Preparing to Support Adolescent and Young Adult Mental Health for Life Beyond COVID-19 Will Require Time, Support, and Patience

On May 13, 2021, the CDC announced that, with some exceptions, fully vaccinated people in the United States no longer need to socially distance themselves or wear masks indoors. The collective exhale was almost palpable. As we all take stock of what we can expect next, two things are quite clear. First, returning to any previous state of normalcy will likely be elusive for some time and may never happen for many of us. Second, the unusual and stressful nature of the past year, coupled with continued uncertainty about the future, will have lasting effects on our individual and collective mental health. While not all mental health effects will be negative, they will require a collective level of patience, understanding, and responsive support.

In the past several months, The Jed Foundation (JED) has supported thousands of schools, mental health providers, caregivers, and youth as they navigate the challenging terrain of a global pandemic. As we look forward to once again moving out into the world and into schools, businesses, restaurants, and other spaces where we gather to learn, work, or play–there are several considerations to keep in mind.

Achieving positive mental, social, and emotional health will take time.

For many of us, the prospect of re-engaging with life outside of our homes after the past year is rejuvenating and exciting. Although some found pandemic living a welcome respite from an otherwise stressful life, many are eager to leave behind the need to stay home as much as possible, have a ready supply of masks on hand, and figure out how to navigate social distancing in small spaces. Moreover, hearing about daily loss of life (or experiencing loss directly), witnessing the closing of small businesses, thinning of store shelves, and emptying of office spaces has evoked feelings that many of us instinctively find stressful and unsettling.

And yet, not only does any semblance of normalcy remain somewhat distant, many report feelings of residual fatigue, grief, and malaise. The accumulation of loss, sustained stress, and trauma that has marked a year filled with COVID-19, racial trauma and reckoning, and political polarization and uncertainty has left many of us feeling what some describe as “languishing”–a sense of stagnation, emptiness, and a general lack of interest–basically, feeling “blah.”

What this means for the future is unclear. Research shows that deleterious mental health effects of similarly impactful historic events often endure well beyond the event itself. Since survival is a primary psychological goal during traumatic situations or in times of deep and chronic stress, such as a pandemic, full experience of the effects of the stress often happens later, once it feels psychologically safer to process the experience. Because of this, some have proposed that this may be followed by more serious and long-lasting depression, anxiety, and other mental health challenges, an assumption supported by current reports of high levels of anxiety in both young people and adults.

Some individuals, families, and communities were disproportionately impacted.

COVID-19 fatigue is made even more acute by the fact that for many individuals, the impacts of the past year and a half were barely survivable. Millions of people lost loved ones, and some people lost multiple loved ones–many without being able to say goodbye in person or hold a proper memorial. And since coronavirus disproportionately affected Black, Indigenous, and People of Color (BIPOC) and women, whole communities were particularly hard hit, a fact also reflected in the also disproportionately elevated rates of mental health effects in BIPOC communities. These challenges were compounded by vivid reminders and experiences of long-standing race-based discrimination, amplified by the murder of George Floyd, the demonstrations that followed, and the rise in Asian hate and bias affecting Asian Americans and Pacific Islander (AAPI) communities. Political polarization hit an all-time high and remains disruptive and troubling. Moreover, individuals and families already struggling with economic, educational, and mental health challenges will continue to grapple with difficulties in meeting basic needs.

It is against this larger social backdrop that teens and young adults were forced to navigate disruptions in every realm of life–from missing graduations, internships, schooling, and the myriad of extracurricular activities that they relied on for exercise, diversion, and connection to grappling with major developmental disruptions, leaving many of them feeling purposeless.

On top of this, remote and hybrid schooling resulted in educational gains for very few teens and young adults; many lost academic ground. And, while everybody increased reliance on technology because it was often the only link to work, school, and social life, the amount of time spent on social media, gaming, and other problematic internet use activities increased for young people, in particular. In addition, the opportunity to embrace the age-appropriate developmental task of navigating independence was acutely challenging and for some, resulted in a full-scale halt. The loss of focus and goal-directed activity contributed to a sense of loss of purpose and hope–both major contributors to mental health challenges.

