Practical Analysis of Mental Health Assistance in Elementary and Middle Schools under COVID-19 Pandemic A Case Study of City A in Jiangsu, China

The COVID-19 outbreak has severely affected the mental health of elementary and middle school students in China, and has had a negative impact. How to help elementary and middle school students overcome the negative psychological impact caused by pandemic has become a common concern. During the COVID-19 pandemic period, City A of Jiangsu Province actively carried out mental health assistance for elementary and middle school students, by opening a psychological hotline, publishing mental health micro-classes through the platform, and posting mental health tweets through the WeChat public account and the Ailing (Love-listening) mini program. Ways of assistance. This greatly helped the students overcome the negative psychological effects. This article reviews and analyzes the psychological assistance measures taken by City A in Jiangsu Province during the COVID-19 pandemic period, in order to provide a reference for researchers.■


BACKGROUND
OVID-19 has become a "pandemic" due to its rapid spread and strong contagion. As a largescale public health emergency, COVID-19 pandemic not only threatens people's lives and health, but also impacts people's mental health, resulting in a series of mental health problems such as panic, anxiety, depression, and hypochondriasis, etc.
According to the Psychological Stress Theory of Lazarus and Folkman (1), when an individual encounters a huge crisis, a series of emotional, behavioral and physical stress responses will be generated based on their own cognitive assessment. For example, Wang et al. conducted a questionnaire survey on adults aged 18-70 in 31 provinces, autonomous regions, and municipalities across China on both New Year's Eve and Spring Festival (January [24][25]2020) and found that there is widespread worry, and most of them have fear, anger, sadness and panic when the public was facing this sudden pandemic (2).
This kind of negative emotion is a strong emotional experience caused by the change of the autonomic nervous system and neuroendocrine system in the individual in a crisis state (3), which will even further stimulate defensive behaviors to deal with sudden emergencies threats (4). This emotional change has adaptive significance. However, if such negative emotions cannot be actively regulated and the individual is under stress for a long time, it will damage the individual's physical and mental health, and easily lead to depression, anxiety and post-traumatic stress disorder and other serious mental problems (5).
Studies have found that an individual's mental health is related to its social support and coping style (6). To this end, the National Health Commission of China issued the "Guiding Principles for COVID-19 Pandemic Emergency Psychological Crisis Intervention." It is proposed to incorporate psychological crisis intervention into the overall deployment of pandemic prevention and control, with the premise of reducing the psychological harm caused by the pandemic and promoting social stability. According to the advancement of pandemic prevention and control, timely adjust the focus of psychological crisis intervention (7). The release of the document provides powerful guidance for the organization and development of psychological crisis intervention under pandemic. Different regions have issued no-tices on psychological assistance for students during the pandemic period. Through the psychological epidemic prevention hotline, accurate psychological assistance and professional guidance are provided to improve the scientificity and effectiveness of psychological assistance (8).
The psychological development of elementary and middle school students is not yet mature, and they are more susceptible to changes in the external environment, resulting in psychological problems that require timely intervention (9). Based on this, City A in Jiangsu Province has done a lot of work on mental health assistance for elementary and middle school students during the pandemic period of COVID-19. This psychological assistance provided students with ways to seek help and methods for relief, which ultimately played a certain role.
This study reviewed the development process of psychological assistance work for elementary and middle school students during the COVID-19 pandemic period in City A. Through the analysis of the relevant data and documents, the actual situation of the work development was analyzed, and the psychological assistance experience of City A in Jiangsu Province during the COVID-19 pandemic period was summarized in order to provide a reference for researchers.

BASICS OF ADOLESCENT MENTAL HEALTH EDUCATION IN CITY A
As one of the relatively developed areas of basic education in Jiangsu Province, City A has always attached great importance to the mental health education of children and adolescents. Relying on the Minor Growth Guidance Center, the city has provided free services to more than 1,000 families and more than 3,500 people through face-to-face, QQ, hotline consultation, parent salons, group counseling, and loving assistance to the orphans and the disabled. Meanwhile, the city relies on the established mental health care cloud platform for minors to provide mental health education courses and activities for the city's elementary and middle schools, and provides public welfare growth guidance and psychological counseling for the city's youth and parents to help children grow up healthy and happy.

