Coronavirus (COVID-19): children, young people and families - evidence summary - December 2020

11. Mental health and mental wellbeing

Coronavirus: Impact on Young People with Mental Health Needs - Survey 3: Autumn 2020 - Return to School (UK-wide)
Source: Young Minds
Date: Autumn 2020

This report outlines the results of Young Minds' third online COVID-19 survey with young people aged 11-18 (who have recently returned to secondary school or college) with a history of mental health needs. 2,011 respondents completed the survey. The majority of respondents identified as female (74%), and 82% said they were White British. 8.5% of respondents were from Scotland. The data is therefore not representative. This survey was conducted 15 -30 September (the previous two ran in March and June). Key findings:

• The survey suggests that young people with pre-existing mental health problems have, for the most part, found the immediate return to school challenging. This is predominantly for three reasons: a rapid return to academic pressure; concerns about safety and social distancing measures; and difficult relationships with peers, including bullying.
• Rather than improving, mental health problems appear to have increased for many young people with a history of mental health needs - 58% of respondents described their mental health as poor prior to schools returning; this has risen to 69% now that they are back at school.
• When asked how they think the return to school so far has affected their mental health, 61% of survey respondents said that it has had a negative effect. 27% said it has had a positive effect.
• There is indications of insufficient mental health support in schools. Only 15% agreed that there was enough information and support available for their mental health at their school, while 58% disagreed. The survey reports a lack of counsellor support and wellbeing support from teachers.
• Respondents highlighted seeing friends and teachers and returning to a routine as being positive for their mental health; negative factors included renewed academic pressure, concerns about the virus, social distancing measures and reduced mental health support.
• When asked what kind of information and support in school would help, the top three things were 'space to take some time if things get too much', extra help with school work and mental health support from teachers.
• Whilst 60% of respondents said that there are friends in their lives that they can talk to about how they are feeling, nearly one in four (24%) reported that they do not have friends in their lives that they can talk to about the way they are feeling.
• The top three concerns about the coming months were a second wave/future lockdowns, exams and related pressure, and concerns about mental health worsening. Other concerns included adulthood, body image/appearance, bullying and/or peer pressure and having to wear face masks for a long time.

The report notes that it is too early to draw definitive conclusions about the mental health impact of returning to school. Recent evidence from Ofsted suggests that many young people in England are settling in well and happy to see friends again, while others are more tired, upset, agitated, subdued and anxious than they were previously.

Report 06: Changes in children and young people's mental health symptoms from March to October 2020 (UK-wide)
Source: University of Oxford
Date: 11 Nov 2020

Oxford University's Co-SPACE (COVID-19: Supporting Parents, adolescents and Children during Epidemics) study is tracking changes to mental wellbeing over the course of the pandemic and has published its sixth report (based on non-representative survey data from over 7000 parents/carers), finding:

• That children with special education needs and/or neurodevelopmental differences and those from lower income household (< £16,000 p.a.) displayed consistently elevated behavioural, emotional and restlessness/ attentional difficulties throughout the whole period (March – October).
• Over the course of the first national lockdown (between March and June), behavioural and restless/attentional difficulties of primary school aged children increased while most children were not attending school but generally decreased from July (i.e. when home schooling demands typically reduce), throughout the summer holidays, and as children returned to school in September.
• Parents of young people of secondary school age reported more stable mental health symptoms throughout the pandemic.
• Secondary school aged girls were reported to have higher levels of emotional difficulties than boys overall, with an increase at the end of the summer (July to August) before the reopening of schools.
• Restless/attentional difficulties in secondary school aged children (11-17 year old) decreased from August to September. Overall, they were higher in secondary school aged boys than girls, especially in June.

Emerging Minds has launched a further project called the Co-RAY project (Covid-19 response: Mental Health resources for and by Young People). Working with a range of mental health organisations, this 18 month project aims to make sense of the research and support young people themselves to develop and share resources that will be helpful for other young people. The project will also share existing evidence based resources.

Emerging Evidence: Coronavirus and Children and Young People's Mental Health (Issue 4) (International)
Source: Evidence Based Practice Unit
Date: 21 Oct 2020

This the fourth in a series of evidence reviews on the impact of the pandemic on children and young people's mental health and what might help children and young people with these challenges. Key sub-groups covered include children and young people with pre-existing health and education needs, children and young people experiencing socio-economic disadvantage and social care needs, and black and minority ethnic (BME) children – the findings from this section are reported in the relevant sub-heading of this briefing. This report covers academic research and grey literature between June and July 2020 and focuses on newly emerging evidence rather than recurrent themes covered in previous editions. Summary findings below (excerpt from report p3-4):

What are the key mental health challenges for children and young people during the pandemic?

• During the extended periods of local lockdowns and home confinement, children and young people have displayed a range of psychological distress.
• Lack of outdoor activities, poor social support, close family members contracting the virus and gender may all be contributing factors in the development of these mental health challenges.
• Other young people have been enjoying more time at home, more time and flexibility to take part in leisure activities, and developing routines at home. This also applies to some young people with Autism Spectrum Conditions (ASC) and Attention Deficit Hyperactivity Disorder (ADHD).
• Outdoor access and optimal housing conditions may help young people manage the negative mental health effects of the pandemic, and is especially important with young people with ADHD and epilepsy.

