Jordan: I’m fairly certain that all of us would, if asked, want all of our kids back in school in September. Look, we’ve done episodes, multiple episodes of this podcast about how necessary that is. It’s necessary for the sanity of parents. It’s necessary for mom and dad’s productivity. It’s necessary for the economy, which can’t return to normal until parents have normal childcare. And what we’ve also done in those episodes while having those conversations, is to make a pretty general assumption that kids need to be back in school in person as usual. That it would be good for the kids, good for their development and their futures, and importantly good for their mental health. Today we’ll ask: What if that assumption is just wrong? What if there are things about returning kids to school in the middle of a pandemic that we’re not taking into account? What if all the reasons that we do need schools to be open again don’t matter if we can’t do it safely? And what if the threat and the risk of COVID-19– just the threat and risk, not necessarily the virus– makes traditional school, the way we’re used to it and the way we want it to be when it comes back, unsafe for the kids. What do we do then? I’m Jordan Heath Rawlings. This is The Big Story. Tyler Black is a suicidologist, an emergency psychiatrist, and a pharmacologist based in British Columbia who wrote one of the more counterintuitive Twitter threads, at least for me, on the problem of sending kids back to school. Hello, Dr. Black.
Dr. Tyler Black: Hi, thanks so much for having me.
Jordan: No problem. Why don’t you first of all, just to sort of set the groundwork for our discussion, explain emergency psychiatry and how it applies to this situation we’re in today?
Dr. Tyler Black: Sure. So, so at my hospital, we have a unique program. Often child psychiatrists are on call for the emergency department or our units are used for both emergencies, as well as longterm care. But in my hospital, we’ve had an emergency unit specifically dedicated to psychiatric crisis in children. And so for the past 11 years, I’ve been the medical director of that unit. We admit about 400 children a year in BC and the Yukon for psychiatric crises, which would include suicidal thinking, suicide attempts, severe conflicts and the family, bipolar disorder, schizophrenia, anxiety, and lots of challenges with home and school. But then we’re also on call for the emergency department, where we see another 1000 to 2000 kids per year in similar crises. And as this, you know, pandemic has developed, one of the reasons I wrote the Twitter thread that’s gone out there is because I’ve seen the nuance of my job being more busy during school months and school days prior to the pandemic. So our admission rates increased. The number of kids who come to the emergency department increased. The number of suicide attempts increased. And definitely the number of suicide completions increased for children during school days and school months. And so I’ve always just been frustrated to see the framing of the return to school debate being about going to school being good for children’s mental health, and staying home from school being bad for children’s mental health. Because we actually haven’t seen that reflected in the work that I’ve been doing.
Jordan: So what goes through your mind then, from that point of view that you just described, when we discuss reopening schools and how to do it safely and what we need to consider?
Dr. Tyler Black: Well, I think what we need to really look at is the tremendous variety in which children require education. Now, there isn’t a lot of scientific support for individualized education plans for each child. But at the same time, we know that many children don’t fit the square hole or the round hole of the educational model that sort of predominates. And when we see more educational options for children, especially when we account for mental health disorders, neurodiversity, and even just different ways that kids appreciate or want to learn, and certainly as we hit adolescence, we start finding out what kids are more interested in and what they want to be doing. If we have the flexibility of a system to account for all of those things, we run into less problems. I can’t overstate how often one of my jobs in the emergency department is to call a school counsellor and to ask for forgiveness for lateness or not attendance, or, you know, a delayed exam or even a different type of environment to do the exam. And as we add that flexibility to schools, our kids do better.
Jordan: What does in-person schooling do for kids, both good and bad, then? I’m just trying to get a sense of what we are potentially missing if we do it virtually, and also what the drawbacks are to putting all these kids back in school, taking even COVID out of the equation.