Mental Health Status of Adolescents in City A
In 2019, City A conducted a survey on the mental health of 115,992 elementary and middle school students in the city. Among them, 41,053 (35.4%) were elementary school students; 42,760 (36.9%) were middle school students; 32,179 (27.7%) were high school and vocational high school (hereinafter referred to as high school) students. Through continuous tracking of elementary and middle school students, the overall level of the mental health of minors in City A is analyzed and summarized. In general, among elementary and middle school students in the city, the total number of students with mental health is 92,105 (84.6%); 11,202 (10.3%) are in poor mood or tend to have psychological problems; 5,605 (5.1%) are in poor mood. Mental health accounted for the vast majority, and the overall mental health status was good, and there was a certain incidence of bad mood.

Operation of the Mental Health Cloud Platform in City A
The Minor Mental Health Cloud Platform in City A is a psychological service cloud platform built with cloud services and other technologies based on the overall level of the city's youth mental health. In this process, through the online evaluation section of the psychological cloud platform, the professional psychological evaluation scale is used to conduct psychological evaluation of elementary and middle school students, and targeted assistance measures are taken through the analysis of the evaluation results. At the same time, the relaxation and decompression platform and learning platform in the cloud platform will provide elementary and middle school students with a music relaxation system and mental health education videos according to the psychological needs of students, so that students can learn to release their psychological pressure. In addition, the psychological service cloud in City A also opens a quick question channel for parents and students. Parents and students can dial the psychological hotline for psychological consultation through the quick question channel. The platform provides mental health education and services to minors in the city through modules such as online assessment, psychological lectures, psychological science popularization, and quick questioning. From the operation of the platform, since the completion of the platform, 23,410 people have logged in, answering questions for more than 100 people.

PSYCHOLOGICAL STATUS AND ANALYSIS OF MINORS IN CITY A DURING THE PANDEMIC
A study suggested that because of "the social demand for psychological counseling is large and the content involved is wide, the psychological hotline plays an important role in psychological crisis intervention" (10). During the COVID-19 pandemic, the start of school was postponed for students, and mental health classes and educational activities were difficult to carry out. When faced with the psychological impact of students' psychological anxiety, loss or panic caused by pandemic, the psychological hotline has become the best carrier for psychological counseling and assistance (11). To better cope with the psychological impact and influence of the pandemic on the majority of elementary and middle school students, City A first organized a team of volunteers and experts to establish a psychological hotline group. Through the analysis of the object and content of the call, they summarized the problems of the mental health of the adolescents in City A during the pandemic, so as to facilitate the targeted development of follow-up psychological counseling and education.

The Situation and Analysis of the Psychological Hotline in City A during the Pandemic Period
City A invited psychological experts from Jiangsu Psychological Association and universities to form a sixmember expert committee as the core expert group and recruited a psychological hotline volunteer group to jointly form a psychological hotline team in City A during the pandemic period. After the training, on February 1, 2020, City A officially opened the psychological assistance hotline for elementary and middle school students for "fighting pandemic and protecting the soul". From 9:00 to 21:30, the hotline accepts city-wide calls for psychological consultation.
As of May 31, the hotline received a total of 2,464 calls. By sorting out and researching the incoming call information, we try to show the basic situation of the caller and the troubles of the caller. To analyze the   difference of the callers, the statistics and analysis of the students' calls and the parents' calls are made respectively. The basic situation of the students' calls are shown in Table 1, and the basic situation of the parents' calls is shown in Table 2.
From Table 1 and Table 2, it can be seen that the hotline calls are mainly from parents, and the total number of calls was 2,464. Among them, the number of incoming mothers (34%) exceeded that of fathers (19%), and the number of incoming parents was as high as 49%. The total number of student calls was 1,166, of which girls (27%) were more than boys (20%). From the perspective of school level, there were 1,103 high school students, 860 junior high school students, and 501 elementary school students.
In the 2018 Chinese Parent Education Anxiety Index Survey Report, it was mentioned that about 70% of parents are anxious about their children's education, and the most anxious topic of education is their academic performance. Parents in high school have the highest amount of calling, and the direct reason may be that high school students face the "life-determining" test of college entrance (12). This is particularly evident in our data.
For the number of calls from parents exceeds the number of calls from students, this does not mean that students have fewer problems than parents, or that students lack awareness of their own problems. But it may indicate that Chinese parents have a higher level of anxiety about their children's problems, while the students' help-seeking awareness or actions are relatively weak.

