Dr. Kevin Most: Mental Health and dealing with stress and anxiety in children
This weekend has shown us how that the predictable world we used to live in is no longer that. On Saturday and Sunday, we had 2 mass shootings that left close to 30 dead and over 50 injured. The health impact of this is far reaching, Our emotions range from sadness, anger, fear, anxiety and depression, for most of us it is a mixture of all of these. On a global level we find ourselves concerned about our lack of mental health resources that are shrinking each year, to dealing with the stress and anxiety of not only ourselves but also our children. Unfortunately we are seeing no end in sight and feel that our response to these shootings have not been close to adequate.
We know that mental health is a large concern, a study completed 10 years ago showed the US with the highest rate of mental illness when compared to 14 other developed countries, at that time estimates were that one in four individuals in the US suffered from some form of mental illness, compare that to less than 10 % of the population of Italy. We all know that the events of the past 10 years along with opioid crisis has only raised this issue in the US. Current estimates continue to see rates that in some cases approach 30% of individuals with some form of mental illness in areas in the US
We have seen shootings in schools, factories, movie theaters, churches, office buildings, retail stores and restaurants all areas that we should and used to feel safe at. The amount of media coverage has reinforced that this can happen anywhere which has raised our anxiety level. We always respond to these mass shootings with comments like ”We are strong, we will stand tighter” or we rally by donating blood as the need for blood skyrockets locally when we have tragedies like we saw this weekend.
During this time what is actually going thru our minds as we go thru our normal days, will we all feel a little anxious the next time we walk into a Walmart? Will our stress and anxiety levels go up with our daily activities, experts are saying Yes. We discussed just a week ago that our kids have high stress and anxiety levels just from school and sports activities, lets couple that with the increase in mass shootings in public places and we need to realize that their stress levels will only go up.
Before we talk about what we can do, lets deal with this as we do all health issues. First what can we do to prevent these shootings from happening? I am not talking about gun control, I am talking about mental health identification and treatment. It is sad that individuals in our prison system have better access to mental health than the general public, obviously this is too late in the cycle. When we look at the Federal Budget we see that funding for mental health care has decreased dramatically over the past years as funding has been shifted to other priorities. We have seen decreases in everything from identification, intervention, and treatment. We need to understand this is not only a demand side issue, it is also a supply side issue. What I mean is that in this country more than 60% of all counties in this country do not have a single psychiatrist and that number gets up to 80% as we look at rural counties. To make things worse, we have about 28,000 psychiatrists in the US, but this number is dropping as we see many aging out to a point of retirement. Three out of five current psychiatrist are over the age of 55. So, this problem is only going to get worse. We look for social workers and psychologist to help fill this void however many of them are drawn to work in urban and suburban areas, thus leaving a large point of the country uncovered.
What makes it worse is that those mental health care workers can select to choose only patients with good insurance as the demand is so high. We will rely on primary care physicians to step up and provide that service, yet the reimbursement system even makes this more difficult.
What can we do as individuals in the prevention of mental illness? The most important thing we can do is identify individuals who we are close to who may need help and provide a safe environment for them to seek help. The intervention of individuals who need help is important to the health of all of us. I am not talking about identifying the individual who may become a shooter in the future, that number of individuals is so small. I am talking about identifying the individual who is suffering from stress and anxiety for any reason as incidents like this may push them beyond the comfort zone they live in.
Noting the individual who is showing signs of stress and anxiety and reaching out to help them deal with the stress may seem like it is beyond your “training” , in fact it is not as many of these individuals just need some support from a friend, or spending time with friends in a safe environment, will be helpful. Identifying the individual who needs more than a comforting voice is also important as they may need treatment and possibly medication to assist them thru these times.
Let’s not forget about the kids, with the 24/7 media coverage, hiding these incidents from young children is almost impossible. A very simple thing to do is turn off the TV when they are in the room, or make sure there is age appropriate shows on. Refrain from watching the live coverage with children present. This exposure to children is very detrimental to them, it increases their anxiety and fear of situations they see as normal. Anxiety disorders affect 25% of children between ages 13-18, so it is not rare at all and incidents like these raise that rate. Record the news if you really need to watch it and watch it later when the children are asleep. Children who are young will not be able to understand that the Walmart in Texas is not the Walmart they go to each week. Children can read us as adults very well, they need to see us as concerned but not fearful. It is important for adults to talk to other adults to manage our own stress and anxiety. We do need to understand what the feelings are that the children are having, are they anxious to go to school, do they not want to go to a movie theater or a Walmart. We need to make sure the child’s feelings are valid and important. Experts tell us to resist the urge to just say “everything is fine, don’t worry, that will never happen here” Instead talk about the positive things that you and others are doing to protect them.
Some things to consider when dealing with children and their anxiety around this.
Some simple things families and individuals can do:
1.) Spend more time with the children. If you think they are stressed try to get them in a comfortable place, do not force them to share their worries but make a comfortable environment and they may share their concerns.
2.) Don’t tell them not to worry, or “That cannot happen here”, Instead reinforce everything you do to keep them safe. Build the story of a safe environment for them.
3.) Do not let TV do the talking. The prolonged and continuous exposure will be unsettling to them. Change the channel.
4.) The discussion you have with a 5 yo is different than a teen. The 5 you conversation should focus on their safety and what you do to keep them safe. The teenage discussion can go beyond and discussing how it is wrong to take another’s life, or the incidence and concern for mental illness, and the importance of speaking up if they are anxious or note a change in a friends behavior. The messaging changes as the child ages. There are many resources to help you guide the conversation for specific age groups.
5.) Let your child share their concerns, as they may be concerned about a topic you have not even considered. Correct inaccuracies they may have heard from their friends or that they misinterpreted on the TV
6.) Make mornings calmer, this sets the tone for the day. Refrain from the news as this may add anxiety for the child at the start of their day
7.) We know the importance of sleep, making sure the child gets sufficient sleep and rest empowers them and allows them to avoid stress.
8.) The importance of a healthy diet cannot be overlooked, children and teens especially when left alone will migrate to a non-healthy diet. Making sure that they get the fruits and vegetables needed for our vitamins is important.
9.) Manage your own stress as well. A child will look to you to see your actions or concerns and amplify them. Acknowledging stress and normalizing it can be helpful as the child will now see that stress is normal and finding ways to deal with it are available.
10.) Be patient and understand that the activity which will be old news tomorrow will still reside in their mind as they are put in different situations
What about adults? We cannot over look that incidents like this make us all a little anxious. Do not feel that you are alone with those feelings. Anxiety affects more than 40 million Americans over the age of 18, and that is without the added stress of these incidents which raise anxiety in many who would not have had it in the past. The sad thing is that 40% of patients with anxiety suffer thru it without the help of a professional or medication. Anxiety has a wide spectrum of illness, from general anxiety to PTSD, Panic attacks, social anxiety and many specific phobias. Each have specific treatment plans and options
We have to realize it is not a sign of weakness to be depressed or anxious, it is a treatable illness that will add to the quality and quantity of your life. Seeking help when the anxiety impacts your personal, professional or family life is a key to your health. Seeing your primary care doctor for assistance is the important first step.
The world we live in does not appear to be changing in a way that will limit our stress and anxiety, so learning to identify the stress and learning how we as individuals can best manage it will make our lives a bit more easier