Dr. Tyler Black: I certainly am a fan of schools generally, and education is crucially important for children. So, I think there’s a lot of good that schools provide. I often use the analogy that school is like a child’s full time job. There’s the work to be done. There’s the boss that assigns it. There’s the coworkers and classmates that are just proximal to you. They’re not necessarily people you select, they’re just hanging around beside you. There’s the friends you develop within the work structure. Then there’s the overtime work, the stuff that you take home. And with any child who’s going to school, the school itself becomes the full time job. And of course, some of us love our jobs. I particularly love my job. I know many people who do. And some of us are profoundly stressed out by their jobs. The job requires of them more than they can personally do, or there are systemic barriers in the way, or there’s someone who’s harassing you, or there’s racism, or their sexism. And so we see in, in all of these environments, it’s possible flourish, and it’s also possible to not flourish. And even worse it can be possible to be targeted. Bullying prior to the pandemic was one of the main concerns about in-person schooling when we thought about children’s mental health. And that nuance of the bullied child at school has completely evaporated as we explore returning to school in COVID. So there’s pluses and there’s minuses. And really what I’m trying to do is just to interject that nuance, that we may want to have an adaptive approach when it comes to the mental health of our kids.
Jordan: When you say, as you did earlier, that, you know, individual learning plans could be one way to look at this, and that we need to be more adaptive in terms of how we do school in general, even not in the middle of a pandemic, how much of that are you seeing in the actual school reopening plans themselves? Cause my sense of them has been like, we just have to make it as safe as possible and if that means, you know, the bare minimum, then the bare minimum is what we’re going to do.
Dr. Tyler Black: Yeah. I think generally I’ve seen relatively good response on the Canadian side of return to school programs. Obviously our Southern neighbours in America just really seem to have a lot more of a black and white return of school or not option, though there are some districts that are doing it very well. And I think in general you want to see that flexibility. I think in British Columbia, for example, there are phases, and as the pandemic spreads, the phase can change, and schooling options would change. But I also think that our view is somewhat tinted. We’re finding out more and more that kids can absolutely get this infection, because for about the first three months of the pandemic, parents were keeping their kids home. And so we have all this idea that maybe kids don’t get infected, but it was probably just parents keeping their kids at home. And in the same way, we have this opinion of what online and schooling looks like, because for about three months, a bunch of teachers had to very quickly and quite urgently convert their offline material to online. They weren’t specifically trying to take advantage of computer learning. They weren’t using games and interactivity and delayed response and the ability to listen to this podcast, or watch a video, they weren’t taking those things into account. They were just kind of cramming offline school into online. And so I think a lot of people’s opinion on what online school could look like has been unfairly maligned by the fact that it was done in an urgent way. And of course we could plan these things better. I can’t think of a better teacher and capturer of children’s attention than computer media. When we look at video games and Twitch streaming and all sorts of things, kids are drawn to watching things on a computer and they learn a ton. I would really like to see schools really embrace the online format, such that it doesn’t seem as strong a disadvantage.
Jordan: What kinds of opportunities are there for us to learn during this time about the way children learn, I guess, and to solve some of that complexity you mentioned earlier about some kids thriving and some kids not in our current format.
Dr. Tyler Black: I think, you know, I think some of the big flexibilities that I’d really like to see that would be the most science supported would be looking at the hours of learning. Getting up in the early morning and going to school is not necessarily best for a lot of kids and a lot of troubles and challenges and even fights at home are around bedtimes and the early morning wake up and the inability to get woken up in the morning. So, you know, I’d like to see that be one of– maybe the priority is that attendance maybe isn’t as important as we believe it to be. I always talk to my medical students and residents when I’m teaching about the stresses of school, I always explain that all of us at some point have taken that quote unquote mental health day, because we just didn’t want to go in, and we’ve called in sick. And yet schools punish children who don’t come to school. Children feel guilty that they’re having to stay home for simply not being awake enough to attend or not feeling ready to go. And we reward things like perfect attendance as if perfect attendance is a standard for life. You know, I just think that we need to be flexible in some of these areas that we’ve just accepted as mandatory, even though they’re totally not mandatory, there’s no limit to when children can learn. And so putting these artificial time constraints around learning has created lots of problems for a group of kids, especially children who have a hard time with sleep, who are struggling with anxiety and depression, or children who, who work within family units, where they don’t have nonstandard work or living hours such that they’re chronically late or missing school.