Analysis of the Main Complaint of the Psychological Hotline in City A during the Pandemic
Incoming call problems are mainly divided into three categories: general problems, serious problems and crisis problems. The general problem mainly refers to the mentally unhealthy state that is stimulated by reality, has a short duration, and will not seriously damage social functions under the control of reason, and has not been generalized. Severe problems mainly refer to serious mental unhealthy conditions, impaired social function, and mental illness. Crisis problems mainly refer to the urgent problems of self-injury, suicide, and harm to others (13). In the 2,464 calls, no serious psychological problems and crisis problems occurred, which may be related to the positioning of the hotline to provide psychological support.
To summarize and classify the main complaints recorded in the caller registration form, student consultation questions can be divided into three categories: learning problems, parent-child relationship problems, and life disorder problems (Table 3).
From the perspective of student calls, learning problems are the most prominent among the three types of student calls, about 55%; in terms of content, they mainly focus on learning anxiety, learning methods, and learning motivation. The middle school stage is the most important learning period for students; especially the high school stage faces the pressure of college entrance examination. Students feel the pressure and the pressure from their parents, so it is natural to produce anxiety and other emotions.
Next, about 28% are problems with parent-child relationships. Pandemic has delayed the school start time again and again, and students have to study at home. There is a huge difference between the learning environment at home and school. Studying at home and getting along with parents, parents also consciously enter the supervision of students' learning; therefore, these factors will lead to students' learning anxiety and tension of parent-child relationship.
The disorder of life is mainly concentrated in high school students, accounting for 17%. The main problem of high school students in this regard is that it is difficult to balance their study and life through effective selfmanagement. Part of it is due to irregular work and rest, and some people rely on mobile phones and feel that they cannot stop playing mobile phones because they are uncontrollable. Among these problems, there are different degrees of anxiety, depression, irritability and other emotions. The counselor provides psychological support and assistance based on the actual situation of the caller.
The questions that parents call for consultation mainly focus on children's learning problems, parentchild relationship problems, and children's mobile phone dependence (Table 4).
From the data of parent calls, 49% showed a high degree of concern for students' learning problems. At the same time, parent-child relationships and children's dependence on mobile phones were also highly concerned, accounting for 26% and 21%, respectively. This may be because during the pandemic period, children and adolescents have more time to get along with their parents, resulting in more conflicts; and due to prolonged exposure to electronic products; some of the behaviors of overuse of the Internet are caused. This has stimulated academic anxiety between parents and children due to the use of electronic products (11).
On the whole, parents' attention to children's learning problems is consistent with the students' own attention to learning problems. Only in the aspect of mobile phone dependence is quite different from that of students. Students complained of fewer mobile phone dependence problems, and parents complained of more mobile phone dependence problems. The reason for this difference may be that parents and students have differ-

PSYCHOLOGICAL ASSISTANCE MEASURES FOR MINORS IN CITY A DURING PANDEMIC
The Education Bureau of City A attaches great importance to the main complaints of learning, parentchild relationships, and life disorder in the hotline. From February 2020 to May 2020, the city has integrated the city's main psychologist resources to form a volunteer team, with the help of the 400 hotline platform of Jiangsu Zhuo Dun Technology Co., Ltd., the 96111 platform of the minor counseling center, and the Ailing (Love-listening) Psychology Mini Program, WeChat public account to carry out psychological assistance work for elementary and middle school students and parents. In this way, students are guided to "homestaying without panic", "home-staying without waste", "home-staying without lazy", and "home-staying without chaos".

