Families are continuing to cope with challenges during the pandemic and many are juggling multiple roles, including working from home and caring for children and elderly parents. The American Psychiatric Association Foundation recently hosted a virtual town hall addressing Mentally Healthy Families in Times of a Pandemic with geriatric psychiatrist Uyen-Khanh Quang-Dang, M.D., M.S., Palo Alto Foundation Medical Group, and psychiatrist Lisa Harding, M.D., clinical instructor of psychiatry at Yale School of Medicine.

One overarching theme for helping families cope was creating boundaries for both time and space—separating work time and space versus family/personal time and space. The panelists suggest that when it’s possible, families should try to have places set up for specific activities and set schedules so there is a routine that everyone understands and expects.

Caring for elderly family members

The pandemic has intensified ongoing role reversals between adult children and elderly parents for many families, Dr. Quang-Dang said. Everyone is dealing with significant changes and ongoing uncertainties, and elderly parents may need extra help adapting. Adult children may struggle with concerns over their parents’ safety, such as seeing one’s parents interacting with others without a mask or visiting people or places they don’t feel are safe. Dr. Quang-Dang emphasized having patience and explaining the reasons for safety measures and providing information/resources when appropriate. She also recommends that those helping elderly family members:

• Teach them to use tools for independence and connection – such as delivery of food, supplies and medicine
• Encourage them to talk with their own friends regularly – help them with Zoom, Facetime
• Encourage them to limit their time watching news
• Ask for their advice/help (such as problem solving with kids)
• For relatives living at a distance, schedule virtual get-togethers at a time that works for well for everyone so it can be something everyone can look forward to

Try to avoid raising your voice or trying to control elderly relatives—this can contribute to them feeling sad, helpless, defiant or like a burden. To start a conversation, begin with an “I” statement (such as ‘I’m concerned about….”) and use open-ended questions.

Dr. Harding offered some tips for helping children/teens cope:

• Make sure your child/teen has enough unstructured time (to play, read, be with friends safely)
• Encourage your child/teen to let you know when there’s too much going on and they need a break
• Schedule time for children to connect online with relatives (including activities like reading or playing games)
• Look for opportunities for physical activities and getting outdoors
• If a child is frustrated by a particular activity or assignment, consider breaking up the task into smaller pieces
• To help children calm down, try some simple breathing exercises
• Regularly scheduled alone time may be helpful for older children and teens (and for yourself)

Another suggestion was to make stress relief a family event. The Foundation’s family resource Notice. Talk. Act.™ at Home includes an example family calendar of activities (see below).

Dr. Harding suggests keeping an eye out for changes in behaviors and to trust your gut if you feel your child is having trouble and may need help. Reach out to your pediatrician or a mental health professional if you are concerned. (See more on youth mental health during the pandemic.)

Self-care

Another overarching issue is that of self-care. "We can’t be there for others if we are depleted ourselves,” notes Dr. Quang-Dang. To be in a good position to take care of others, check in with yourself first—your energy level, patience, ability to focus.

Dr. Quang-Dang suggests trying to let go of expectations of control and accept the uncertainties of the situation. One specific tip was to thoughtfully plan activities at a good time for all. For example, consider checking in with an elderly relative early in the day, rather than at the end of a workday when you might have less energy and your relative may be tired. Among her other tips:

• Reach out to friends who are taking care of kids or elderly parents to share concerns, tips and support.
• Give yourself some down time away from screens, especially right before bedtime.
• Don’t forget the basics of overall wellness for you and your family – healthy eating, enough sleep and regular exercise.

We all have different things that make us tick and fill our cup, notes Dr. Quang-Dang—for some it’s exercise, for others its reading or catching up with friends. She suggests people figure out what energizes them and gives them strength, and then make it a priority. Share it with family so they understand why it’s important. Encourage family members to do the same so everyone’s needs for different types of self-care are respected.