diagnosis of a mental illness, by definition includes the feature that the symptoms have begun to interfere with an individual’s day-to-day functioning.

When we have positive mental health, we are equipped to handle life’s challenges and stresses, have meaningful relationships, and make choices that increase our well-being. Experiencing a difficult time does not mean a person is meeting criteria for a mental illness. Just like a person with a diagnosed mental illness may also have periods of positive mental health.

2.   How does abuse and trauma impact children’s mental health?

That’s a question that could take a book to answer. The experience of abuse and trauma impacts everyone who lives it in different ways. For many, the impacts can be far-reaching.

Post trauma reactions can impact neurodevelopmental and emotional development, leading to a variety of mental health disorders. Long term, the experience of trauma also has physical health implications and increases the likelihood of substance abuse. The impact of trauma may be influenced by the age at which the abuse began. It also may be influenced by whether it was a single traumatic experience or years of repeated abuse. The nature of the relationship between the child and the person who abused them is also a huge factor in determining the impact it will have on the child.

Abuse changes the way children view themselves and the world around them. A child might have difficulty managing and expressing emotions, a negative overall sense of themselves, and a general expectancy that the world is an unsafe place. This impacts an individual’s ability to relate with and connect to others. Trauma is rarely visible to others and the behavior of children that are struggling to meet expectations is often misunderstood. Children might be labelled as having negative behavior and experience blame and rejection in their school and peer environment.

When a body’s stress response is over activated repeatedly in childhood, as it is with chronic abuse, it changes the functioning of that body long term. This means that children and adults who have experienced abuse may also experience an increased vulnerability to stress overall, increasing the likelihood of medical conditions they may be predisposed to.

Children who have experienced abuse are more likely to have a positive experience with individuals and within environments that understand how to identify the symptoms of toxic stress and how to differentiate a child who is having a fear response from one who is “being difficult” or “misbehaving”. When we understand that the underlying problem is biological, an over-reactivity of their body’s stress response, the way we respond to the child changes. By understanding how a child’s body might be primed to react in unpredictable situations, we can begin to proactively approach interactions and the way we structure certain environments like classrooms.

Child Advocacy Centres serve to support children by responding to the abuse in a trauma informed manner. They seek to support children through the investigative process in a way that is child-friendly. This means that many processes are in place to minimize the stressful impact of the investigation itself. For example, children are welcomed into a comfortable and inviting space. The locations themselves are strategically designed to promote a sense of safety and security. They are then interviewed by specialized investigators to ensure that the interview only happens once. Support is given to the child and non-offending caregivers as they navigate our justice system by preparing them for what to expect at each step of the process. Child Advocacy Centres promote a child-focused approach to the investigation by aiming to make specialized services available to children who have been abused.

3.  What are the signs of mental health struggles in children and youth?

If you are concerned about a child, consider whether there are changes in the way they think, feel or act. Changes in feelings might include: the child demonstrating reactions that feel bigger than the situation, seeming sad, irritable, angry, hopeless or worried. They may also withdraw from friends and their interests. Other common behaviours we see is reverting back to earlier less mature behaviors and trouble sleeping. For others, the mental health struggle might show through physically, such as: an increase in aches and pains, eating less, and having less energy. Most of the things I just mentioned happen to everyone some of the time. However, it is a cause for concern when these changes stick around for a week or two or if they interfere with the child’s functioning. In this case, it is more likely the child is struggling and would benefit from help.

4.  How has the pandemic and the lockdown impacted mental health in children and youth?

I believe we haven’t begun to understand the magnitude of this yet due to the mental health difficulties being behind closed doors. These difficulties have been especially less visible with the decrease in social contacts. Factors such as: social isolation, decreased access to coping resources, and less to look forward to has inevitably impacted children and youth. Additionally, parents are most likely also struggling with changes in their financial situation while having limited access to their own mental health resources. They are tasked with supporting their child to navigate all of these unknowns while struggling themselves.

