key: cord-352293-ha7xts89 authors: Thakur, Aditya title: Mental Health in High School Students at the Time of COVID-19: A Student’s Perspective date: 2020-08-26 journal: J Am Acad Child Adolesc Psychiatry DOI: 10.1016/j.jaac.2020.08.005 sha: doc_id: 352293 cord_uid: ha7xts89 nan To the Editor: The global impact of COVID-19 is unprecedented and has left countries grappling with uncertainties. Various public health measures all over the world have been implemented to reduce associated illness severity and mortality. Countries are now coming out of 'lockdown' with cautious optimism after successfully "flattening the curve" with measures such as social distancing, quarantine and closure of public places including schools. However, the challenges related to the impact on students' mental health continue beyond this phase of the pandemic. This paper highlights key issues and offers practical solutions to address the mental health of adolescents during COVID-19 pandemic, from a high school student's (HSS) perspective. As with many schools and universities, my school has been closed since March 13th, 2020, and it is uncertain when classes will resume. Adolescence is a crucial period for social development. Social distancing and school closures during the COVID-19 pandemic can worsen existing mental health problems in adolescents and increases the risk of future mental health issues. 1 A loss of routine for many students, social isolation and feelings of loneliness increases the risk of mental illness. 2 An increase in domestic violence and abuse during this pandemic further exposes adolescents to risks of developing mental health problems. Historically, schools may provide a social support network and mental health services for vulnerable teens. However, closure of schools during COVID-19 pandemic have taken away the protective layer of school-based mental health support. Closure of community agencies makes the situation even harder. Conversely, the COVID-19 quarantine has afforded time for family bonding over traditional board games and other activities. However, some students may need additional support for their wellbeing. Virtual meetings with guidance counselors from schools can facilitate early recognition and referral to primary care and mental health services. Within a pandemic environment of furloughs and job cuts, families may struggle to purchase technology for high schoolers who can benefit from school-based counseling support for mental health problems. Efforts should be made for equitable access to technology for adolescents seeking telemental health services through school and community providers. 3 The last few months have seen social media platforms such as Instagram, Snapchat, Reddit and TikTok flooded with COVID-19 materials. 4 The information that trends on these social media sites are due to the 'likes' and 'shares' and any misinformation leaves adolescents exposed to associated vulnerabilities. The "social media infodemic" has been linked to anxiety, feeling powerless and 'catastrophizing' situations. 4 Further, COVID-19 themed jokes and memes circulating on social media can lead to pandemic issues not being taken seriously, which increases the risk of infection, and associated distress and trauma. 4 Partnerships with parents and social influencers can guide students towards healthy information-seeking behavior and positive mental health strategies. Both increased social media use and traditional forms of education moving to digital platforms have led to majority of adolescents spending more time in front of screens. 5 Excessive screen time is often associated with poor sleep, sedentary habits, mental health problems and physical health issues. 5 Uncertainty, fear of getting the virus, sleep problems and worries about the future are some of the common mental health issues impacting adolescents in the face of the pandemic. 3 Increased incidence of mental health problems including stress related disorders, depression, anxiety and substance abuse have been described in adolescents during a pandemic. 3 Quarantine, trauma and grief during the COVID-19 pandemic further increase the risk of mental health problems. 3 A lack of adequate support system leaves adolescents to find resources by themselves in an underfunded area that continues to face J o u r n a l P r e -p r o o f stigma. Family and community supports to foster stronger relationships with children and adolescents and involvement of children safe-guarding agencies when needed can help mitigate risks. Five strategies to support students' mental health during the COVID-19 pandemic COVID-19 is a challenging time and a multi-layered action plan to support students' mental health during the pandemic is necessary: • Improving resilience of high schoolers: self-help strategies: The psychological impact of COVID-19 on adolescents will be felt both in the short and long term 3 and efforts should be made to equip adolescents with strategies to build resilience. Students can be encouraged to create short-term goals, schedules and taught mindfulness techniques to build resilience. 3 Acts of gratitude and compassion such as helping those in need by voluntary activities can also help. • Developing peer support networks (buddy system): Creating a buddy system allows HSS to form peer connections and check in on friends through network hubs or mentoring supports, either created by adolescents connected to each other eg, sports clubs, hobby clubs or facilitated by youth organizations. • Leverage digital technology for mental health support: HSS can access digital options for support and resources by exploring online portals that offer resource hubs and self-assessment tools. Self-help apps, digital counseling and telemedicine services will continue to allow increased access to mental health services from home. 6 • Collaborative partnerships: Community mental health organizations should partner with HSS, their families and schools to co-create mental health promotion programs. COVID-19 pandemic has provided us with an opportunity to be digitally connected and work on collaborative projects such as community mindfulness sessions. • Ongoing government support through its networks: As an HSS, I would like to advocate for greater cohesiveness in governance across all levels, regional, provincial, and national to mobilize and invest in community resources that promote engagement with local youth organizations. Benjamin Franklin famously said: Out of adversity comes opportunity. COVID-19 has presented with myriad challenges and the way we respond is going to shape the mental health of adolescents for the future. Aditya Thakur, Student J o u r n a l P r e -p r o o f Potential effects of "social" distancing measures and school lockdown on child and adolescent mental health. European child & adolescent psychiatry Mental health effects of school closures during COVID-19. The Lancet Child & adolescent health COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and adolescent psychiatry and mental health Social Media Use During Social Distancing. Cyberpsychology, behavior and social networking Screen time for children and adolescents during the COVID-19 pandemic ):e18848. -All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry J o u r n a l P r e -p r o o f Funding information:1. This manuscript did not receive any funding support Financial disclosure statement 1. The author has no financial interest or conflict of interest related to this manuscript. 2. The author wishes to disclose that he has received honoraria from Children's Mental Health Ontario (CMHO) and Reach Out Centre for Kids (ROCK) for various volunteer roles.