Cooperate with "School is Out, but Class is On" to Guide Students to Study at Home Scientifically
Affected by the pandemic, students cannot go to school to receive classroom teaching in person, and home learning has become a new way of learning. Compared with previous school teaching, this method has undergone tremendous changes in both the learning environment and methods, which put forward higher requirements for students' learning ability and management ability. Meanwhile, because the psychological development of students has phases and stages, students at different stages will have different psychological changes when facing pandemic, so they need to be guided scientifically according to the psychological characteristics.
(i) Pay Attention to the Stage Characteristics of Student Learning Psychological research has shown that students of different ages show different levels and characteristics of psychological development, and there are also great differences in learning ability and characteristics.
Elementary school students have a certain degree of development in their cognitive ability, selfawareness, and social development. They have a certain ability to adapt to changes in the learning environment and learning methods, but the ability to learn independently is still poor and requires the supervision of parents and teachers. Therefore, when studying at home, the content of home study of primary school students should not be confined to textbook knowledge, but should involve life, study and activities and other aspects in order to enrich and expand students' learning experience. At the same time, parents and teachers should play an important role of guidance and supervision to promote students to develop good living and study habits.
Middle school students have further improved their cognitive abilities. Its perception, attention, memory, thinking and imagination have all entered a new stage of development. Therefore, in teaching, it is necessary to use specific problems as guides and let them operate independently to stimulate interest and lead them to achieve the teaching goal step by step. At the same time, the learning consciousness and initiative of middle school students are still relatively fragile, and they are still at an age where consciousness and dependence, initiative and passivity coexist. They have conscious and active learning requirements, but cannot withstand temptation and interference. They often fluctuate and are unstable. Therefore, learning activities in a family environment still require the supervision of parents and teachers.
The function of the brain of high school students gradually shifts from the process of excitement and inhibition to balance, coupled with the clear learning purpose and motivation, and the development of will quality, making high school students' selfconsciousness and initiative in learning significantly higher than middle school students. High school students have been able to treat their studies with a conscious, serious, and serious attitude, and can actively carry out learning activities to achieve their learning goals. This is a qualitative leap (14). Therefore, home learning activities of high school students can be more focused on autonomous learning activities, and teachers and parents should focus on guidance and companionship.
(ii) Emphasize Individualized Differences in Student Learning There are great individual differences between elementary and middle school students' cognitive ability development level. This is mainly manifested in students of the same grade, whose cognitive abilities are also at different stages of development. The cognitive ability development level of students in the same grade is different, which creates a prerequisite for teaching students in accordance with their aptitude. For teachers, in the teaching process, they must first understand the level of cognitive development of the students in their class as a whole. On this basis, combined with the corresponding teaching goals, select suitable teaching methods and teaching content, so as to promote the development of students' cognitive ability. At the same time, individual differences among students must be considered. While taking care of all students, new teaching content and learning tasks are added for some students with a higher level of cognitive ability development to promote their further development. For students who are relatively backward in the development of cognitive abilities, more intuitive teaching methods should be adopted according to their actual level to help them deepen their understanding of what they have learned.

Pay Attention to Parent-Child Relationship
Parent-child relationship is the first interpersonal relationship formed in life, and it is also the most basic and critical relationship in the family (15). In the developmental stage of adolescents, parent-child conflict is an inevitable problem (16) and a core problem. Especially during the COVID-19 pandemic period, the family becomes the only place for students to study and live, and parents become the main or even only partner of the students. This makes parent-child conflicts easy to be amplified and more vulnerable to shocks. Studies have shown that the occurrence of too many and too frequent parent-child conflicts will have many adverse effects on the development of adolescents, such as individual cognitive development, emotions, interpersonal, behavior, learning, etc., and even antisocial problems (17). However, some studies have shown that the parent-child conflict in this period also had some positive effects (18). Appropriate parent-child conflicts can enhance communication between young people and their parents, improve young people's ability to deal with emergencies, improve their ability to deal with problems, and discover parent-child problems between young people and their parents. Most studies be-lieve that the impact of conflict in the parent-child relationship is not determined by the parent-child conflict itself, but in the way parents respond after the conflict (19). Therefore, how to handle the parent-child relationship is the key to affecting students and families.
As far as the telephone complaint in pandemic is concerned, parent-child problem is the main problem that most troubles the students and parents of City A in addition to learning problems. Under the pandemic, City A organized society, schools and other forces to address the issue of parent-child relationship, and set up online consultation rooms and telephone hotlines to provide 24-hour online psychological intervention for the resolution of parent-child relationship issues during pandemic.

