Authors: Sue Bell, CEO and Clinical Director, Kids Inspire. MA (Child and Adolescent Psychotherapy), UKCP, Somatic Experiencing Practitioner (SEP), Integral Somatic Psychology Practitioner (ISP), NeuroAffective Touch Practitioner, PGCE, BA (Hons)
Dimitra Theodoropoulou, Clinical Impact Manager, Kids Inspire. Psychologist (BPS), MA Art Psychotherapy, Doctoral Student Essex University
NB. All names used in the case studies provided have been changed to protect the identity of the individuals who are currently being supported by Kids Inspire.
“The pain and anguish out there
A pandemic on top of so much grief and dis-ease
Already suicidal, depressed, anxious young ones now struck with fear and overwhelming feelings
‘What happens if my foster carers die?’ asked a young one.” (Bell, 2020)
We are currently experiencing a Pandemic situation (WHO 2020) with numerous unknown factors. As it is unfolding, the known but yet constantly changing numbers are warning for a trajectory of multi-layered losses on a global scale. The impact will be different for each country and each community.
People everywhere are feeling some level of anxiety. Living with uncertainty and worried about what will happen. Individuals who rarely paid much attention to the news are tuning in, scrolling through social media multiple times a day, clicking on COVID-19 bait and activating the reptilian part of the brain triggering our defensive responses in order to somehow find a sense of safety.
Contact within the last week at Kids Inspire has illustrated that families who were previously ‘functional’ are beginning to become ‘snappy’ towards each other. Many people reported experiencing feelings of loss and grief around things getting cancelled (holidays, family gatherings, the end of University, School and so on). Even the most emotionally stable of us are processing lots of potentially overwhelming emotions. And the uncertainty of when is the end date, so that I can start my life again is proving to be a breeding ground for anxiety. For these individuals offering resources to calm the nervous system, space (online) to receive support is going to prevent and escalation of emotional symptoms. But on a mental health system already at capacity additional funds will need to be found. Prevention and Early Intervention all the more essential.
‘Not knowing’ is always hard to bear, but for those individuals who never formed secure attachments (Bowlby, 1969), it is completely overwhelming and appears to be triggering unhealthy patterns of relating (violence, aggression, depression, withdrawal).
One mum made contact last week. She was sobbing. Her seven-year old’s bursts of violence were increasing. Work for her and school for him used to offer some respite. Dad was swinging from being aggressive to his son (possibly out of a sense of hopelessness) to completely withdrawing and leaving mum to manage the unmanageable. Online support with their Kids Inspire EMDR specialist is going to be imperative. But where the work had focused on the child, support for the parents is now going to be more important than ever. Techniques to help them to learn to co-regulate as a family, to learn to remain calm when every cell in their body is driving them to be anything but can only be provided by a specialist trained therapist.
Researchers in the UK (University College London) are now monitoring closely the Psychological impact of this pandemic and subsequent losses –in all terms- and the consequences of self-isolation and social distancing. In the relevant article (BPS 26.03.2020):
‘A new study led by social epidemiologist Daisy Fancourt is asking how people are responding to these changes in lifestyle. We already know that our mental health can be affected by isolation, says Fancourt, and there’s never been a situation where so many people have been required to remain physically separated from others. “We’ve not really had something like this in living history,” she says.’
There seems to be a consensus that the Trauma – during and after the pandemic- will be significant and with no certainty as to what extent the actual impact will be. There is extended research to evidence such impact due to war, terrorism, natural disasters, epidemics/pandemics and quarantines. What is actually quite unique in the COVID-19 pandemic, it’s the combination of all the above. It is disconcerting that we do not have a precedent situation to guide us through, give us a baseline of data from which we can predict the level of impact, psychological or other. It is even more worrying that one can easily make the hypothesis that the trauma impact will be unprecedented. And thus, it is essential that we are prepared.
Appropriate partnerships need to be formed during this response phase in order to draw on the expertise of those with established trauma informed practices during the recovery phase. We can not underestimate the need for specialist support if those who have physically survived COVID-19 are going to also recover and survive mentally.
Lilly, age 4 lives with her foster carers and was hoping to find a forever home this September, before her 5th birthday. Research shows that once a child reaches five years of age the chances of being adopted reduces by 60%. Her foster father has cancer and was awaiting a life saving transplant that has now been put on hold. Also, in the house are two elderly parents and a relative who is recovering from spinal surgery. Currently the family are self-isolating for 12 weeks. Lilly’s loved the treasure bag provided by Kids Inspire and has with her foster mum engaged in her online sessions with her trauma therapist which she described as a lifeline. The trajectory for this child who has already experienced a lifetime of trauma is bleak. As professionals we hold the hope for this child.
