Page 16 - July Aug 2022 Newsletter Final_Neat

It Takes A Village

Ranvinder Rai, MD
Child and Adult Psychiatrist
“It takes a village to raise a child.” The African proverb, which highlights the notion that it takes an entire commu-
nity to raise and support the child, may also be considered for strengthening policies around promoting the mental
wellbeing of children. COVID-19- related pandemic has further surfaced systemic gaps in the psychiatric health
care model. During the pandemic, psychiatric emergency visits increased by 24% among children aged 5–11 years
and 31% among adolescents aged 12–17 years in 2020, compared with 2019 (7). On the other hand, the impact of the
surge in urgent psychiatric consultation was also noted in the outpatient setting. At our private practice, we noticed
an increased demand for urgent appointments for existing and new patients, as acute and intensive care facilities
were adjusting to the safety protocols such as social distancing, limiting the number of admitted patients, and the
staff shortage. With the increased demand, it was becoming clear that the outpatient clinics, especially small private
practices, were not equipped to deliver specialized care at such a rapid and intense level.

The COVID-19 pandemic has impacted children and families at various levels. The factors such as parents working
from home, while also meeting the basic caretaking and educational needs of their children, created new challenges
for parents. Some families faced the loss of employment, decreased income, and loss of social support networks in
the community. Exposure to multiple familial and community stressors can impact the parent-child relationship
and children’s mental health. However, recent studies have also indicated that protective factors such as adequate
emotional and social support for families were associated with lower perceived stress by parents, resulting in de-
creased cases of child maltreatment and improved child well-being (1).

Supporting parents and children at a ground level can be a step towards promoting the overall wellbeing of chil-
dren and mitigating emergency room crises. Whereas increasing the resources at a tertiary level of care helps man-
age the crisis episodes, the implementation of wellness-promoting services can bring overall improvement in the
health of children and families. Mental health promotion focuses on enhancing the strengths, capacity, and re-
sources of individuals and communities (2). Integration of wellness-promoting programs for youth, focusing on
early detection of risk factors and promotion of protective factors, may mitigate the potential risk of worsening
mental health in the future. For instance, there is adequate evidence of a link between adversities in early childhood
and the potential risk of impaired health in the future. One of the examples of early interventions is the availability
of community-based specialists in the private sector offering home visits to parents who struggle to navigate work
and caretaking duties after the birth of a child. Restoring parental mental health in these families would be vital to
further promote a healthy parent-child bond. This intervention may specifically be helpful for families who strug-
gle with systemic challenges including inadequate maternity leave, and lack of further family support.

Community-based specialists, ranging from fields of social work to public health nursing, can carry out roles and
responsibilities that are family-centered, provide care coordination, and resource linking, address social determi-
nants of health, and promote health care access (3,4). For instance, community-based specialists can act as liaison
workers by working closely with parents and school staff during periods of school transitions, hospitalizations, and
family stressors. By delegating such tasks, parents can continue to focus on further supporting children by engag-
ing in positive family activities during periods of transition. These community-based specialists can help mitigate
the crises by offering emotional and practical tips to traverse difficult situations that the families may face. In addi-
tion, community mental health specialists can bridge the gap in accessing psychiatric services for ethnic and racial
minorities by offering culturally sensitive screening and education for mental illnesses.
In addition to family support, schools can serve as platforms where the social programs promoting social aware-
ness, connectivity, and inclusivity, can be further integrated into the educational curriculum. Many countries with
universal healthcare have also been using schools as a way to provide preventative mental health care; for example,
Norway offers free mental health services for all youths under age 18. There, the preventive services for mental
health toward children and adolescents are directed through the school system, further removing accessibility and
cost-related barriers (8). In addition, environmental factors such as affordability of healthy foods, and the adequate
ratio of recreational parks in safe neighborhoods along with the accessibility to dietitians and exercise specialists

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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 16 July/August 2022