And, we are not out of the woods yet.

Despite the fact that the worst of COVID-19 seems to be behind us in the United States, we are unlikely to return to life as usual anytime soon. In addition to the sustained economic, political, educational, and social fallout we are struggling with, the cumulative mental health impact of the past year and a half  likely will remain significant. Drug overdoses among adults and young people have increased and a number of school systems report that they have lost track of a significant number of students and are not certain if they will return. Families face unique challenges, as well. Divorce rates have crept up and are expected to continue to climb and systems designed to support families and young people in crisis, such as in homes where abuse is occurring, have been compromised and will take time to recover.

Such changes are occurring in a landscape of already emerging negative mental health effects.

Rates of substance use, depression and anxiety in young people (and adults) are on the rise; research suggests that over half (56%) of young adults (ages 18-24) report feelings of anxiety and/or depression and one in four report substance use and suicidal thoughts–significant increases from the previous year. This is echoed by significant increases in private mental health claims for youth ages 13-18, which show doubled rates of mental health service use over the previous year. Similarly, recent CDC data documents a 31% increase in mental health-related emergency room visits for children between the ages of 12 and 17 from March to October of 2020 compared to the same period in 2019.

The disruptions we’ve experienced are likely to have significant downstream consequences for youth, families, and ultimately for society at large. Experts suggest that many young people will experience profound and long-lasting mental health effects, disproportionately accrued to youth with preexisting mental health conditions, youth from marginalized or minority communities, and youth lacking supportive social networks. In addition, teens and young adults who found online learning exceptionally challenging or who relied on educational support disrupted by the pandemic may return to the classroom with significant educational gaps. For many families, the economic protections put in place by local, state and federal governments may give way to duress as protections are lifted and current and backlogs of rent and/or mortgage payments come due. Moreover, shifts in work and school arrangements (e.g., in-person schooling to fully digital learning; working in an office to working from home, etc.), meant that youth in families where abuse was occurring were left without critical wrap-around services and will likely need deep support and connection.

It is important to note that, despite the clearly deleterious effects of the pandemic on teen and young adult mental health, not all young people and families suffered. One study of COVID-19 effects on youth ages 6-18, for example, showed that while nearly 70% showed deterioration in at least one mental health area assessed, 19–31% of children/adolescents experienced improvement in at least one domain. Notably, the most important predictor of mental health deterioration was the stress that resulted from social isolation.

Adjusting to living in a “post-normal” world opens new opportunities. 

As difficult as pandemic living has been, for some individuals, families, and communities, the return to life as they knew it pre-pandemic is not entirely welcome. Young people and adults who struggled with social anxiety or other pre-pandemic mental health challenges that make being in high stimulus environments challenging, for example, have found solace in the much smaller social circles and more tailored learning and working environments demanded by pandemic life. Teens and young adults who experienced difficulty in school settings–because of bullying, overstimulation, poor environments for academic learning, or challenging social interactions–may be apprehensive about returning to school and other youth-focused settings. And some families and individuals have found that a slower pace of life, more sustained intimacy and social connections with family and other loved ones is rewarding; many do not want to return to a life where work, school, and family life are as siloed as they have traditionally been. Lastly, opportunities to more functionally tailor work and family life balance has opened the door to imagining a different way of living post pandemic.

Many of the adaptations we made during the pandemic are worthy of integrating into the post-pandemic world. Teletherapy, for example, turns out to be an excellent modality for many people, including young people who find in-person sessions off-putting or difficult to maintain and digital mental health apps are prolific and easy to access/use. Opportunities to integrate remote and in-person learning and working are critical pathways for accommodating heightened demands for greater flexibility in work-life balance and delivery of educational offerings at all levels. And, being able to work from home has been particularly useful for people with disabilities who found work accommodations insufficient but have benefited from the work arrangement flexibility. Moreover, for better or worse, the pandemic revealed a number of seriously compromised healthcare, economic, and support provision systems. While challenging, we can collectively use this opportunity to reimagine and better align service provision to individual, family, and community needs. In short, it will be important to integrate the positive lessons learned in the pandemic year to set up systems that both preference and encourage well-being, broadly conceived.

