Under pressure: Children and Young People’s Mental Health, the hidden impacts of COVID-19

Originally posted as a blog piece for The Voice of UK Health Services Research (HSR UK).

On the 18th March 2020, schools across the UK closed their doors. Children said goodbye to their teachers and friends, some for the last time, not sure when they would see them again. This unprecedented move by governments in all four countries of the United Kingdom was taken to reduce the spread of the virus and protect the NHS. The global pandemic has not only attacked citizens physically but has also created uncertainty about the infrastructure of our future and concern for the wellbeing of the next generation.

The far-reaching effects of school shutdown

Understandably, immediate policy concerns focused on children about to sit exams, young people due to go to university in the autumn, and latterly vulnerable children now confined to potentially dangerous home environments. However, hidden beneath these structural concerns, was something perhaps more destructive for children and young people; the impact of school closures on their mental health and wellbeing. This presents a complex challenge for policy makers, healthcare professionals and the health services research community.

Almost 10 million children are currently out of school due to the UK lock down (UNICEF, 2020). School for many children offers a place of safety and support around mental health. With the sudden onset of COVID-19 children have lost access to these often crucial resources, isolation from their support network of friends and trusted adults. Parents find themselves as not only teachers but purveyors of psychological support, perhaps more intense than usual, and requiring professional support from Child and Adolescent Mental Health Services (CAMHS), which were stretched long before the onset of the pandemic.

Exacerbating inequalities

Vulnerable children are likely to suffer the most. Over 4 million children were already living in poverty around the start of the pandemic, 160,000 living in households with domestic abuse and 800,000 estimated to be young carers (UNICEF, 2020). Teachers are now fighting a losing battle to contact at-risk children as children and young people explain that ‘they are fine’ as they have no way to communicate that they are not. Some children may be lost to education altogether. For example, those in their final year of secondary school who were struggling to stay engaged but managing, and who may now find themselves without support to link into further education or, for example, apprenticeships where firms have gone into liquidation.

There is also the impact of equality of access to education, concerning parents’ and schools’ differing approaches to learning. Some children will be hugely disadvantaged with potentially half a school year of education lost. Depending on their developmental age this could have a combined impact on future learning and self-esteem. School closures will be especially difficult for adolescents (12-17 year olds), those from Black and Minority Ethic (BAME) backgrounds, and lower-income families, who are likely to receive support exclusively from education settings (Golberstein, Wen & Miller, 2020).

Demand for mental health services

Then there will be the children that experience mental ill-health for the first time during social isolation that may stay imbedded long after the measures are eased. The knock-on effect on support services is something that will need to be accounted for, especially in the climate of struggling CAMHS services, where over 350,000 young people accessed NHS mental health services in England alone during 2018-19, with referral rates are often higher than the proportion of staff available to treat children.

The role of Health Services Research

However, although this overview presents a dark landscape for our children and young people, there is light to be found. NHS Clinical Psychologist, Dr Philip Martin believes young people’s voices are central to our response:

“Whilst the current situation has undoubtedly had a detrimental impact upon some young people’s mental health, I think it is extremely important to not make assumptions and to learn from the very people we are concerned about. I have seen a high level of distress experienced by some young people, which under the circumstances is completely understandable, and I have also been struck by the resilience and ingenuity of young people. The factors behind any response need to be better understood and the young people themselves are best placed to help that understanding”.

It is vital that health services research plays its part in responding to this evolving social crisis. By being ready and highly adaptable, and placing children and young people firmly at the heart of any approaches going forward (Fenton & Carr, 2019; McKenna & Edwards, 2016; McKenna, 2015a; McKenna, 2015b). According to Dr Sarah-Jane Fenton, Lecturer in Mental Health Policy at the University of Birmingham it would be useful to try and identify early and plan now for a predicted increased need for in-school support services; wider services such as specialist bereavement support; social care; CAMHS; and adult mental health support services in the coming months.

The wider message for our community is this: tolerating uncertainty is difficult for anyone, especially during these challenging times, and is at the heart of a lot of difficulties experienced by people. A society that is not able to tolerate uncertainty will therefore struggle to tolerate it for its children. Where does that leave our children and young people’s mental health? The role of Government, policy makers, practitioners and researchers must be to predict, prevent, and prepare approaches to protect children and young people’s mental health with them leading the way (McKenna, 2015).