It is now clear that children and young people of school age are susceptible to changes in their mental health caused directly or indirectly by the ongoing COVID-19 pandemic. The actions necessary to slow the spread of the virus have caused major disruption to children's school and home lives over the past year.
The roles of schools in mitigating these psychological effects of the pandemic are vital in protecting children from the long-term consequences of this societal catastrophe. The NHS now aspires to accelerate its mental health support for children and young people and in May 2021, in recognition of the effects of the pandemic on the mental health of children and young people, it was announced that more than a million children were to be given access to NHS mental health support at school (NHS England/NHS Improvement, 2021a).
The NHS England report shows that mental health issues among children in England aged 5–16 years have risen from one in 10 in 2017 to around one in six in the summer of 2020. More than one in four children has had trouble sleeping while one in 10 often or always felt lonely during the pandemic.
Background
Undoubtedly the COVID-19 pandemic and the restrictions it has placed on normal childhood activities is responsible for a raft of serious threats to child mental health. Children by nature are gregarious and need the company of other children to thrive. Two prolonged periods of societal lockdown coupled with school closures and a reliance on e-learning have taken a toll on the mental health of large swathes of children and young people. Children's need for peer companionship is essential for their normal psychological development and wellbeing. Going to school is not just about learning, but also about engaging in social play with other children. Play is the very language of children and the vehicle through which they learn about themselves and the world. It's not much fun being a 6-year-old Princess Elsa from ‘Frozen’ if you don't have an Anna to play with!
Playgroups, nurseries, schools and colleges were all shut during the first lockdown and after the first year of the pandemic UNESCO (2021) revealed that nearly half of the world's school children were being affected by full or partial school closures. Worryingly over 100 million children are predicted to fall below the minimum proficiency level in reading as a result of the pandemic, with 1·5 billion young people worldwide missing out on their education, fuelling the disenfranchised ‘generation Z’.
Children and young people with mental health needs are especially affected by school closures because this results in a lack of access to the resources they usually have when they attend school. The charity Young Minds (2021) has revealed that the pandemic has had a devastating impact on many young people. Since March 2020, Young Minds has conducted four UK surveys with young people who had a mental illness history. Many respondents admitted to becoming deeply anxious about the pandemic, with some starting to self-harm again and others having panic attacks. Some respondents told Young Minds that they were losing motivation and hope for the future. The majority of respondents indicated that the pandemic had made their conditions worse and around one in three of those who needed mental health support in summer 2020 were unable to access it, especially where support groups and face-to-face services had been cancelled because of lockdown restrictions. Lee (2020) has discussed how support by phone or via online contact can be challenging for some young people.
Fegert et al (2020) also highlighted the effects of the pandemic on adult mental health leading to an increase in domestic violence and subsequent child safeguarding issues. Perhaps most at risk are children and young people with pre-existing fragile mental health such as those with learning disabilities where disruption to normal daily routines can exacerbate symptoms. Children and young people who already live with a mental illness are especially susceptible to the changes to lifestyles that have occurred, exacerbated by the constant media coverage, which heightens fear of the virus itself, and the significant societal changes implemented to tackle the spread of the disease.
Ashbury et al (2021) conducted a survey of 241 parents of children with special educational needs and disabilities in the UK where they were asked to describe the impact of COVID-19 on their own mental health and that of their child. The analysis of the data showed that the parents and children were experiencing loss, worry and changes in mood and behaviour as a result of the rapid social changes that occurred during lockdown. Children as young as 2 years are aware of changes around them precipitated by the pandemic. Dalton et al (2020) discussed how younger children especially need to be given information about the pandemic that is tailored to their age and level of understanding so that they do not become overly frightened by what they hear and see during this difficult time.
Support in schools
The decision to give children more mental health support in school (NHS England/NHS Improvement, 2021a) is part of the £500 million the government plans to invest in mental health services overall, of which £79 million has been allocated to promote mental health support for children and young people in England (Department of Health and Social Care, 2021a; 2021b). This reflects the commitment in the NHS Long Term Plan that ‘funding for children and young people's mental health services will grow faster than both overall NHS funding and total mental health spending’ (NHS England/NHS Improvement, 2019: 50). In addition to embedded mental health support in schools, the document also sets out ambitions for children's community mental health services, eating disorders services and crisis services.
Throughout the remainder of 2021 these affected children and young people will have access to mental health support at school, as the NHS rapidly expands services to help deal with the disruption caused by the pandemic and restrictions. Teams of mental health professionals including nurses are planning to offer support to children who because of the pandemic are experiencing anxiety, depression, and other common mental health issues. The government plans to develop up to 400 mental health support teams to cover 3000 schools in England to provide support to almost three million pupils, by 2023. To meet these objectives NHS England/NHS Improvement (2021b) will
- Support commissioners and providers to maintain improvements in supporting children, young people and those who care for them to be more involved in their care and in the development and feedback to services
- Support commissioners and providers to develop integrated services with clear care pathways from early intervention to crisis and inpatient care
- Improve collaboration between Clinical Commissioning Groups and specialist commissioning
- Support commissioners and providers to develop the infrastructure to deliver services that can demonstrate outputs and outcomes, including waiting and access times
- Work with Health Education England to support workforce planning
- Work with other partners across the system to implement the agreed outcomes from the child mental health aspirations outlined in the NHS Long Term Plan.
The aim is that early interventions will prevent initial childhood problems escalating into more serious mental health issues. It is already known that the isolation and disruption caused by the pandemic can be exacerbated by certain domains within social media platforms. There is no doubt that social media can be a double-edged sword and even though during the pandemic they may provide a healthy substitute for regular social interactions and a break from home confinement for some children, many have concerns that there are links between social media exposure and poor mental health, including depression and anxiety (Williams, 2020). Young people especially may be susceptible to poor mental health outcomes during the pandemic. This can be attributed to increased loneliness and isolation in addition to a lack of access to mental health resources during the periods of lockdown when schools were closed.
NHS England/NHS Improvement has commissioned over 280 mental health support teams, of which 183 teams are fully operational with the remainder still in training. These teams will offer children one-to-one and group therapy sessions. Furthermore the teams will offer workshop training for parents and teachers with the aim of heightening awareness of mental health across the whole of the school community. The 183 teams currently operational are giving 15% of pupils in England access to the mental health support they need. The initiative is expected to be rolled out to reach 20–25% of pupils by 2022, with 35% of pupils in England gaining access to mental health support in schools by 2023 (NHS England/NHS Improvement, 2021a).
The launch of this initiative to coincide with ‘Mental Health Awareness Week’ has signalled a whole raft of support for children and young people of school age. It is now compulsory for all schools to teach pupils about mental health and wellbeing as part of health and relationships education (Department for Education, 2021). Part of the new funding stream is going to be used to train a senior mental health lead from each cohort of school staff during the next academic year. These strategies may help in alleviating some of the negative mental health consequences of the ongoing pandemic.
KEY POINTS
- In May 2021 NHS England/NHS Improvement highlighted a new raft of initiatives to address damages to children's mental health caused by the COVID-19 pandemic
- Schools have a vital role in mitigating these psychological effects and protecting children from the long-term consequences
- Mental health issues among children in England aged 5–16 years rose from one in 10 in 2017 to around one in six in the summer of 2020
- Children and young people with mental health needs are especially affected by school closures because this results in a lack of access to the resources they usually have at school
- To achieve aspirational objectives for protecting the mental health of children, NHS England/NHS Improvement has commissioned over 280 mental health support teams to offer children one-to-one and group therapy sessions