Recommendations

In light of the challenges we face as we move into post-pandemic life, we urge particular consideration of the following:

1)     Prepare for a different educational landscape. Assume that meeting expected learning milestones was compromised this last year for many students. Prepare for developmental arrest in some areas, especially: educational attainment, social skills and comfort, capacity to withstand a lot of stimulus, capacity to focus, and endurance. It will take time and coaching/teaching to rebuild skills that teens and young adults need and use regularly. We may also see some behavioral and/or mental health issues in this adjustment period, even among young people who were not struggling prior to COVID-19. Have patience and set realistic expectations for staff and students.

2)     Expect and address emotional, social, and mental health needs. Clearly recognize the impact that the last year has had on all domains of student mental health and overall well-being. Plan to move back to in-person learning slowly, with extra time built in to assess and address student readiness and support needs. Find ways of checking in with all young people through informal connection channels or through administering brief assessments of student mental health status and connecting to treatment when needed, broader family pandemic year impacts, and/or learning status and readiness.

3)     Equip staff to notice and respond in functional and supportive ways to mental health needs. All faculty and staff should be educated to recognize signs of struggle and know how to reach out to offer support, as well as be knowledgeable about where to refer students for professional help when needed. Expectations for learning, focus, and sustained attention should be kept at a minimum until it is clear that the pace can quicken. Staff will need to know how to create and sustain trauma-informed healing spaces and support.

4)     Integrate culturally responsive and humble approaches to supporting youth and their families. Last year’s mental health impact was not solely linked to the COVID-19 pandemic. The racial trauma experienced as a result of George Floyd’s murder surfaced painful and long-standing anger, despair, and frustration. A return to pre-pandemic systemic racism is not only undesired, but unethical. Schools, youth-serving organizations, workplaces and businesses are all responsible for integrating the lessons of the past year and actively creating culturally responsive environments focused on equity and inclusion. Since this conversation is one that is in many ways just starting at a broader social level, creating space for ongoing exploration, expression, and healing is imperative.

5)     Create spaces and opportunities for youth to process and understand their experience. Schools and other youth-serving organizations can assist students in understanding and sorting through their experience by creating dedicated time, space, and techniques like journaling, talking circles, culturally-grounded rituals and healing approaches, artistic expression, body movement, and interactive group and/or self-reflective activities to encourage review and integration of their experience. Techniques can be used to help teens and young adults understand and integrate both silver linings and to identify hopes for the future–some of which may have changed as a result of the pandemic year experience.

6)     Focus on building connectedness. Connectedness is a protective factor for mental health and youth desire for social connection is likely to be high. At the same time, many young people may be awkward and/or uncomfortable in high density, high stimulus, and high expectation environments. Make space and time for reacquaintance and social connection activities–between students and between young people and staff. Ideally, every young person will have one-on-one time with a staff member dedicated to welcoming a student back, establishing a personal connection and, when possible, assessing social, emotional, and mental health status and needs.

7)     Conduct periodic assessment. As is often true at the beginning of a long time away from friends and routines, the excitement and enthusiasm may mask vulnerabilities and challenges that have yet to surface. Be sure to maintain personal connections with young people wherever possible and watch for signs and symptoms of a struggle over the course of weeks and months.

8)     Prepare for an increased need in social support programs. Prepare for increased need in extracurricular programs to increase childcare hours for families working new or extra jobs. Given that some families may be facing ongoing financial struggles, prepare for an increased need for programs like free and reduced lunch and breakfast.

9)     Support staff needs. Staff will return with their own loss experiences, mental health impacts, and processing and integration needs. It is common for people who work in youth-serving settings to be naturally attuned to serving and supporting youth, but this means that they may inadvertently minimize or neglect their own needs. Systems should be as mindful about creating spaces for staff to process, integrate, and innovate going forward as they are for youth.

10)   Keep the things that worked. Teletherapy, remote learning and work, and new strategies for establishing and maintaining work-home balance are important to continue, even as the pandemic fades. Taking time to assess what worked in families and systems is a worthwhile endeavor.

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