‘The unprecedented impact of COVID-19 thus will be particularly the case for children and young people who are facing a ‘domino effect’ due to fear of losing and/or actually losing: vulnerable family members due to hospitalisation/death, financial stability due to parents’ job loss and a knock on effect on housing security and access to food, social and peer support network due to school closure and pause of extracurricular activities, parents’ emotional availability due to extreme distress. The most up-to-date survey conducted by Young Minds (20-25 March 2020) highlighted that the children and young people in the UK are already under state of immense anxiety. In the relevant BBC article (01 April 2020):
A survey by Young Minds has shown that the coronavirus pandemic is having a profound effect on young people with existing mental health conditions. Although they understood the need for the measures taken in response to the virus, the report says, this did not lessen the impact. Many of those who took part in the survey reported increased anxiety, problems with sleep, panic attacks or more frequent urges to self-harm’
Andrew, age 14, is in his second foster care placement following the breakdown of his placement with his biological relatives as part of a special guardian order. He has experienced a life of complex trauma, loss, chaos, parents with severe mental health issues addicted to drugs and alcohol. The only constant in the last two years has been his therapeutic relationship with his trauma trained psychotherapist. Initially he shared that ‘social distancing’ was dumb and it was all a fuss about nothing, but underneath this bravado is intense fear. Fear of even more loss and a recognition that the world continues to be an unsafe place and he too is unsafe in it. Within the last week, he has withdrawn, refused to communicate with anyone and has stayed in his room. Previously suicidal, Andrew’s freeze response cannot go ignored. This young person continues to be seen face to face at Kids Inspire. His school part-fund the support on offer, Kids Inspire use unrestricted funds for the remaining cost. All unrestricted funds have ceased since COVID-19
The common denominator in all 350 open cases at Kids Inspire, is the lack of sense of security in all levels that is so needed for children to survive and thrive; Maslow’s theory of the hierarchy of needs in human development was interestingly developed at the end of WWII (Maslow, 1943) when people’s basic needs were threatened. In today’s threatening situation the children and young people may return to schools, at an unknown date having survived a global pandemic; however, it is uncertain how they will be able to make the transition from Survive to Thrive and how long it will take for their brain and nervous system to switch off from the Survival Loop (Fight, Flight and Freeze). It is important here to refer to the science of the traumatised brain, as this knowledge needs to be used in our recovery planning.
Warnings of such impact and how the system may fail to respond to the children’s needs during a pandemic were highlighted by Bruce-Barrett et al (2007) in their article ‘Pandemic Influenza Planning for Children and Youth: Who’s Looking Out for Our Kids?’ written after the experience of previous pandemic1 similar to COVID-19. They warn:
‘No amount of planning prior to a pandemic can fully prevent the uncertainty, loss and grief that a pandemic will wreak. Indeed, the social, psychological and financial disarray attendant upon a pandemic will far exceed the physical impact.’ (Bruce-Barrett et al 2007)
With the same tone of urgency the article ‘A Collaborative Approach to Meeting the Psychosocial Needs of Children During an Influenza Pandemic’ was warning the USA:
‘Paediatric healthcare professionals must be prepared to collaboratively address the psychosocial needs of children before, during, and after a pandemic in order to avoid fear and panic.’ (Murray 2010)
Another study of the pandemic in Canada, ‘SARS Control and Psychological Effects of Quarantine’ (Hawryluck et al 2004) showed that quarantine measures were followed by a high prevalence of psychological distress, including symptoms of posttraumatic stress disorder (PTSD) and depression, which seemed to increase the longer the period of the quarantine was. Knowing someone or being close to someone who had been infected by the virus was also associated with PTSD and depressive symptoms. With the current UK government predictions of the spread of COVID-19, the rates of morbidity and a trajectory of 6 months or beyond, we are facing long term psychological impact of long-term quarantine measures.
Sam, age 9 who has experienced physical and emotional abuse now living with grandparents who are vulnerable in their health. In the home live 6 individuals, including family members with learning difficulties. The lock-down means a very busy household 24/7 that re-creates challenging and threatening conditions that the child experienced in the past. The child had previously the school as a place of healthy social interactions and engaging activities. Currently, the child experiences fear for his grandparents’ health, fear that if something happens to them he may return to abusive parents or placed in fostering. He currently operates from a survival mode expressed through anger outbursts that can lead to aggression. When this happens, the child can hurt him/herself or the younger children in the home. Without therapeutic support that could provide the tools for self-regulation, this child could remain in this survival mode with escalated aggression expressed towards the family and upon return to school towards other children.
Trying to understand the extent of this impact one can turn into research evidence from natural disasters. A study, ‘Impact of a natural disaster on preschool children: Adjustment 14 Months after a Hurricane’ (Swenson et al 1996) showed that children were presenting with high levels of anxiety, withdrawal and behavioural problems for up to 14 months after the disaster. Another longitudinal study with children aged from 5 to 12, ‘A longitudinal study of the psychological morbidity in children due to a natural disaster’ (McFarlane 2009), showed that rather than decrease with time, the prevalence of psychological morbidity increased significantly, being as great 26 months after the disaster as at 8 months. A previous study, ‘Family Functioning and Overprotection following a Natural Disaster: The Longitudinal Effects of Post-Traumatic Morbidity (McFarlane 1987), had shown that eight months after the disaster, the interaction in the disaster-affected families was characterised by increased levels of conflict, irritability and withdrawal and that maternal overprotection was also a common feature of the pattern of care in these families.