This weeks focus: COVID-19 and Mental Health
COVID-19 situation needs no introduction. We are all changing and adjusting our lives currently. As a service we are now mostly operating via video or phone-based sessions. We are trying to continue therapy as normal as possible and encourage people to continue therapy at this time for continuity and support. Many people are feeling a range of emotions, such as anxiety, boredom, sadness and frustration. We are also seeing increased anxiety, depression, OCD and eating-disorder symptoms.
These are some great tip put together by Mental Health Foundation New Zealand:
Find ways to connect:
Connecting with others is so important for our wellbeing and helps to make us feel safer, less stressed and less anxious. We can support each other to get through this.
Some ideas to connect include: writing emails that share a favourite memory, playing video games with mates, playing online scrabble or other board games, joining or starting a virtual book club, sharing a favourite karakia or waiata with your friends on social media, having video catch-ups with workmates, calling friends and whānau who are in self-isolation and reaching out to neighbours to ensure everyone has what they need to get through.
Find ways to take notice:
Notice the beauty in the world around your home. Take time to feel the sun on your skin, breathe in fresh air whenever you can, make a list of what you’re grateful for, take the time to thank someone for how they make you feel, do a mindfulness exercise on YouTube, watch the plants in your home or outside your window growing and changing with each passing day.
Find ways to be active We know this is a tricky one without gyms or sports but it can be done! Play ‘the floor is lava’ with the kids, do a yoga class online, try out a new workout on YouTube, go for walks or runs outside (just stay 2m away from others!), use the cans in the pantry as weights, stretch.
Find ways to give Give compliments, think about a skill you have you could share with your whānau/flatmates/friends, share a favourite recipe, let people know you’re there to help (and tell them what help you can offer – e.g. can you pick up food for a neighbour when you go shopping? Can you help your friends’ kids with their English homework via Skype?). Check in on neighbours and members of your community who may need to hear a cheery voice or need a helping hand.
Find ways to keep learning:
Staying curious and engaging with the world around you is a great way to uplift your wellbeing. Pick a question you’ve always wondered about and take some time to look it up. Call your parents or grandparents and ask them questions about life when they were growing up. Research your whakapapa or family tree. Look up stories, myths and legends from different cultures.. Download an app like Duolingo and start learning a new language. Ask your tamariki/kids to teach you something they learned at school.
Spend time with nature:
While staying at home doesn’t mean you have to stay indoors all the time, it might feel safer for you to do so! Think about how you can connect with nature from your home. Can you bring some nature indoors? Put up pictures of nature settings. Listen to nature sounds – birdsong is a lovely background noise while you work. Open the windows as often as you can. Take time every day to feel the sun or the wind or the rain on your skin.
Keep taking your medication:
Don’t stop taking any of your regular medication without first talking with your doctor. Phone or email your GP to get any new prescriptions you may need. If you’re staying at home and that’s throwing off your routine, set reminders to take your medicine when you need to.
If you're currently getting help with your mental health, continue with this if possible Talk to your GP, counsellor, case worker or mental health team about how they can continue supporting you. Can your appointments take place over the phone, via email, text or video chat? What tips do they have to help you get through? Who can you call if you need help urgently? Write this down so you have it handy when you need it.
Great story for children explaining COVID-19 and coping:
This weeks focus: Victorian Bushfires and Trauma Support
Here at Ivanhoe Psychological Services we take this seriously and offer our support to all victims of the Victorian Bushfire victims and their families.
Some of our therapists have, in the past, worked with Black Saturday victims and in the affected areas, as well as with people affected by the traumatic incident/s.
Alternatively, we also offer our services to people who have families or friends affected and are in a state of grief or shock and require immediate trauma-intervention.
The Australian Government has released free therapy sessions (without needing a mental health care plan) for those affected by the recent bushfires. At Ivanhoe Psychological Services we will be offering sessions face-to-face and/or via video-link or phone.
Please see the Victorian Government site for further information:
Handout on surviving a traumatic event:
This weeks focus: Gender Dysphoria in Children and Adolescence
Julia McCarthy has a keen interest in supporting young people and adults who are gender-diverse. At Ivanhoe Psychological Services we believe it is important that everyone receives support they are seeking in a safe place. The RCH and Kids Health Info have put together a great info guide explaining gender dysphoria. We have included it below for your information:
Gender dysphoria is the distress felt by people whose sense of being male or female differs from the gender they are assigned at birth based on their sex. For some people, the difference between their gender identity and physical characteristics can cause significant and persistent emotional distress.
