One by one, the faces popped into a Zoom window. Boys eating breakfast. Entire families and their pets. Within minutes, nearly 80 children and parents had joined. They were present, digitally, to learn about mental health.
It didn’t last long.
Therapist Lizz Dexter-Mazza and her husband Jim Mazza, a University of Washington professor, began their broadcast by welcoming people to their living room. “We’re going to teach some social emotional learning skills,” Lizz said. Tuesday was the first day of the couple’s new experiment: livestreaming twice-weekly, free mental health education for kids stuck at home.
They didn’t anticipate how challenging it would be. In the middle of Lizz’s lesson on mindfulness, at least one anonymous participant hijacked the meeting by writing a racial slur over the presentation and asking derogatory questions. Parents yelled at the Zoom bomber before the couple quickly ended the meeting. Few returned when they restarted the session.
Their experience illustrates how challenging it is to offer digital mental health support to children — an endeavor providers, schools and academics are beginning to navigate in the wake of the coronavirus.
Since school buildings in Washington closed in response to the virus, educators have reimagined how to reach children who rely on school for basic necessities, such as food and before- or after-school care. As schools now attempt to offer remote instruction, they’re starting to provide remote mental health support, a service that isn’t guaranteed even in the best of circumstances. Like many aspects of education in Washington, access and quality are determined by ZIP code. That was true even before an unexpected crisis forced schools to close.
Getting all students help, experts say, is particularly important now. Children’s routines are upended, the news is frightening, and boredom leaves room for bad habits, such as substance use. The fallout since COVID-19 surfaced here — sickness, uncertainty and an unprecedented shutdown of public life — amounts to this young generation’s first collective trauma. “They are going to mark [this time],” said Thomas Halverson, principal lecturer in the University of Washington’s College of Education. “The time ‘before’ and the time ‘after.’ ”
Stay-at-home mandates may be especially difficult for children with a rough home life and those with existing mental health concerns. Although providers they trust may be a click or text away for some students, they might spiral without a new routine. For students without a computer or phone, trusted adults could be difficult or impossible to reach.
“This current situation could be a powder keg for those families,” said Robert Franks, president and CEO of Judge Baker Children’s Center in Boston. “If you are a child who has had a history of mental health challenges or behavioral health challenges, if you’ve struggled with anxiety or depression, this isolation can really exacerbate that.”
Lizz and Jim’s livestream is one example of how mental health providers are trying to adapt.
Lizz is founder and president of a mental health consulting company called DBT in Schools, and Jim is a professor in school psychology at the University of Washington. The pair is well known for developing a mental health school curriculum, which teaches mindfulness and emotion regulation.
When the couple decided to transform their Ballard home into a virtual mental health classroom, they weren’t sure how well their curriculum would transfer to the cloud. As for technology, “We’re making this up as we go along,” Lizz said.
The couple is part of a larger effort at the University of Washington that’s creating online mental health programs. Elsewhere, K-12 mental health therapists say they’re offering privacy-protected sessions online, a form of telehealth that allows them to continue meeting regularly with students. School counselors, who help with both academic and emotional needs, say they’re calling students’ homes.
Some districts that gave students laptops are using software to flag worrisome search terms, such as “suicide.” But some of these changes are hard, and as Lizz and Jim learned, they don’t always go as planned. They’re not giving up: The couple is committed to offering lessons for parents and children most days of the week.
Kyle’s stomach aches are back.
Kyle, a 10-year-old in Bellevue, has difficulty using words to express his emotions — he usually answers questions with a single word or short phrase. But he’s no stranger to depression and anxiety. And when he has those feelings, they often become pains in his stomach.
His world is off-kilter. “I like knowing what’s going to happen,” Kyle said. He’s no longer allowed to go rock climbing or play nerf guns outside with friends; instead, he spends hours at the dining room table doing school work, or in the basement playing video games. When the news is on, Kyle asks his parents to switch it off.
The coronavirus and its consequences have set off concentric circles of stress for children such as Kyle. He misses his friends and wants to shut out scary news. Many parents are out of work. Others are worried about their health, or the health of family members. High school seniors are fearful that school won’t reopen before they’re supposed to graduate.
Lily, a high school senior in Queen Anne, spends days distracting herself with baking, school work, German practice and sewing fabric masks. She makes to-do lists. By nightfall, a sense of sadness sets in.
