Coronavirus; impact on children and young people’s mental health

Children in care are four times more likely to have a mental health problem than children living with their birth families[i]. Prior to the pandemic, these mental health needs were often unmet, putting children at risk of poor outcomes, including placement instability and poor educational achievement.

Given that the current public health crisis has led to reports that distress has increased amongst young people, and that the majority of lifetime mental health difficulties occur before the age of 24 (Broadhurst et al [ii]), this is a concerning picture.

[i] Bazalgette, L., Rahilly, T. and Trevelyan, G. (2015) Achieving emotional wellbeing for looked after children: a whole system approach. London: NSPCC.

[ii] Broadhurst, K., Erlam, J., Fledderjohann, J. and Knowles, B. (2021) Mental health and care needs of British children and young people aged 6-17. Children and Youth Services Review 126 (2021): 106033. https://doi.org/10.1016/j.childyouth.2021.106033.

The 19th Report of the All-Party Parliamentary Group for a Fit and Healthy Childhood (APPG), published in April 2021, focuses on the impact on the mental health of children and young people during the Coronavirus pandemic. The report claims that ‘shocking disparities’ in the quality and provision of mental health services for the UK’s children and young people have been exposed. This is also highlighted In Lennon’s 2021 report ‘The state of Children’s mental health services 2020/2021’ (Lennon, 2021 [iii]) where it is identified that there is continued unmet need across the country in regard to young people’s mental health services.

The AAPG Report suggests that unless the mental health crisis for children and young people is addressed urgently by the Government, it may become entrenched long after the lockdown periods end. The Royal College of Paediatrics and Child Health has also warned that mental health will be the greatest challenge facing children in 20 years’ time.

The group, chaired by Steve McCabe, reported mental illness is common amongst the youngest children in our society. One child in every seven in a primary school class will have a diagnosable mental illness and 75% of mental illnesses begin before the age of 18. Factors impacting children’s mental health range from individual family circumstance and socioeconomic status to deeply embedded funding failings at service research levels, and which part of the UK the child/young person/family resides affect the outcomes on mental health.

Although available data was reported as limited, a survey of care-experienced young people found half reported feeling lonely and more often during the first lockdown and nearly a quarter said they had less contact with their social worker. A tenth had no contact with their social worker at all. The National Youth Advisory Service (NYAS) created this survey to provide a snapshot of how 230 care-experienced children and young people aged 5-25 (the majority were from those aged 12-20 years old, 52% of respondents identified as female, 44% as male and 4% as other or did not disclose their identity) were managing in England and Wales during the lockdown period 15th April – 7th May 2020.  NYAS found that 4 in 5 care leavers felt lonely and anxious more often, 1 in 5 did not have the technology they needed to stay in touch and half of children in care reported they were feeling lonely more often during lockdown. NYAS also found that almost a third of children in care had contact from their social worker only once.

A a study conducted in Northern Spain [iv] with 1225 children from the ages of 2-12 years old, during one of the strictest lockdowns, found that children’s wellbeing had been notably impacted. Although this study was completed with children living at home, and data gathered from their parents, it demonstrates the global impact the pandemic has had on young people. Those who were particularly affected were boys, older children and those with no access to outside spaces. The study identified a number of  factors that could improve this outlook, however suggested a need for local and national [and international] effort to introduce measures that can mitigate these effects from a multi-dimensional perspective that considers the social, emotional, academic, and physical aspects of well-being. The study found that physical activity, creative play and thinking and time spent outside had a positive correlate to wellbeing.

In the scoping literature review by Broadhurst et al [ii], they noted consistent findings across categories of mental that clinical populations and children and young people with additional needs are at greater risk of mental distress. However, the literature is weighted towards conduct disorders in clinical populations of children and young people, at the expense of a broader lens on the nature of children and young people’s distress, for children in care for example. Greater focus on the mental health of young people in care, and those most vulnerable, is needed.

This is a concerning picture for young people across the UK and the AAPG report is clear that without action, children in the UK, particularly the most vulnerable, could face a lifetime of depression, anxiety and other mental illnesses.

So what can be done?

Recommendations from the AAPG report include a cross-government department commission on the funding of children and young people’s mental health provision to encompass NHS and other budgets; and the adoption of a multi-sector approach to improve the mental health and wellbeing of the current cohort of children and young people.

To protect the futures of our children, the report advises we must work together coherently across the UK and across sectors and invest appropriately. Future Covid-19 specific policy should make special provision for the requirements of children and young people with special educational needs and/or disabilities, those with an existing mental health condition, those from marginalised and socioeconomically deprived communities as well as those who are in Local Authority Care, in custodial accommodation, or living in violent or abusive home environments. The AAPG suggests that only then will the wellbeing of all the UK’s children and young people be properly safeguarded and supported so that no one is left behind.

In addition, the Report states we need to know what interventions work well for whom and why, including what barriers exist to effective care and how best to identify and support vulnerable groups. A cross-national strategy needs to be introduced, prioritising the finest initiatives of a devolved UK, including a Joint Policy Statement by the four Children’s Commissioners and a collaborative national and global standing post Covid Forum, to be convened by the World Health Organisation (WHO) and the United Nations. We need to take accord of lessons learnt and the mental health and wellbeing of all children and young people would be at the forefront of all strategies.

Other recommendations from the report include:

  • Ringfenced and substantial Government funding for children and young people’s mental health to marry resource with need and level up historic funding
  • Effective economic support for disadvantaged families
  • Strategic review of benefit systems and school meal provision as a recognised vital component in children’s mental health and wellbeing
  • Integration of the voices of children and young people (regardless of their age or developmental level) and third sector and lived experience. Also, to empower their parents/carers by placing them at the centre of all strategies designed to improve their welfare.
  • Root and branch revision of CAHMS (to include consideration of other methods of approach to wellbeing and mental health) and the clinical waiting list, referral and hospital procedure
  • The adoption of a whole school ethos in the promotion of mental health with the finest current provision in schools rolled out to cover all devolved nations of the UK. Outdoor spaces for play should be available to all. The reduction of the number of playgrounds should be not only halted but reversed. Outdoor play should be part of the National Curriculum
  • A shift in national strategy towards positive policies to support mental wellbeing and enhance wellbeing and resilience throughout the course of life.

There is a clear and concerning gap when it comes to the focus and provision of mental health services for young people in the UK. The pandemic has worsened still the outcomes for young people in relation to their mental health. Now is the time to change policy, approaches and services to ensure young people are given the tools, support and environments in which they not only maintain good mental health, but also flourish.

 

[i] Bazalgette, L., Rahilly, T. and Trevelyan, G. (2015) Achieving emotional wellbeing for looked after children: a whole system approach. London: NSPCC.

[ii]Broadhurst, K., Erlam, J., Fledderjohann, J. and Knowles, B. (2021) Mental health and care needs of British children and young people aged 6-17. Children and Youth Services Review 126 (2021): 106033. https://doi.org/10.1016/j.childyouth.2021.106033.

[iii] Lennon, M. (2021) The state of children’s mental health services 2020/21. UK Government Children’s Commissioner, London.

[iv] Berasategi, S., Mondragon, N., Munitis, A., Santamaria, M. (2021), The Well-Being of Children in Lock-down: Physical, Emotional, Social and Academic Impact. Children and Youth Services Review 127: 106085. https://doi.org/10.1016/j.childyouth.2021.106085.

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