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Supporting Whole-Family Mental Health During COVID-19

daughter, mom, and grandma

Whether you’re 5, 35 or 95, sheltering in place and social distancing can be challenging. With consistent feelings of uncertainty, interruptions to routines and activities, and limitations on seeing friends and family, it’s no wonder reports of effects on mental well-being are on the rise. Recent surveys indicated young adults are feeling more anxious and fearful than in their pre-pandemic lives, and symptoms of depression have gone from appearing in a 37 percent baseline of respondents to appearing in 49 percent [1].

“Social isolation affects us all, but adolescents can be particularly vulnerable as social interactions are an essential part of development,” notes Benjamin Maxwell, MD, medical director of inpatient psychiatry and interim director of child and adolescent psychiatry at Rady Children’s Hospital-San Diego and an assistant professor for the Department of Psychiatry within University of California San Diego School of Medicine.

“Loneliness has been linked to mental health conditions such as depression and anxiety,” adds Desiree Shapiro, MD, attending physician and school wellness partner at Rady Children’s, program director of UC San Diego School of Medicine’s Child and Adolescent Psychiatry Fellowship Program at Rady Children’s, and an assistant clinical professor of psychiatry at UC San Diego School of Medicine. “Feelings of sadness, disconnect or fear are common responses to the challenging circumstances we are universally facing. It is increasingly important that our families check in with one another and with their friends and loved ones to listen, offer support and look out for anyone struggling with their mental health. ”

Dr. Maxwell and Dr. Shapiro say that signs kids or adults may need professional mental health support or psychiatric care include the following:

• Expressing a feeling of being overwhelmed by sadness or anxiety
• Stating a desire to end their life or discussing death
• Engaging in self-harm
• Using substances to “escape”
• Experiencing changes in sleep, either significantly more or less than usual
• Exhibiting aggression toward others, or taking out aggression on objects
• Expressing or showing an inability to relax or to control anxiety
• Acting with extreme irritability

Another scary side effect: Isolation may also increase risk for abuse within the home. Experts are likening our current situation to circumstances following past large-scale natural disasters, in which related pressures often contributed to a significant rise in reports of domestic abuse — but note pandemic risks could be more severe and drawn out [2]. “With children out of school, parents and caregivers are responsible for providing homeschooling,” says Lisa Conradi, PsyD, director of clinical operations at Rady Children’s Chadwick Center for Children & Families. “We also do not know how long we will be asked to shelter in place, or to practice social distancing, and that creates a huge sense of uncertainty for the future. Add in the stress of financial instability and a general fear regarding safety in the community due to COVID-19, and families are experiencing more stress than ever. This is enough to overwhelm anyone.”

“Family members may not have their usual outlets to cope and manage stress, and sadly, that can be dangerous. We have seen an increase in the severity of abuse cases at the Hospital, as well as a higher degree of self-harm cases,” continues Sandra Mueller, Rady Children’s senior director of behavioral health.

Even if elements of your life feel out of control right now, Dr. Maxwell and Dr. Shapiro say there are a number of activities you can do and actions you can take to ease anxious feelings, be social and set healthy boundaries to allow for time to relax and unwind. To stay connected, consider the following:

• Stepping back from texting and social media platforms and using technology that supports face-to-face interactions
• Setting up virtual game nights, movie or TV watch parties, or trivia events, which provide ready-to-go conversation starters that avoid pandemic discussions and encourage fun distractions
• Arranging a neighborhood walk (with a safe distance between everyone and face coverings used, of course)
• Incorporating loved ones into children’s day-to-day routines, such as scheduling a video to help with homework, work on crafts or read stories.

For parents, it can be all too easy to hesitate to take a moment alone, and juggling working from home, supporting home school lessons and round-the-clock child care, and handling chores and meal planning in a new way only adds to that for many. But take note: “It is not only normal to want and need a break, it can be detrimental to your own mental wellness, and potentially to that of your loved ones, to deny yourself,” emphasizes Dr. Maxwell. “Parents should absolutely not feel guilty or selfish for engaging in self-care, asking for a bit of space each day or seeking support.” Incorporating guidelines from medical and mental health professionals around the country [3], Dr. Conradi, Dr. Maxwell and Dr. Shapiro suggest some of the following strategies:

• Allocating small increments of time — even a few minutes a day can have significant benefits — for mindfulness, guided meditation with an app or simply doing something enjoyable.
• Getting some exercise, especially when done outdoors.
• Maintaining a regular daily schedule for meals, work, school and sleep.
• Practicing good sleep hygiene and getting as much high-quality sleep as possible.
• Setting up regular chats with friends.
• Exploring new hobbies, particularly relaxing ones such as gardening or art.
• Taking a few minutes away from a baby that won’t stop crying — leave them in a safe place, check in with a supportive family member or friend, and come back.
• Identifying emotional hotspots or triggers and making a plan to address them if they come up. This can also be a great practice to include children in.
• Counting to 10 before responding to a stressful question or situation.

Requesting help from older children, friends and family members, or seeking external support for yourself or your loved ones, can also be important steps. “It is okay to need help sometimes, and the resources are there,” confirms Dr. Conradi. If someone is a threat to themselves or others, please call 911 or the San Diego County 24-Hour Emergency Access and Crisis Line at 800-724-7240, or seek care at the nearest emergency room immediately. In addition, Rady Children’s has a number of resources available to children and families, including the following:

• Behavioral Health Urgent Care: Call 858-966-5484
• Chadwick Center for Children & Families: Visit to learn more about trauma counseling and child abuse pediatrics services, including some available through new telemedicine visits
• Child and Adolescent Psychiatry Services Unit: Visit for details on the CAPS program and admissions criteria
• Eating Disorders/Medical Behavior Unit: Visit to learn more about this collaborative program between Rady Children’s and UC San Diego, or call 858-576-1700 and ask for the adolescent medicine specialist on call for immediate admissions
• Outpatient Behavioral Health Services: Visit for details and information on scheduling new telemedicine visits

The following community resources can also offer supportive services:

• 211 San Diego: Call 211 from mobile phone or 858-300-1211, or visit
• Crisis Text Line: Text HOME to 741741 to text with a trained crisis counselor or visit
• Imperial County Mental Health Crisis Hotline: Call 800-817-5292
• National Alliance on Mental Illness San Diego Helpline: Call 800-523-5933 or visit
• National Suicide Prevention Lifeline: Call 800-273-8255 or visit
• Psychiatric Emergency Response Team (PERT): Call 911 or your local police department
• Riverside County HELPLine: Call 951-686-4357 or visit
• San Diego County 24-Hour Emergency Access and Crisis Line: Call 888-724-7240 or visit or
• San Diego County Child Abuse Hotline: Call 858-560-2191
• SmartCare Behavioral Health Consultation Service: Call 858-956-5901, visit or email

It’s been said before, but it bears repeating: We’re all in this together, and this will pass. But while we’re finding our own ways to work through, remember to be kind to yourself and others; pay extra attention to your feelings and behaviors, and to those of the ones you love; and keep the hope for brighter days ahead.