Norah Nabkey has always been more nervous than her two older siblings.
Living in a global pandemic, however, has further heightened the 7-year-olds anxiety levels. Its made her fear leaving the house or visiting her grandparents. She has asked her mother, What happens if I get sick? Am I going to die?
Its so hard to drive home caution without instilling fear in your kids, said Brooke Nabkey, a mother of three in Ada Township. She was already an anxious kid to begin with and weve sort of created a monster.
This summer, she just crumbled.
Across the state in Grand Blanc, Michelle Counts has grappled with finding balance between keeping her three sons vigilant and aware of the dangers of the virus that has hospitalized multiple family members and friends, while not overwhelming them.
I wouldnt say depression but the majority of kids have dealt with fear surrounding things, Counts said. Both my little ones have voiced being scared, I dont want to go back to school, get corona and die ... they miss being with their friends but they dont want to lose their life or spread it.
The Nabkeys and Counts arent alone. Over the last five months, mental health experts across the state have noted elevated levels of stress, anxiety and depression among people of all ages, including children and teens.
The pandemic, along with attempts to reduce the spread of COVID-19 in communities, have altered routines, isolated youths from their friends, teachers and coaches, and raised concerns over the threat of the virus itself.
In some cases, youth have been further affected by seeing loved ones get sick or die from the virus that has killed more than 6,400 Michiganders since mid-March. Others have had their home life impacted by a parents loss of income due to the associated economic recession.
Across the state and the nation, weve seen an increase in anxiety and trauma symptoms, said Lauren Kazee, a social worker whose career has focused on the mental health and wellness of youth. It has impacted different people in different ways.
Michigan has not yet compiled data on the mental health impact of the coronavirus pandemic. But the state is working in partnership with school leaders and mental health experts to prepare for the fallout by providing schools and parents with additional resources.
In April, Gov. Gretchen Whitmer announced the state would provide funding to make a program known as Michigan Cares free to children, teachers and parents for the 2020-21 school year. The program, presented by the non-profit Michigan Virtual, provides free digital lessons focused on developing social, emotional and mental well-being skills.
Hindering the states response is an already apparent shortage in access to mental health services, Kazee noted.
We were already looking at such a huge need, a huge gap in service provisions and providers around mental health and to compound it with a pandemic has exponentially increased the need for these services, Kazee said.
Elevated risk of trauma, suicide
In June, Pine Rest Christian Mental Health Services in West Michigan published a report forecasting the profound impact that the COVID-19 crisis would have on the mental health of Michiganders.
Due to the emergence of the disease and its impact on our lives and economy, many of the conditions that are known to increase risk for suicide are now in place in Michigan, reads an executive summary of the report.
The report includes children and adolescents among the groups who are especially at risk for a behavioral health crisis. They are at a higher risk for trauma and suicide due to being isolated from positive external supports, witnessing increasingly stressed family members and may be experiencing a lack of parental engagement as families try to balance work, homeschooling and childcare.
The economy could also play a role. In July, the U.S. Bureau of Labor Statistics reported Michigans unemployment rate at 8.7% -- a drop from Junes 14.9%.
Heightened unemployment rates suggest a potential for increased child abuse and neglect instances as well, according to the Pine Rest report. Individuals who are victims of child abuse and neglect have three to five times greater odds of suicide than others.
For teens, the impact of social distancing may be particularly difficult, and teens who are experiencing social isolation are two times more likely to attempt suicide, the report states.
Among the recommendations called for by Pine Rest is for Michigan to continue to scale up teletherapy and telepsychiatry, and to urgently address shortages in the mental health workforce by retraining those whose jobs have been eliminated to work in entry level positions in the mental health field.
How to address the news with your children
Brooke Nabkey has taken differing approaches to keeping her children informed with the coronavirus based on what they can each handle. She lets her 12-year-old son Simon watch the news with her and they discuss it.
But for Norah, its better to filter the news.
With my son, Im showing him the world, she said. But for Norah, Im keeping the world away because thats what she can handle. When we watch the news or read an article, we can set it aside. But as a 7-year-old, everything she has stays right there in front of her.
Michelle Counts said her family initially kept a close eye on news related to the pandemic, but as things became too sad she limited her sons viewing and began coming up with activities to distract them like projector movies in the yard or making crafts on the weekends.
We decided lets not drown ourselves, she said. We know its out there, but lets not be so into it that were not living.
Bob Sheehan, executive director of the Community Mental Health Association of Michigan, noted that children start to make sense of the world around them around ages 5-7 years old. Youth 6-12 years old are more likely to ask questions and talk to their parents than older teens, who tend to rely more on discussions with their peers than their parents.
When it comes to informing your kids about the pandemic, he recommends finding a middle ground between scaring them into complying with safety guidelines and keeping them informed on how to minimize the risk of catching the virus.
