It is early days to understand what Covid-19 means for physical health, let alone mental health. I would expect that, in time, in the Child and Adolescent Mental Health Service (Camhs), we will receive referrals for children whose mental health problems are triggered or worsened by the pandemic, as we did after other worldwide tragedies, such as 9/11.
However, this comes at a time when rates of mental health problems among children are already higher than they have ever been. What impact the outbreak will have on mental health will depend, in part, on how we as adults deal with it.
Triggering mental-health conditions
Children may suffer in a number of different ways. First, in the short term, there is likely to be an increase in the rates of children’s anxiety.
Anxiety is the body’s response to threat, and coronavirus is a threat. Uncertain threats make us more anxious still, and in this rapidly changing situation, we are all facing uncertainty.
Children will worry about their own health and, of course, symptoms of anxiety can occur in the chest, setting off a vicious circle. Older children who understand the virus better will understand the risk it puts their grandparents under and worry particularly about this.
For some children, this anxiety will not be a short-term problem and will develop into a long-term anxiety disorder, such as separation anxiety or obsessive-compulsive disorder.
Our vigilance around washing hands is necessary but, for those with a pre-existing vulnerability, this will inevitably trigger serious mental distress.
Second, children may be placed in traumatic situations, seeing scary protective suits or being separated from loved ones. Again, this is a necessary evil to fight this disease but will trigger short-term distress in most, and medium post-traumatic symptoms in a smaller minority.
Third, some children are inevitably going to be bereaved by this unfolding tragedy.
Impact on current mental health
It is likely in the next few weeks that all the normal structures of life, school, activities and visits to Grandma will be turned on their head. That can be alarming for young people.
There is uncertainty about exam season – will they be sitting their exams? The most academically anxious will be worried about missing their revision classes or sixth-form places. There will be worries about sick relatives and older relatives in care homes.
Some young people are going to have their current mental-health problems worsened by the virus. I was working with one young person on reducing her OCD extreme-cleanliness routine but that is harder to do at the moment.
Other young people will find their Camhs workers off work, self-isolating or redeployed temporarily to other medical pathways. That may decrease the support young people receive and heighten the sense of the world out of control.
The importance of keeping calm
I am a parent as well as a psychologist. On Tuesday night, I put my phone down for an hour over dinner, and when I returned there were 75 coronavirus WhatsApp messages from my son’s Year 7 parents’ group chat.
There was a sense of gossip, misinformation and rising hysteria in the messages. There were tales of Year 11 boys reporting symptoms, of dirty toilets, of no soap and a lack of communication from the school.
Anxiety is contagious, and schools and parents need to do the best they can to keep calm and set an example.
Adults should endeavour to keep up to date with information without seeking out spurious or endless coronavirus stories. Notice the tipping point in yourself, where information-seeking becomes alarming. Encourage kids to do the same.
1. Never lie
The first rule of what information to give children is never lie. But that does not mean we have to tell them everything.
2. Give appropriate information
The information you give to children has to be developmentally appropriate.
With infant-school children, we want to protect them from the full details, and the benefits and holiday-style nature of life under current conditions can be emphasised.
As children get older, the message can be more detailed but not alarmist.
Which leads to the third rule.
3. Hide your own fears
Please, please don’t let your pupils see any panic you feel. Language is very important in anxiety. The virus is bad enough. Extreme hyperbolic language can fuel anxiety.
As adults, we need to contain our own anxiety and not to communicate it to children. Their worry needs to be recognised, acknowledged and validated, without being hyped up. It is worth reminding them that lots of people won’t be infected. And, of those who are, most will survive.
Children need to be offered reassurance from the adults in charge about their formal exams. Arrangements will be made for e-learning, and the exam boards will have to take it into account in one way or another. It will all work out in the end: the students just need to do their work and not to worry.
The best message for mental health probably overlaps with the best message for physical health: life is going to be different and difficult for a while. In the long run, we are probably going to be OK because we are lucky that we have a national health service (unlike the US, for example). Our doctors and scientific experts seem to know what they are doing.
Encourage a sense of togetherness
Follow-up questions are inevitable: as discussed earlier, lots of children are worried about their grannies and granddads.
We are all concerned about the older people we know. But we need to reassure pupils that most older people will either not get the virus or will recover, and that we can all do our bit by washing our hands and social distancing.
If we want to take anything positive mentally from this horrific situation, please encourage a sense of togetherness and hope. These can be protective against mental health problems.
Tell them we are getting through this as a country and a school. We will support each other. We all have to do our bit. You’ll look back on this and tell your grandkids about it. Humour can be used to cope, although sensitively.
We may also be able to use this as an opportunity to recalibrate our priorities. The coronavirus certainly puts all the normal hysteria about test and exam season into perspective. What matters is our health and that of our loved ones.
Dr Tara Porter is a clinical psychologist in the NHS and private practice. She also works at the Anna Freud National Centre for Children and Families, and is Tes' mental health columnist. She tweets as @drtjap. The views expressed are her own