These stresses in combination with the anxiety and stress surrounding the potential impact of the virus itself has inevitably had a huge impact. So many other factors come into play, such as the uncertainty on the length of the restrictions and long term impact to our economy. Additionally, there is stress and anxiety surrounding the social and economic impact of social distancing, loneliness, potential stigma of contracting the virus, and navigating the financial insecurity. There has also been increased tension in relationships and domestic violence as a result of being confined to our homes. Also, accessing support itself has become a source of increased risk for some people.

5. Do you have advice to help teachers promote positive mental health within their classrooms? Physical or Virtual classroom.

I’m so grateful for how our education system has taken on so many additional responsibilities to support our children and families through the pandemic.

Some ideas for how teachers might support would be to build aspects of a social-emotional curriculum into their daily routines in order to provide a consistent time and way for children to use strategies for coping. For example, a teacher might start the day by “checking the weather.” This would include labelling emotions and the level of intensity of those emotions on scale from 1 to 10. Students could be invited to scan their body for tension, stomache or headaches, a racing heartbeat, and have the opportunity to practice some strategies for coping with their classmates.

Due to lack of opportunities to be together, providing exercises or organizing virtual activities for the students to connect in a fun or meaningful way with each other will hopefully lead to an increased sense of belonging to the school. It might also give ideas to families for ways children might connect with friends virtually outside of class. Where possible, assign hands-on activities to break up the time in front of the screen. It is also important to get them moving with body breaks or physical challenges, if possible. I understand the pressure and worry everyone is feeling with respect to what is felt to be lost time learning. The reality is, the children whose mental health is suffering are not likely at a place where they have the capacity to take in new information and apply it. The quality of the work of the class as a whole is likely to improve with some time dedicated to connecting, sharing feelings, and practicing some strategies to decrease unpleasant emotions.

Make conversations about emotions and checking in the norm so that the children’s comfort level with the subject increases. Ask open questions and encourage respect for different views. Validating the children’s feelings not only increases the feeling of safety they will have with you, but also models for them how you hope they will respond to others’ experiences. Support the building of connections between the students to increase their sense of belonging to the class and feelings of connectedness. Feelings of connectedness and belonging is what I feel is the single most powerful gift that teachers can give students.

6. What can we do at home to promote positive mental health?

At home, parents and caregivers are already struggling with increased demands and less breaks. However, there are many ways parents and caregivers can support, but there are a few I will emphasize.

For some, implementing a strict schedule may feel unmanageable. This is because structure and routine combined with uncertainty and anxiety experienced over the concerns expressed may lead to a negative outcome. Instead, you might try beginning with setting an expectation for the order that events will happen during the day. For example, expressing to your child that “first we will eat dinner then you will do your homework” will help establish a sense of predictability. This method allows for some flexibility and does not set up parents to fail if they do not stick to the clock.

You can also call your family doctor or look up the mental health resources available on the AHS website. Professionals at AHS working in children’s mental health are available to discuss the nature of your worries and recommend the level of intervention that is appropriate for how much your child is struggling.

7.  What are resources for children and youth who are struggling with mental health?

A list of COVID resources is available by population and concern on the Alberta Health Services website. Many sites dedicated to supporting the mental health of children and families are offering resources for free that used to come at a cost. If feeling overwhelmed, start small by getting some rest and finding even a few short minutes to have a positive connection with your child.

8.  What are some resources for parents and caregivers to support positive and effective conversation around mental health?

Resources for talking to your children are also available on the AHS website. I would suggest that for caregivers feeling especially overwhelmed, they should set aside a few moments to support their own mental health and well-being. This is likely to go the farthest as your children will learn what they see, modeling ways to cope is the most effective way to pass these behaviors on to your children. It also increases the likelihood that the grownup will be able to manage their own unpleasant feelings and reactions, which increases their capacity to respond effectively to their children’s needs.

Reports of child abuse must be made to the following reporting sources:

Child Abuse Hotline: 1-800-387-5437 (KIDS)

Kids Help Phone: 1-800-668-6868 or Text CONNECT to 686868

Crime Stoppers: 1-800-222-8477

Online Exploitation:

Or your local police/RCMP detachment

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