“I start thinking about things I’m missing out on. Especially as a senior, there’s a lot of things up in the air,” she said. “Will I graduate? How will I graduate?”
Lily says she’s experienced depression and anxiety before, but senior year generally felt better. But now, a choir trip to New York is canceled. Prom, commencement, a senior party — all up in the air. She’s not sure if college is right for her, but she has a plane ticket to Germany, where she hopes to move and find a job this summer. She’s worried it will be unsafe or impossible to travel.
Some students, though, found comfort as the pressures of daily life have quieted. Megan Fantozzi, a community-based youth therapist in Shoreline, says she’s decreased the frequency of teletherapy sessions with some teens whose anxiety and depression have eased since school closed, though she continues to check in with students on a regular basis. “A huge portion of my teens have felt a decrease in their symptoms,” she said, noting school is a trigger for many of them.
Such is the case for Charlotte. After experiencing a panic attack at sleep-away camp last year, she’s struggled to keep feelings of panic and anxiety at bay. Those sensations have waned, said Charlotte, a sophomore who lives in Leschi. She sees this time away from “real life” as permission to start new hobbies and do things she was nervous about, like learning to process film or dying her hair purple.
Kyle, too, is finding some solace at home. He Facetimes with friends. Mom’s cooking beats school lunch, he says. “And he’s getting sleep. Too much sleep,” says his mom, Melissa.
Search for solutions
The mental health community is working swiftly to reinvent how it serves children in need.
In general, it’s harder for youth than adults to access mental health care: Kids can’t make decisions about buying insurance that covers therapy, they might lack transportation or parental support to pursue help. Many Washington schools try to fill these gaps by teaching “social emotional” curriculum such as the one Jim and Lizz developed and by hiring school counselors, therapists and social workers.
But this system is imperfect. Counselors and mental health professionals report heavy caseloads, and many schools lack funding to hire more. Gov. Jay Inslee recently vetoed funding that would have allowed some high-poverty elementary schools to hire additional counselors.
Jennifer Stuber, who is aiding Lizz and Jim’s efforts and is the center director for Forefront Suicide Prevention, said finding new ways to reach youth is critical — and it’s important that people are innovating now. “This could get really bad from a mental health perspective and from a suicide perspective, so we need to get ahead of any possible curve,” she said.
Experts don’t yet know how this era will affect kids, but they’re trying to find out. Seattle Pacific University researchers, for instance, found that young adults aged 18 to 24 are reporting more features of depression and loneliness than their older peers.
The results are preliminary and unpublished, and the researchers are still recruiting participants. But early results include more than 2,000 respondents, said lead researcher Amy Mezulis, professor and chair of clinical psychology at SPU. Mezulis is surveying participants for six weeks, and plans to soon include data from 14- to 17-year-olds.
Results like this add urgency for school districts, community organizations and public health departments looking to reach students where they are.
In King County, school-based health centers are helping at more than 30 schools. When schools are open, they provide space and health agencies staff the centers with at least one mental health professional. Officials say they are still figuring out how to provide these services remotely, but most therapists have begun reaching out to their caseload.
In the Vancouver School District, where most students have a school-issued laptop, staff receive alerts when students use search terms that suggest they’re thinking about suicide or harming themselves. This type of monitoring was in place before, but could become more important now.
“Instead of pulling a kiddo into your office,” said Brian Mathieson, a school counseling specialist and former president of a statewide school counseling organization, “You are having to do it on the telephone or on Zoom or contacting the parent or guardian.”
Mathieson is concerned about the children he and other staff fail to reach. “I’m also worried about students who had equity issues,” he said, such as students with disabilities or those who are learning English. “I don’t have easy answers.”
Local responses are fragmented, but what the mental health field lacks in coordination it makes up for in information, some experts say.
When schools closed, the first impulse of dozens of mental health organizations was to post information and email blast best practices, said Eric Bruns, associate director of the School Mental Health Assessment, Research & Training Center at the University of Washington.
Bruns and several colleagues are trying to absorb and curate this firehose of information.
“People haven’t necessarily thought ahead about what would be the response of the field to deal with the mental health issues that are going to arise through all of this,” he said. “This is unproven ground.”