The terms ‘transgender’ or ‘gender diverse’ are often used to describe these identities. About 1.2 per cent of Australian school children (about 45,000 children) are thought to identify as transgender. Being transgender or gender diverse is seen as part of the natural spectrum of human diversity.
Signs and symptoms of gender dysphoria
Almost all children begin expressing their gender identity at two to three years of age through their preferences for particular clothing, toys and interests. Many transgender or gender diverse children will also express their gender identity around this time, and this may differ from what parents are expecting.
It’s normal for children to experiment with gender roles. Many children will not desire any form of transition and will feel comfortable with their gender identity.
For others, living in their birth-assigned gender role is extremely distressing. In these cases, it is important for families to discuss with their child or teenager what they need to do to protect their physical and mental wellbeing, and consider seeking professional assistance.
For many transgender children and teenagers, the onset of puberty, with the development of secondary sex characteristics (e.g. breasts, changing voice) that don’t match their gender identity, is a particularly distressing time.
Difficulties associated with gender dysphoria
Being transgender or gender diverse is not a mental health problem. However, many young people with gender dysphoria also experience mental health concerns.
In younger children, this is often in the form of emotional and behavioural difficulties.
For teenagers, there are higher rates of depression, anxiety, self-harm and suicide attempts.
A supportive family and school environment that affirms the child’s gender identity helps protect young people against these difficulties, and can improve mental health outcomes.
When to see a doctor
Knowing when a child needs support can be difficult for parents and carers to determine. If your child or teenager has been showing ongoing distress about their gender, visiting your GP is a good first step to take in seeking professional help.
In Victoria, The Royal Children’s Hospital (RCH) Gender Service will see children aged three to 17 years. You will need a referral from a GP. In other states, talk to your GP about what services are available.
The RCH’s Gender Service team includes child and adolescent clinical psychologists or psychiatrists and paediatricians who specialise in gender identity. The team will work with your child to assess their gender diversity or gender dysphoria. Following the assessment, support and treatment pathways will be proposed and discussed with your family.
Treatment for gender dysphoria
Treatment for gender dysphoria depends on the individual needs of the young person and their family. Treatment aims to support individuals in affirming their gender identity, with a focus on physical and psychological wellbeing.
Treatment before puberty
For children who haven’t yet reached puberty, treatment focuses on gender affirmation through talking to the child and their family and providing support for home and schooling environments.
Treatment after puberty
Once puberty has started, treatment options include the use of puberty blockers to stop the physical changes of puberty that the adolescent finds distressing.
Known as Stage 1 treatment, puberty blockers are used mostly in early puberty. Stage 1 treatment is reversible.
Stage 2 treatment involves using gender-affirming hormones (oestrogen or testosterone) to change the body to be more consistent with the teenager’s affirmed gender. Depending on the circumstances, this treatment can usually be started around the age of 16.
Stage 3 treatment involves surgery, which is not commonly undertaken before adulthood.
For all forms of treatment of gender dysphoria, your child should be monitored and treated for other medical and mental health difficulties that may occur. It is also important that families and schools are supported in maintaining a gender-affirming approach.
Treatment focused on changing someone’s gender expression and identity to match the gender assigned at birth (known as conversion or reparative therapy) causes harm to the young person and is considered unethical.
Key points to remember
Children whose gender identity differs from the gender they were assigned at birth are known as transgender or gender diverse.
Gender dysphoria is the distress a child experiences about the difference between their gender identity and their physical body.
Treatment for gender dysphoria can take many forms, and is always tailored to the individual and their family.
After puberty has started, treatment may involve puberty blockers.
For more information
The Royal Children’s Hospital: Gender Service
Common questions our doctors are asked
Are stage 1 and stage 2 medical treatments for gender dysphoria reversible?
Puberty blocking medication (stage 1 treatment) slows the development of sex characteristics (e.g. breasts, underarm hair, voice changes), while allowing time for the child to develop cognitively and emotionally. This treatment is reversible. Gender-affirming hormone treatment (stage 2), which initiates puberty in the teenager’s affirmed gender, is only partially reversible.
What is the difference between gender and sex?
Sex indicates whether a person is male or female, according to their sex chromosomes (female XX, male XY). These determine a person’s physical appearance (e.g. breasts, penis), internal organs (e.g. ovaries, testes) and hormones. Sex is not able to be changed with medication or surgery. Gender is how an individual identifies in society – their innate sense of being male or female."
Developed by The Royal Children's Hospital Gender Service. We acknowledge the input of RCH consumers and carers.
Reviewed September 2018.