You can tell them we wear masks to protect ourselves like we wear mittens in the winter, or wash our hands after going to the bathroom, or look both ways before we cross the street, he said. We dont show our kids horrendous crashes to teach them, we just say look both ways before crossing and alert them to the danger.
Sheehan recommends putting your kids on a news diet. Too much can be overwhelming, but not enough could leave them only learning from their peers. He noted that some kids will link the pictures and headlines of civil unrest related to police brutality with the pandemic, if the fact that theyre separate issues isnt explained to them.
Returning to schools
As students begin returning to school, both virtual and in-person, Kazee said its going to be just as vital for teachers to address their students emotional and social health as it is to get them back on track in math and science.
I think itll be important for us to really go slow, for schools to have permission to not push academics first and really attune to social and emotional needs of their students, Kazee said. Were coming into a unique situation we havent faced before.
To help schools prepare to welcome back students, both virtually and in-person, The Michigan Department of Education partnered with School Based Mental Health Professionals Coalition to create a pandemic return to school toolkit.
The toolkit provides resources for administrators and teachers, as well as parents and students. It focuses on disease prevention, but also addresses the underlying long-term effects of the pandemic, including the impact of collective trauma on students and their families.
Theres been a lot of focus on how to check in with kids as they come back, Kazee said. Thats the focus of meetings Ive been in.
If schools and mental health providers are able to bring in protective factors to offset the impacts of the pandemic, Kazee anticipates that theyll be able to build resilience in students and prevent lasting negative impacts down the line.
My hope is we want kids to have some type of routine and progress academically but we cant do it without addressing the social and emotional impacts of all of this, she said.
Michelle Counts youngest sons, Caden, 14, and Jordan, 11, will be starting the school year with remote learning through Grand Blanc Community Schools. To combat distractions from learning at home, shes setting up a phone- and video-game free area of her house with desks for completing school work.
Im nervous about that, she said. Its so easy to get distracted and I dont want them falling behind. I work from home but my job can be so demanding. I worry that a bunch of kids may struggle.
New counseling services emerge
Between January and June 2020, Michigan saw a 33.7% decline in the use of its mental health services for kids 17 and younger. Utilization declined each month from January through April, likely due in-part to the governors stay-home order to slow the spread of COVID-19.
That doesnt mean the need for those services declined though.
Its like after a car wreck, you see people walking around before they realize they broke their arm, Sheehan said. Thats what were seeing. Then there comes a wave of calls, people not taking their medications, and a rise in anxiety.
In May and June, Michigan reported a rise in mental health service use from the prior months, though with a notable difference in service type. While face-to-face contacts dropped significantly, virtual and phone-based counseling services grew exponentially.
Michigan has seen a significant increase in virtual forms of mental health services since the beginning of the year, due in part to the coronavirus pandemic. (Courtesy | MDHHS)
Kazee called the growth in telehealth and teletherapy a silver lining for the pandemic. She said youth have shown in many cases that they feel more comfortable and are more honest during these sessions. She also noted that some providers are experimenting with text-based services as well.
Im hoping it will increase accessibility for those services, Kazee said. Were trying to think outside the box.
That doesnt mean tele-medicine is right for everyone. Brooke Nabkey said shes tried it with her daughter Norah, but its harder for her to focus than during in-person sessions.
Nabkey has seen improvements in her daughters anxiety levels since she began speaking with a therapist and taking lexipro, a medication that helps to restore balance of serotonin in the brain. Shes using virtual counseling in the short-term, but is looking forward to a return to normal.
As weeks of the pandemic have turned to months, Nabkey said she and her husband have gotten better at helping Norah through her anxiety. The therapy and medication have helped her to verbalize her feelings, Nabkey said.
Last week for the first time we took her to a restaurant again; we sat outside and she was OK as long as we explained the safety measures, like a constant reassurance of how were going to stay safe, she said.
We try to be patient but its hard to rally understanding for it if you dont suffer from it. Its trying to be logical and anxiety isnt logical.
For more information, visit the states mental health resources website, here. The U.S. Centers for Disease Control and Preventions also has resources available, here.
COVID-19 PREVENTION TIPS:
In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.
Health officials say you should be staying at least 6 feet away from others and working from home, if possible.
Use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and carry hand sanitizer with you when you go into places like stores.
Michigan Gov. Gretchen Whitmer has also issued executive orders requiring people to wear face coverings over their mouth and nosewhile in public indoor and crowded outdoor spaces. See an explanation of what that means here.
Additional information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.
For more data on COVID-19 in Michigan, visit https://www.mlive.com/coronavirus/data/.
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Wednesday, Aug. 26, coronavirus data by Michigan county: See counties with highest, lower infection rates
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Put your kids on a news diet and other tips to coping with anxiety during a pandemic - mlive.com
