By Dr. Mark Fishaut

Hard times are always harder on children. The challenges of ordinary life are magnified when the stress of economic difficulty is imposed on a family. Foreclosures, layoffs and budget woes can lead to desperate behaviors. The overall gloom of the times affects even those who are not at immediate risk.

Families are often thrown into disarray and find they are unable to cope with drastic change. Despite the fact that help is available to them, a kind of paralysis sets in and otherwise rational adults are unable to look for that assistance. This is compounded by a sense of personal failure and guilt that prevents parents from availing themselves of their community’s resources.

As life becomes more difficult, adults often suffer from frustration and anger and take these issues out on those around them. The incidence of homelessness, substance abuse, family and partner violence, and abandonment always accompany times of economic stress. Such catastrophic behaviors get public attention but there are subtler and more pervasive effects.

Parents will often attempt to be secretive, not sharing anything about economic woes with their children. But the kids know. Some, especially single parents who have no one else lean on, will share too much with their kids. And the kids don’t want to know.

When times are tough, health care takes a back seat to more pressing priorities such as food and shelter. More and more families are falling into the abyss of not making enough to purchase health insurance and but still too much for government assistance. Medical care becomes a low priority: appointments are skipped, routine well care is not maintained and medications not purchased.

Children often internalize stress and display it in other ways such as stomachaches, headaches, emotional withdrawal and deterioration of school performance. Children in crisis are also often the first public sign of families in distress. But when a desperate family’s access to pediatric mental health care, limited even in the best of times, becomes impossible, the downward spiral is accelerated.

Hard times will bring out the best in us; our community can do much to support its families. Professionals and nonprofessionals alike must become more proficient at identifying the subtle indicators of stress. We must share with each other the truth that there is no shame in seeking help. If that stigma can be diminished, it will allow parents to have healthier conversation s with their children and allow them to manage their family’s needs without embarrassment. We must also insure that they can easily and quickly access and navigate the resources we do have.

The San Juan Island Community Foundation’s Critical Needs Health Task Force has mobilized a wide array of citizens to address these challenges. Our children are depending on us. Let’s make sure we are there to help.

— Dr. Mark Fishaut is a physician at San Juan Healthcare and a periodic columnist for The Journal. E-mail him at markfishaut@sanjuanhealthcare.org