The COVID-19 pandemic has had a devastating impact on the health and economy of the whole country. Although the death toll from this disease is broadcast to the nation on a daily basis, mainly from among the frail elderly population, the impact on children's and young people's mental health is less well reported. Precisely how children and young people are coping with the impact of the pandemic and now two periods of lockdown and its effect on their education, access to health services and emotional health and wellbeing is still being evaluated.
Background
On the first day of the country's second COVID-19 pandemic lockdown, as I walked through the New Forest, I was able to indulge in ‘forest bathing’, an important aspect of preventive mental health in Japanese medicine (Tsunetsugu et al, 2010). And during the first lockdown I had been able to sit in my garden sipping my ice cold beer long into the summer evenings. However, lucky as I have been, what about the plight of other, less fortunate people, and especially children and young people who live in flats in cities and town centres with little immediate access to outdoor spaces?
How much worse must it have been for children and young people, especially during the first lockdown when they were unable to meet their friends or go to school, college or university? Optimum emotional development of children is a complex myriad of interrelated factors that transcend social, psychological and biological factors. We have known for decades that sensory deprivation, for example, can have devastating effects on child development, causing, in some cases, intellectual disability. Early sensory deprivation and an impoverished environment, such as that experienced by orphanage children in the aftermath of the Romanian revolution in 1989 has been associated with adverse mental health among the survivors (Mackes et al, 2020).
The Office for Standards in Education, Children's Services and Skills' (Ofsted) second report into the impact of the COVID-19 pandemic has shown that the children who were most affected by school closures and social restrictions have regressed across a whole range of basic developmental skills and learning (Ofsted, 2020). For example, some young children, who had been fully toilet-trained, have now regressed into nappies, especially those whose parents were not able to work flexibly during lockdown. Among older children, the Ofsted report reveals that some have regressed in their reading and writing skills and that, in others, signs of psychosocial distress are emerging, coupled with evidence of self-harm. It is important to stress that the parameters of child development across all of the social, psychological and biological paradigms cannot be stopped and started like a car's engine. Children progress through many stages in their development towards independent adulthood, with some periods being particularly sensitive—there is a finite window of opportunity to achieve optimum language development, for example (Sylva, 1997).
Even before the pandemic it was widely acknowledged that emotional problems in childhood are increasingly a cause for concern in the UK, with up to 10% of children suffering from a diagnosable mental health disorder, and with half of all mental health conditions beginning before the age of 14 (Glasper, 2017).
Ofsted has also raised concerns about aspects of child safeguarding that may have been missed during lockdown and school closures, such as domestic neglect and abuse (Ofsted, 2020).
Young people have also been adversely affected by the COVID-19 pandemic and a Prince's Trust research report published in September 2020 reveals that 44% of 16-to-25-year-olds believe that their aspirations for the future are now lower as a result of the pandemic. Data obtained from 2000 young people indicates that more than one in three have lost hope of getting their dream job because of COVID-19. The report uses the term ‘the lost generation’, with 41% of young people surveyed believing that their future goals now seem impossible to achieve, which has eroded their self-esteem. Rising unemployment rates linked to the economic downturn caused by the pandemic will no doubt exacerbate the incidence of mental health problems among young disaffected people (Prince's Trust, 2020).
Effects on mental health
Children are gregarious by nature and companionship is essential for their normal psychological development and wellbeing. Social play with others is the very language of children and, as such, it is a vehicle through which children learn about themselves and the world they live in. Play is a unique way in which children of all ages communicate. It's not much fun being a 5-year-old Jedi knight if there are no little starship troopers to play with. Play groups, nurseries, schools and colleges were all shut during the first lockdown. However, during this the second lockdown the Government made a decision to allow children to remain at school. This ruling may reflect Golberstein et al's (2020) assertion that schools provide mental health support for children in addition to education.
Children with special educational needs, such as those on the autism spectrum, may be susceptible to emotional trauma, especially when their daily routines are disrupted.
The United Nations Educational, Scientific and Cultural Organization (UNESCO) has pointed out that most governments around the world temporarily closed educational institutions in an attempt to contain the spread of the pandemic (UNESCO, 2020). Efforts to mitigate these effects are now taking place in many countries.
The Royal College of Paediatrics and Child Health (RCPCH) has been working with young people to examine the impact of COVID-19 and lockdown. An RCPCH report (2020) reveals that 83% of young people have said that their mental health has worsened during COVID-19. One of the important recommendations of this report is that NHS Trusts should provide opportunities for children, young people and families to access peer support (virtually or in person) connected to their health experiences or conditions, and rebuilding relationships with friends.
The charity Young Minds has also investigated the effect of COVID-19 on the mental health of young people. Its report is based on a survey conducted on 2011 young people with a history of mental health problems shortly after schools had reopened for the autumn term. The survey found that 23% reported less mental health support in their schools than before the pandemic and 40% indicated that their schools did not have a dedicated school councillor to advise them.
The Mental Health Foundation, working in collaboration with Barnardo's and the University of Strathclyde, has published a report on the affects of lockdown on the mental health of children and young people (Millar et al, 2020). This report suggests that young people, and in particular teenagers, are feeling more anxious than they did before the COVID-19 pandemic, particularly among black and mixed-race participants. A number of specific factors that have affected the mental health of children and young people include:
For the so-called generation Z (the generation of children born between 1996 and 2010), these uncertainties about their future are seen as key factors influencing their mental health and wellbeing. Huge post-pandemic national debt and climbing unemployment will continue to blight the aspirations of generation Z for many years. Advisers from the Scientific Advisory Group for Emergencies (SAGE) have informed the Government that the pandemic has exacerbated inequalities and has left children from the poorest families at least a year behind their classmates (Hill, 2020).
Likewise, the NHS Every Mind Matters initiative (2020) highlights that children and young people can be particularly overwhelmed by the stress that the COVID-19 pandemic has caused in society. Children and young people react to stress through increased anxiety, fear, sadness or worry and when they are struggling to cope with stress, they may exhibit unhealthy eating or sleeping habits, changes in activity level, or substance abuse, among other problems.
New data released by the NSPCC charity has revealed an increase in the number of telephone calls by children and young people to the NSPCC ChildLine service, which reached nearly 43 000 between March and October 2020, with a third of these calls being related to mental health (Sample, 2020).
This is reinforced by data produced by the Samaritans, which indicates that young people, but especially young women, have experienced much greater declines in their mental health during the pandemic when compared to other groups (Samaritans, 2020).
Singh et al (2020) assert that the provision of strategies to help children and young people develop coping mechanisms during the ongoing pandemic must be improved if the long-term consequences on their mental health are to be avoided. It is salutary to note that research from the University of Oxford shows that nearly one in five people who have had contracted COVID-19 are diagnosed with a psychiatric disorder such as anxiety, depression or insomnia within 3 months of testing positive (NIHR Oxford Health Biomedical Research Centre, 2020). Furthermore, this research reveals that patients with previously diagnosed mental illnesses are more likely to be infected with the coronavirus and therefore having a psychiatric disorder should be added to the list of risk factors for being infected with COVID-19.