Mental Health focus: Dr. Triveni Joshi interview

Concerns around the implication of prolonged lockdowns for children’s education and development have abounded over the last few months. Having recently spoken to campaign groups and other concerned stakeholders for our feature on self-employed parents, Finito World decided to follow up with Dr Triveni Joshi. 

Dr Joshi is the Medical Director at Cygnet Joyce Parker Hospital, and a Children and Adolescent Mental Health Services (CAMHS) Consultant. Dr Joshi’s main areas of interest are neurodevelopment disorders and psychosis. She also works with young people suffering from depression anxiety and early childhood trauma. Dr Joshi has extensive experience across the NHS and independent sector, as well as experience working in Specialist ASC schools and Tier 4 service in-patient units.  

How concerning do you find the lockdown situation for children with them being out of school and having a lack of social contact?

There is evidence that is available suggesting there were some groups of young people who coped well for some time without much reduction in life satisfaction. However, the overwhelming evidence suggests particular groups of young people such as those with pre-existing mental health conditions, the economically disadvantaged, females and LGBTQ young people have been adversely affected in terms of their mental health and wellbeing.

Lack of social contact, not having their outlet for continuing to be actively engaged in activities, changes in the way support could be accessed, anxiety about school work and uncertainty about what the future holds, may explain some of the reasons why young people have struggled.

How does that lack of social stimulation affect their neurological development?

To be honest this will need further research. I have so far not seen any evidence regarding this but it’s probably too soon to be able to draw any conclusions. 

There is a publication titled ‘Babies in lockdown’ which was written following a survey between April and June looking at lockdown babies and the impact this may have in the long term. The conclusion from that study was that there could be severe and long-lasting effects on these babies. 

However, we are seeing a wide range of symptoms of psychological stress due to lockdown with an increased number of young people presenting with low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms.

As mentioned previously, young people are not socialising as before and there is an increased use of social media which has its pros and cons. The fact that they’re not socialising as usual has an effect and using social media a lot more exposes them to false messages about lockdown and COVID-19, that might have an impact. There is a possibility of exposure to more cyber bullying and other online risks with young people spending more time on social media.

I think the messages on social media regarding COVID-19 have been very varied and for young people who are probably already anxious, that can create a lot of anxiety, not knowing what it might mean for them or their family.

For those young people who have anxiety disorders such as OCD, the messages of COVID-19 may have exacerbated their fear of contamination and may have increased symptoms such as hand washing and any other safety behaviours they may have.

That is interesting you talk about the messaging, because I just read a piece a couple of days ago about how the government has bought a lot of advertising on TikTok to target young people with quite scary new adverts. What do you think about that? Is it maybe a bit harsh on young people or do you think it’s necessary to get them to comply with the rules?

I cannot see how that will increase compliance because fear is not one of the best motivators for anyone. I think honest, transparent, consistent messaging is far more helpful.

Scaring someone takes away from the message itself and if it’s too harsh, can have a negative impact on young people. It might increase anxieties that they already have and could disengage young people. I don’t think guilt or fear is best way of engaging young people. 

You suggested you’re seeing many patients with anxiety around contamination. Have you seen an increase in referrals for OCD and related conditions?

From my own experience and talking to colleagues at the London Psychiatry Clinic and in the community, there’s been an increase in a wide variety of referrals such as anxiety, low mood, depression, OCD and eating disorders. Referrals are being made from GPs and other professionals as well as schools, anxious parents and carers. 

How do you think that we as a society, and with our health care, can help children that are suffering mentally now, and those that will continue to feel the impact when we leave lockdown?

By staying connected. I think all of us need to be aware of the impact of lockdown and loneliness and take small steps to stay connected to young people within our circle. Give someone a call or be available in the variety of platforms that you have at your disposal. 

If you are a parent or know other parents, be supportive of each other. It is equally important that adults take time for their own breaks and look after themselves so they can better support others. 

It is difficult and it is stressful but we need to focus on quality time with each other and each day decide if there is a need to plan a fun activity to provide something positive to look forward to.

If the weather allows, outdoor activities are a good way to get out of the house and get exercise, this always helps.

As far as healthcare goes, we have to be more flexible in our working. Virtual appointments are readily available, meaning we can reach out more. There are some young people who might struggle with online appointments, so we need to ensure we also offer face-to-face appointments following safety guidelines.

We also should be offering quality information around COVID-19 and related anxieties. 

Websites such as Mind, YoungMinds and Children’s Society have some really good information for young people on how to cope during this time. 

As we know, schools have already adapted their way of working to safely provide education to children. Some identified vulnerable children are also attending schools and getting the support they need.

We also need to be prepared for when children come out of lockdown as however positive a step this is, we need to be aware that this is a change from what they have been used to which will create its own problems. We need a phased return, to be flexible and to factor in that some children may have increased anxiety returning. 

Testing will be another thing some children will be scared of. We need to support the schools, parents and children in navigating this without disadvantaging anyone. 

I read that some neurodivergent children have actually thrived educationally in lockdown because learning remotely really suits them. Do you think that this might actually be a bit of a turning point in understanding that different children will need to learn differently and perhaps some neurodivergent children can maybe adopt a more flexible approach?

We do need to look at the whole of last year and have some take-aways from it. 

We have always known that schools can be difficult for some young people and there has been a percentage of young people who have been home schooled previously and are doing well. Maybe it is time to start looking at flexible ways of learning and teaching, utilising the best of both worlds and taking into account different home circumstances. We are used to traditional ways and this may be the time to challenge those traditions and explore new ways and new methods to support young people through education. 

As you said, when children come back after such a long period of isolation they will need to be cautiously reintroduced, what kind of behavioural symptoms do you think might occur when children go back to school?

As mentioned previously, some young people will struggle with going back to school and they may struggle with the increase in social demands that they will be exposed to.

While we have discussed the downsides, reintroduction to a different routine after a while is always going to be hard.

We may see increased anxiety in facing those demands, as well as increased anxiety about catching the infection and we may see worries about what next and if this could possibly happen again. 

One of their spokespeople for UsforThem told me last week that they’ve been speaking to school governors and headteachers that are quite worried because there’s been a significant increase in safeguarding referrals, particularly incidents of abusive trauma at home. Are you concerned that there might be a tidal wave of trauma to come from this generation of children that may have been in unstable homes?

Yes, during lockdown there has been an increase in referrals to safeguarding. Increasing difficulties within the family, stresses around finance, increase in parental mental health problems, children not having their usual contacts or people they could talk to have probably all contributed to difficult situations at home and led to increased referrals. 

As we come out of lockdown, we need to ensure the mental health and emotional wellbeing of children and young people is high on the agenda. We need to ensure we pre-empt and are prepared to support young people so that the long-lasting negative effects of lockdown are minimised. 

Dr Triveni Joshi is a leading consultant psychiatrist in London who specialises in child and adolescent psychiatry. She has over 17 years worth of experience in psychiatry and over 14 years working with children and their families. Her areas of expertise include autism, mood disorders, behavioural problems, anxiety, ADHD and OCD.

For further information:https://londonpsychiatry.clinic