The impact of Covid 19 on Children’s Mental Health
As a Clinical Psychologist working with children and families I’m often asked about the effects of the pandemic on child mental health. COVID-19 has bought with it stress and, for some, trauma that has inevitably taken its toll on the mental health of our young. They’ve had to manage so much. They’ve had to manage fear of the virus itself, anxiety and uncertainty about loved ones and their future, and grief for those who have been lost. And they’ve had to manage lockdown, which has bought with it social isolation, lack of stimulation, reduced physical activity and increased screen time, all of which we know can be detrimental to their mental health. For some children the closing of schools has meant the loss of a safe haven from a family life that was already stressful, and where stresses may have increased as a result of lockdown, including exposure to parental conflict and domestic abuse. And then there’s the length of time they have had to manage this for. One year on, young people have missed landmark birthdays and rites of passage; no prom, no graduation, no chance to say goodbye to their friends from primary school. Those who are not yet at school- toddlers and babies born in lockdown- have lived in a shrunken world, unable to benefit from the social stimulation and support that is crucial to their early development, and to their parents’ and carers’ wellbeing.
With this in mind, it’s not surprising that the statistics show a deterioration in child mental health in the UK over the course of the pandemic. The Mental Health of Children and Young People in England 2020 report(1), which is produced by NHS Digital and the Office for National Statistics, reported in autumn 2020, that overall one in six children aged five to 16 had a probable mental health disorder, up from one in nine three years previously. The Co-SPACE study (2), set up as part of the UK Research and Innovation’s rapid response to COVID-19, also indicates a negative impact of the pandemic on children’s mental health. It shows a clear increase in behavioural, emotional and attentional difficulties of children and young people in June 2020 and February 2021, when restrictions were highest. The study, set up to track the impact of the pandemic on children and young people’s mental health, also reported that younger children (aged 4-10) have had greater changes in levels of behavioural, emotional and attentional difficulties throughout the pandemic while levels of difficulties among secondary school-aged children (aged 11-16) have been more stable. Patterns of parent/carer-reported behavioural, emotional, and attentional difficulties over this time were reported to be relatively similar for boys and girls. Older teenagers and adolescents have been affected too as they have seen their prospects shrink. The Youth Index, published in January by the Prince's Trust in partnership with YouGov (3), has been tracking the wellbeing of young people aged 16 to 25 for 12 years. It found more than half of young people were always or often feeling anxious - the highest level ever recorded.
The loss of support
It’s not just the direct impact of the pandemic that is likely to have effected children’s mental health. Lockdown has meant reduced services and professional support. For example, specialist nurses such as health visitors have been required to help the fight of COVID-19 on the front line, reducing the support available to new parents. Children with special needs requiring a high level of care and support from professionals and services have found themselves housebound. Social workers unable to monitor children so closely and professionals, such as teachers, being less able to perform their safeguarding duties has meant that children’s experience of abuse and neglect has gone under the radar. Between April and September there were 285 reports by councils of child deaths and incidents of serious harm (4). This was a rise of more than a quarter on the same period the year before.
The child mental health teams I support have been working flat out through the pandemic, firefighting under incredibly stressful working conditions, barely able to keep their head above water. In my own practice I have spent hours with high need families, checking in several times a week, struggling through glitchy Wi-Fi signals and struggling to follow what is being communicated: ‘Can you hear me?’; ‘Can you see me?’. These phrases seem so poignant. It can be so difficult to provide therapy online, particularly with whole families and primary school children. I’ve found myself in all sorts of new territory. I’ve found myself trying to persuade a very dysregulated eight year old to stop wielding a sharp pair of scissors while frantically phoning his father in the next room to come and take them from him; I’ve had long whispered conversations with a mother who is so depressed she is finding it hard to get out of bed in the morning and care for her daughter, but doesn’t want her daughter to hear her tears through the wall of the tiny flat where they live; I’ve attempted to manage escalating arguments and fraying tempers between family members as a face on a laptop. These encounters have left me feeling impotent and useless, and after the calls more than once I have cried with frustration and lay awake with worry. Now we see Child and Adolescent Mental Health Services having to manage a backlog of mental health problems triggered and/ or exacerbated by pandemic conditions resulting in the extension of NHS waiting lists that were already considered unacceptable by many, even before the pandemic.
Strength in the face of adversity
So, the direct and indirect impact of the pandemic on child mental health has been, and probably will continue to be, significant. However, there is another side to this. The Co-SPACE study also reports a sharp decrease in behavioural, emotional and attentional difficulties among primary and secondary school-aged children as restrictions have eased since February 2021 (however children with SEN/ND and those from low-income households have continued to show elevated mental health symptoms, providing further evidence of the unequal way this pandemic has impacted on our society). In highlighting this improvement I’m not trying to minimise the impact of the pandemic, or say that everything is going to bounce back to ‘normal’ within the next few months. That, sadly, is not the case. However, what this finding does pay testament to is the resilience of young people and their families. Resilience is often defined as ‘the ability to cope in the face of adversity’. That is what so many children and families in the UK have been doing this last year and I am hearing stories about it in the therapy room. I had a young person explain to me that, since they hit ‘rock bottom’ during lockdown, and came out the other side, ‘I know it passes and I know I can cope’. I have seen parents and carers who have battled through so many difficulties with their children over the last year and found themselves now with a stronger relationship. I’ve seen children whose anxiety has worsened over the course of the pandemic, but whose resolve to get better has never been stronger as they fight to return to a world they are determined to miss no more of. I’ve seen families who have experienced loss and hardship, but who have been moved and strengthened by a support network they never knew they had. I am seeing children and young people talking with a wisdom and maturity that I don’t know they would have if they hadn’t been through the pandemic. Yes, children and young people are vulnerable in many ways, but they are also flexible, adaptable and resilient, and I am hopeful for them. They have had to manage so much, and they are doing a really good job of it.
References
1- mhcyp_2020_rep_v2.pdf (digital.nhs.uk)
2- Children's mental health: One year in the pandemic - Co-Space (cospaceoxford.org)