Jordan: Explain from the point of view of the work you do when school matters and– when in person school matters particularly, and when it just doesn’t.
Dr. Tyler Black: Well, I always find that schools really care about the mental health and wellbeing of their kids. It’s hard for me to think of a time where I’ve spoken to a school principal, a school district, or a school counsellor who hasn’t really taken into account the mental health needs of the children that they’re working for. And so whenever I’m having these conversations, I think schools really do do their best. But there are limitations to the regional courses that they have and the structure that they have. And I seem to be having the same conversations all the time, such that I know that it’s not systemically accepted. It really should be more that attendance isn’t as important, or that school work may be forgiven if it’s not completed on time. There are really important discipline things to be learned about how to get projects done on time and time management. But there’s lots of reasons why kids may need a little bit more extra time in an exam, or may not do well in an exam format or may not get their homework done. And we kind of punish or reward them the same, regardless of their circumstances.
Jordan: In your thread, you kind of spoke about the prospect of in-person schooling not being the most necessary or important thing for kids right now. And, you know, I called it counterintuitive off the top because I think most of the conversation about reopening schools is we have to do it safely. And the idea that we might actually not really have to do it without sacrificing a lot of what the kids are getting out of it isn’t really part of this conversation. What kind of feedback have you gotten from that idea?
Dr. Tyler Black: Well, I think it has been quite good. I still have my notifications on, so I see a lot of the feedback. And for the most part, it’s people feeling heard and validated and some of the things that they were thinking or wondering about were articulated sort of in writing for the first time. And so I’ve gotten a lot of that feedback. When we look at these reopenings under the lens that there is a natural distress and stress being caused by this pandemic, and any time in my life as a physician before, before I would even did emergency psychiatry, anytime in my life as a physician where health and safety became more important, we suspend school. We think about the child who’s diagnosed with cancer. Their chemotherapy can take months, and we don’t really care that much about their schooling. We recognize that the child can catch up, they can do the work that they need to do. If there’s some things that we miss, we can just resume, and their brains will catch up. Many times in my emergency psychiatry work, I’m specifically asking for a child to take a few weeks off school and prioritize spending time with our family or getting therapy started or all these other things. So there’s so many times in medicine where we routinely say, right now school doesn’t matter. And so I think there’s just an intuitiveness that clicks when you hear it, of course, during a pandemic where thousands of people are getting sick in North America, hundreds of thousands of people are dying, and this thing is not well contained. There is community spread. As I speak right now, BC is experiencing this is that kinda peak of infections. It’s okay for us to say, hold on maybe school isn’t as important right now as health and safety. And when we prioritize those things, we should also consider that if we return a child to school and then they get sent home because someone gets the sniffles or a fever, it could be COVID or it could not be COVID. There’s going to be a fear that’s introduced. If a teacher, parent, classmate, or even friend of a classmate or family member of a classmate dies of COVID, there is going to be a distress there. And the distress is unavoidable because this is a pandemic that spread in the community, but we don’t have to make in-person schooling our absolute number one priority for children. We can, for safety reasons say, you know what, right now let’s just focus on living, surviving, being together, being healthy, focusing on underprivileged and marginalized people who always bear the brunt of a pandemic or any health crisis. And just keep her approach measured, as opposed to so desperate to return to school.
Jordan: You mentioned underprivileged kids and that’s another aspect to this. There are a lot of kids, and we’ve heard the stories, who depend on schools for access to technology, or breakfast, or just a safe place to be. And that’s part of the argument for reopening them.
Dr. Tyler Black: Yeah. And it’s definitely not my intention to say that those children should be ignored. I always think that school has taken on a social burden that it was never intended to be. The provision of food for underprivileged kids during school days and school months is fantastic. And no one should ever feel like that’s not appropriate. But it also kind of shows us that we have a societal neglect towards underprivileged children and children in poverty, such that they need to go to school to get their food or to take out their technology, or to get their support, or to be protected from harm. And that’s not fair either. Schools, take breaks during the summer during weekends, during, you know, holiday breaks, and all of these supports fall away. So underprivileged children can be more systemically supported if we, as a society, decide, Hey, this is a priority we should financially and substantially support marginalized and underrepresented youth. You know, we don’t have as much data coming out of Canada, but in Arizona, for example, there’s a huge disproportionate burden of the COVID virus, including illnesses and death, in Indigenous communities in Arizona. And I don’t think we’ll be surprised to see the same thing occurring in Canada when the spread reaches all the places that it can reach.