What are the key mental health challenges for disproportionately affected groups?

• Children and young people receiving mental health care, such as for PTSD and other trauma related disorders, have experienced substantial restructuring of their support in the context of the pandemic.
• Parents and caregivers have expressed concern about the health and wellbeing of children and young people who are living with complex health conditions such as epilepsy and cystic fibrosis.
• The pandemic has amplified many of the existing risk factors for poor mental health in children and young people experiencing socio-economic disadvantage; including poor health, social isolation, uncertainty, financial stability and job loss.
• Structural inequalities are resulting in disproportionate mental health impacts for young people from minority ethnic backgrounds in the UK and the USA, seen in levels of anxiety, stress and sleeping difficulties and overt racial discrimination.
• LGBTQI+ youth may be disproportionately affected by mental health challenges associated with the pandemic owing to the loss of safe spaces and difficulties accessing health and psychosocial support services.
• Non-binary and gender queer young people may be more likely to report high levels of PTSD symptoms and suffer losses of peer support.

What might help children and young people to manage these challenges?

• Parents and carers can support access to healthy, stimulating activities and to accurate, age appropriate health information.
• Alternative provisions, such as online counselling, are vital in providing urgent care to those who may be struggling the most during the pandemic, for example with self-harm and suicidal thoughts.
• Increasing capacity in early years and community based interventions will help identify those who may be experiencing abuses "out of sight" to virtual services.
• Efforts to upskill teachers in the mental health challenges of pupils and to reinforce referral pathways to available supports will enable school staff to signpost appropriately. Equally parents and carers should be made aware of the signs of difficulties and available support.

'Her whole little life has changed dramatically' Findings of a Qualitative Study into Children's Mental Wellbeing in Bradford during Covid-19 (England)
Source: The National Institute for Health Research under its Applied Research
Collaboration Yorkshire and Humber
Date: 11 Nov 2020

This research is based on 43 phone and video interviews with purposefully selected families from the Born in Bradford longitudinal research cohort. Interviews were held with 21 Families (21 parents and 22 children aged 10-13) between August and September 2020, just before the majority of the children returned to school (Bradford was in local lockdown at the time). The focus of the research was on children's mental health. Key findings:

• COVID-19 anxiety - Children and parents reported a moderate, sometimes high, level of health anxiety about COVID-19. Engagement with news cycle and social media worsened children's anxieties. Children needed a lot of reassurance from parents, but parents felt confused and worried themselves. To mitigate this the report recommends easily shareable resources aimed directly at young people to help them understand the virus and the rules and mental health advice and support for parents.
• Boredom & lethargy - Children complained of days being boring, repetitive, lacking purpose and feeling stuck indoors, unable to do extracurricular activities. Lack of school routine, late bedtimes, long lie-ins and more time spent on devices meant some children fell into lethargy. To mitigate this the report recommends advice and ideas on age-appropriate local activities for children to do at home or outside in a socially distanced way could be collated and shared.
• Disengagement from school - Home-schooling was very variable and often a catalyst for arguments. Parents and children felt that not attending school had decreased children's ability to concentrate and learn. There was a destabilising effect on children who had just transitioned or were just about to transition to secondary school. The report recommends teachers staying in touch with pupils especially during transitions.
• Reduced social contact - Due to their age, social abilities and financial means, children were often cut off from contacting their friends. Virtual contact was more difficult and strange compared to face to face interaction. There was distress and unhappiness about being cut off from family that lived outside the household. To mitigate social isolation the report recommends encouraging parents to take a more active role in facilitating children's social interactions especially for younger children.
• Positive aspects of lockdown - Children enjoyed the opportunity to spend more time with their families. For some children with additional needs, lockdown offered a welcome respite.

Coronavirus: Mental Health and Wellbeing
Source: Public Heath England
Date: 12 November 2020

Public Health England (PHE) has updated its review of population mental health and wellbeing during the coronavirus pandemic. Chapter 3 of the report covers emerging findings from English/UK studies of the mental health and wellbeing of children and young people. The findings derive from two main categories of information: weekly data drawn from the UCL COVID-19 Social Study and other sources up to week 38 of 2020 (week ending 18 September); and analysis from a range of ongoing academic research projects up to 14 August.

Important findings so far:

• There is growing indicative evidence that COVID-19 and associated interventions, such as social distancing and stay at home guidance including school closures, have likely had an adverse effect on the mental health and wellbeing of children and young people. There is also increasing evidence that many children and young people are coping well overall and some have reported benefits for their mental health.
• Loneliness has been a challenge for some children and young people, who have felt less able to cope with not being able to see their friends, compared with other aspects of life during the pandemic.
• While many children and young people have retained some access to support for their mental health during this period, a lack of access or disruption to support during the pandemic has been reported by families to be associated with worse mental health and wellbeing for some of those with existing needs.
• There are indications that these experiences may vary by children and young people's characteristics, with those from Black, Asian and Minority Ethnic backgrounds, with existing mental health conditions, Special Educational Needs and Disabilities, or living in low income families or areas more likely to have been negatively affected than other children and young people.