(i)
Establish an Online Consultation Room Centered on a Variety of Chat Software Affected by pandemic, psychological teachers or counselors cannot provide face-to-face psychological counseling to teachers, students and parents in need. Based on this, City A organized social professional psychological consulting institutions, public welfare organizations and school psychological teachers to participate in the psychological counseling of family relationships. In response to family relationship problems during the pandemic period, the family education network consulting service in the mental health cloud platform for minors in City A was opened to the whole city, and various consulting experts from the City Family Education Association and the Community Psychological Assistance Volunteer Association were invited to settle in. This achieves the purpose of effectively answering questions for students and parents.
In addition, City A made full use of the chat platform between classes in each school, arranged for psychological teachers to enter the QQ group and WeChat group of the class, and used social software to build a temporary online counseling room. Through private chat, psychological teachers can provide individual psychological counseling to teachers, students and parents in need in a relatively confidential situation. In addition, use platforms such as class groups and home-school mutual aid groups to carry out online group psychological counseling to create an atmosphere of mutual support. The psychological hotline is a process in which the telephone is the medium, through a good counseling relationship, using basic psychological counseling methods and techniques, to help the caller clarify the problem, use resources to solve the problem in a constructive way, effectively meet their needs and promote their growth (20). During the pandemic, it helped everyone to prevent and alleviated the psychological distress caused by the pandemic, so that the public could get psychological assistance services in time.
After pandemic broke out, City A integrated high-quality resources in real time and established a municipal psychological support hotline. Some schools also set up the telephone of psychological teachers as their own psychological support hotline, which provides a strong guarantee for the psychological epidemic prevention of students. Hotline members actively participate in pandemic programs organized by two-level radio and television stations in the city, spread the knowledge of psychological epidemic prevention to the public through television, radio and other channels, and provide consultation services to people in need by answering the hotline.

Focus on Emotional Problems Caused by Life Disorder
Studies have shown that both order and disorder can cause individual psychological discomfort, which in turn leads to different psychological and behavioral results. In a disordered state, the breaking of rules or habits often brings some negative results (21,22). Pandemic has broken the normal life order, work and rest are disordered, eating and sleeping are irregular, and sitting in front of computers and game consoles for a long time lacks exercise. Study has shown that sleep quality and Internet addiction may play a key role in this. Maintaining this disordered life state for a long time will lead to the reversal of living habits, which in turn will affect behavior, cognition, emotion, and physiology. In particular, high school students facing the pressure of entering higher education may have a negative coping style and more significant mental health problems due to lack of normal teaching supervision, chaos in life and learning order, and lack of energy to communicate with others. In this regard, City A sent mental health articles and videos to students and parents through online platforms to provide knowledge and help for psychological, learning or family relationship problems that may be encountered during pandemic. Meanwhile, use the relaxing and decompression space in the online cloud platform to provide students and parents with a way to vent their emotions. (i) Correctly Understand the Emotional and Psychological Problems during the Pandemic The sudden outbreak of COVID-19 has had a greater impact on the lives of the general public and has also put everyone under tremendous psychological pressure. When facing the anxiety and depression in this special period, we must first recognize and accept the fact that the pandemic will affect our lives from a cognitive perspective, and actively adjust ourselves to adapt to the changes and challenges brought about by this special event in our lives.
In response, City A organized mental health education experts to record mental health micro-classes, integrate mental health resources, and publish them on the platform of the Minor Counseling Center and WeChat. The content sent can be divided into eight categories according to the theme: emotion regulation, time management, home learning, efficient learning, family relations, reasonable use of the Internet and electronic products, career guidance, and preparation for class resumption. It includes popular science articles on pandemic and mental health, mental health videos at various stages of elementary and middle school, family education videos, child development videos, and psychological counseling skills videos. After the resources are integrated, they will be released through the platform of the Minor Counseling Center and WeChat. Students and parents can watch micro-classes and learn resources through the learning channel of the platform. These topics basically cover the main psychological problems and perplexities faced by elementary and middle school students. It provides abundant resources for elementary and middle school students in City A to conduct mental health education at home during the COVID-19 pandemic.