Jordan: How can politicians handle this, from a mental health positive and harm reduction point of view. And I’m not going to get deep into this because we’ve literally done separate episodes on this, but to get kids to school, whether virtually or not, and learning safely, and balance that with the mental health of parents who need childcare to work, because that’s obviously– emergency psychiatry might come into play there as well.
Dr. Tyler Black: Right. I think politicians are always best served when they recognize that there’s a portion of this that politicians don’t control. The virus will dictate what happens. If there’s a spread in a region, there is going to be an economic shutdown. If there’s a spread in a school, that school is going to close. And if people start getting sick and dying, people are going to stay at home. And so this idea that there’s a direct control we have on the spread of the virus, we can certainly influence it through our policy, but it will also declare itself. And as long as it remains community spread, we will have to deal very dynamically and quickly to outbreaks. You know, I hope that the politician’s effort is less on the sort of political point rewarding nature of saying things about returning to school or making people feel safer, and more on developing the infrastructure to trace and detect and quickly respond to outbreaks. Because the simple nature of this virus is that controlling the virus is the best policy. We just have to do our best in that regard. So I’d like to see more of a focus on the infrastructure of the virus control, rather on this idea that by influencing social policies, we’re going to indirectly control the virus. We just have to respond quickly when it crops up and make sure that we stop the spread.
Jordan: So in a perfect world where we’re aiming to control the virus, keep kids healthy, and also let them learn in a way that’s as positive to their mental health as it can be during a pandemic, what kind of back to school plan would you be looking at if, you know, all of a sudden you’re the minister of education in your province? You probably don’t want that job right now, but what kinds of things would you take into account and maybe try to put into that plan that you’re not seeing in the plans now?
Dr. Tyler Black: I think, you know, like I said, I’ve found the Canadian plans to be a little bit more nuanced, which I’m always happy for. I would like to see much more clarity on what’s truly necessary with respect to curriculum and education, and what’s unnecessary burden. Because even if we could make schools points of learning, we don’t necessarily have to load all of the curriculum on children at the same time that they’re dealing with all of these new complexities of the pandemic. So I’d really like to see more of a focus on perhaps a streamlining or reduction of the curriculum. Really, the curriculum is largely done just because that’s the way it’s done. And there’s a lot of learning that kids can do that doesn’t require a strict curriculum.
Jordan: What would that learning look like without a strict curriculum?
Dr. Tyler Black: I think it can be a lot more interactive. It can be a lot more practical. You know, I’m sure there’s going to be curriculums on good social distancing, and good hand washing, and why it’s important to wear a mask, that are naturally built into this pandemic. But there could also be, you know, a learning block, how is my family doing? And a social-emotional block about, how I’m doing during this pandemic? And what’s it like to be missing my friends? And what could we do to stay connected using online, virtual, or other technologies? These types of blocks would probably be as helpful as, you know, learning calculus in grade 11. It’s certainly crucial to learn calculus for getting into university. It’s a lot harder to make that argument that it’s really important right now, especially if universities were more flexible on who they would accept during the pandemic.
Jordan: Dr. Black, thank you so much for taking us through this and giving us a look at what we could be doing better.
Dr. Tyler Black: Thank you very much for having me. I really appreciate the nuance.
Jordan: Dr. Tyler Black from British Columbia. That was The Big Story. If you would like more head to thebigstorypodcast.ca, you can listen to those previous conversations that I mentioned in the intro about bringing kids back to school. You can also tell us what you think about this episode, about those other episodes, about all the episodes, on Twitter. Just follow us at @thebigstoryFPN. If you don’t want other people to see what you have to say to us, you can just email us alone. We’ll read it, we’ll keep it to ourselves. The email address is email@example.com. Subscribe, rate, review. Tell your friends all that good stuff. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.
Back to top of page