(ii) Reasonably Vent Negative Emotions
Emotion is kind of psychological experience that people have on whether objective things meet their physical and psychological needs. It is closely related to people's work, study and life. Emotions are dual. Negative emotions can weaken and reduce human behavior. Especially for adolescent students in adolescence, the accumulation of negative emotions may have serious consequences (23). Studies have shown that listening to music is one of the important ways to express emotions. Listening to music can divert people's attention, especially some music with beautiful melody and tranquility. This kind of beautiful music can divert attention from the original negative emotions and thoughts to the beautiful music appreciation, avoiding the continued deterioration of emotions and thoughts (24). The relaxation and decompression part of the platform of the Minor Counseling Center in City A includes a cloud intelligent music relaxation system. The relaxation music in the system can help students and parents vent negative emotions, relieve excessive and inappropriate emotions, and maintain mental health.
In addition, Sha believed that speaking out is the best way to relieve it, and if someone can listen, the effect will be better (25). Therefore, City A used platforms such as the online consultation room, psychological hotline, and WeChat public account of the Minor Counseling Center to provide students and parents in need with a space to talk to, and encourage people to develop an intimate interpersonal relationship. They confide in others, express their worries and depression, and release their emotions in the form of words to achieve emotional stability and relaxation.

Pay Attention to Students As Well As Parents
Emotional problems are one of the most common adverse psychological reactions in public health emergencies. Through the analysis of the callers, the number of calls from parents exceeds the number of calls from students. In the parent's call problem, although the theme is the same as that of the student, the psychological problems of the parents themselves cannot be ignored. In the survey of Wang et al., it was also mentioned that in the COVID-19 pandemic, parents' emotional and physical functions were affected (26). In this regard, in addition to organizing mental health assistance for students, City A also listed parents as one of the targets of this psychological assistance. Provide parents with psychological intervention for sudden pandemic and pay attention to the guidance of parents' emotions. In terms of government behavior and organization, strengthen the social support system for parents during major public health incidents.
In addition, during the COVID-19 pandemic period, the family is the environment that students directly contact every day, and parents play an essential role in regulating the psychological balance of students. Therefore, City A also paid attention to the status of the parents and the situation of the family when carrying out psychological assistance work for students. Paid attention to family resources, guided parents to obtain information through professional network platforms, increased their understanding of pandemic, helped children face scientifically and reasonably adjusts negative emotions or psychological problems caused by the pandemic, gave full play to the role of family education, and better serving the mental health of students.

CONCLUDING REMARKS
The occurrence of COVID-19 pandemic has shaken people's original sense of security, and the public's mental health has been significantly impacted (27). Especially for children and adolescents, as vulnerable groups of stress events, providing them with timely and appropriate psychological counseling are an effective means to prevent stress-related psychological problems (28). Based on this cognition, City A used the established mental health platform for minors to provide mental health assistance to elementary and middle school students and parents in a variety of ways, and solved the psychological problems of students and parents during the pandemic through multiple channels and perspectives. A multi-pronged approach played a pivotal role in satisfying students and parents in terms of mental health knowledge and service support.
At the same time, we have also noticed that during the implementation of psychological assistance, there are still areas for improvement in the objects and content of assistance. For example, in terms of aid objects, teenagers and parents have become targets, but the teachers' mental health was ignored. For example, in Yang's research, it was believed that the pandemic has a more obvious impact on teachers, especially teachers 30 and below (29). This may be related to the duality of teacher status. Teachers must not only face the pressure of online teaching, but also deal with the psychological distress caused by the pandemic. Therefore, in the sub-sequent development of psychological assistance, teachers should also become one of the objects of assistance.
In addition, life education is an extension and expansion of mental health education (30). The pandemic is a challenge to human life and a good opportunity to carry out life education. Therefore, the relevant content of life education should be appropriately added to the content of psychological counseling to cultivate students' awe and respect for life, and form a positive selfawareness.■