Features

Pandemic impact: what about the kids?

19 March 2021

Young people are emerging as the pandemic’s collateral damage. Their mental health and education are under strain, and their struggles include anxiety, isolation and poverty. Journalist Jo Waters asks what can be done to support them.

The Covid-19 pandemic has severely disrupted our children’s lives – emptying schools for the best part of a year, causing a spike in levels of child poverty and mental health problems and revealing a shocking digital divide in education. One commentator compared the effects of the pandemic on a generation of children and young people to the impact of mass evacuation on families during the Second World War (Cottrell Boyce, 2021).

What's the scale of the problem ?

Anne Longfield, who served as children’s commissioner for England until earlier this year, says young people are suffering from a ‘toxic cocktail’ of secondary effects from the pandemic.

‘These include children who are losing out on their education, particularly those from disadvantaged backgrounds, who were 18 months behind their peers even before the pandemic. Others have had their mental wellbeing affected by the isolation, worrying about their own health and that of their family and friends, but also experiencing a huge slump in confidence, as well the school routine being taken away from them.’

Services have all been scaled down or changed, she says. ‘Most children will have had just a few weeks of education and normality over the last year and will end the year in a much more fragile place than where they started it.’

Some families don't have the right internet connection or computer equipment. And they have to feed the kids more as they are always home

‘A lot of health visitors were redeployed to the frontline in the first wave, and we know that some lockdown babies did not get the level of support from HVs they would normally.

Anne says many vulnerable children didn’t take up their school places because their parents were too uneasy about the virus or felt it was too stigmatising. Referrals to social services from GPs and others plummeted too; some local authorities say they fell by as much as half in the late spring last year, she says.

Bruce Adamson, children and young people’s commissioner for Scotland, agrees that Covid is the sternest test children have faced in a long time. ‘Over the past year, we have seen significant gaps in children and young people’s education, but also corresponding effects on their mental development and socialisation. It’s hugely concerning, especially the disproportionate effects on those who were already most at risk, such as disabled children and children who live in poverty.

‘What is worrying is that a lot of the studies that have been coming out have said we haven’t done enough to support them, particularly with mental health issues and child protection.’

The Mental health of children and young people in 2020 survey (NHS Digital, 2020) found a 50% increase in the prevalence of probable mental illness in children since 2017. One in nine children aged five to 16 in 2017 had a probable mental health disorder compared with one in six in the 2020 group. For older children, the figure is now one in five, and for women aged 17 to 22 it’s one in four.

A more recent survey found that one in five young people (aged 16 to 25) had experienced suicidal thoughts since the start of the pandemic, 10% had self-harmed, and 22% had experienced panic attacks (Prince’s Trust, 2021). Paediatricians have noticed large increases in the number of referrals for young people with anorexia and other eating disorders (Royal College of Paediatrics and Child Health (RCPCH), 2020). Dr Karen Street, a consultant paediatrician at the Royal Devon and Exeter Hospital, and officer for child mental health at the RCPCH, says: ‘We are extremely concerned about many children and teenagers’ wellbeing. Many of them are just not coping. Eating disorders are often related to a need for control – something many young people feel they have lost in the pandemic.’

Soaking up anxiety

Koulla Yiasouma, commissioner for children and young people in Northern Ireland, warns: ‘If we let our children’s mental health carry on deteriorating, we may never get them back on track. I can tell you how poorly, anxious and stressed children and young people are. We are mistaken if we think that we are protecting our children by not talking to them about our worries. They are like sponges, and have taken our anxieties and absorbed them.’

She accepts there is light at the end of the tunnel, as vaccinations are rolled out across the UK, but recognises that can be hard to see after months of lockdown. ‘Children are still doing great things and are remarkably resilient but, as with adults, some of the optimism has left us.’

Clinical psychologist Dr Nihara Krause, founder of the teenage mental health charity stem4, says downloads of its NHS-approved mental health apps, aimed at managing the urge to self-harm and symptoms of anxiety, went up to 12,000 a day during the A-level exam results fiasco and at the start of the school term in September. Numbers are still rising this year.

Nihara says there has been a huge rise in mental ill health conditions – primarily anxiety because of the threats to our health and security. ‘It’s really important that children have access to early interventions and to a variety of different treatments that they can access within a school or community setting, as well as services such as CAMHS [child and adolescent mental health services] for the more serious cases,’ she says. ‘But I don’t think much of this is available now, as obviously the nation has had to take a big breath and deal with the Covid crisis.’

Children are likely to experience high rates of depression and anxiety long after lockdown and social isolation ends

On the community practitioner (CP)front, Heidi Ferrier-Hixon, a school nurse team leader in Sandwell in the West Midlands, says her colleagues have been running online consultations and some face-to-face home visits for those children with mental health or child protection issues, and families who have lost a parent to Covid.

‘In the first wave, school nurses were redeployed to hospitals, but thankfully this time we’ve been able to support pupils because safeguarding demands have gone through the roof for domestic violence. Suicide attempts have risen too. There are huge levels of anxiety among young people, and this has the potential to escalate to some of them becoming school refusers when schools reopen.’

Heidi’s biggest concern is how services will cope at that time. ‘There’s going to be huge demand for support – we need school nursing teams to be better resourced so we can help. We are a workforce that is skilled, trained and already in place to do this work but we find the funding never comes.’

The effects of home schooling

Ofsted paints a bleak picture of the wide-ranging effects home schooling has had on children and young people. In November, it described how some children have regressed in basic skills and learning. Older children had ‘lost stamina’ in their reading and writing, some had lost physical fitness, and there was an increase in self-harm and eating disorders (Ofsted, 2020a). Another report in December described the effectiveness of remote education as ‘varied’ and how repeated isolation ‘chipped away’ at the progress pupils had made since returning to school in September (Ofsted, 2020b).

Anne Longfield says that 575 million school days were lost during 2020-21, and the disruption to schooling was on such a scale that a major recovery programme is now needed. ‘We’ve managed to do some amazing things during the pandemic such as the vaccination programme and the Nightingale Hospital and the furlough scheme, but providing digital education hasn’t had its “Nightingale moment” yet.’

Despite the government announcing the provision of one million free laptops, only around half that number had reached schools by mid-December (Department for Education, 2020), and many families are still struggling with home schooling.

Heidi says one mother was distraught a teacher had cut a session down to 10 minutes because only five out of 30 pupils had logged on for a lesson. She said her child felt he was falling behind and felt lost. ‘This is a major transition point for them and it’s going to affect their futures massively. We can’t just expect everything to return to normal when they go back.’

Janet Taylor, chair of the CPHVA Executive, says HVs know that parents, especially women, are finding it stressful to work and supervise home learning.

‘Some parents don’t have the space, and they are finding it hard as the whole family’s routine has gone out of the window,’ Janet says. ‘They don’t have the right internet connection or enough computer equipment. On top of that, they have to feed the kids more as they are always home, so food bills are rocketing. Some are also worrying about how much time their kids are spending online, and how reliant they are on devices for school work, as well as play and socialising. The UK is rich, but the pandemic has exposed a deep digital divide.’

Exposing poverty

A survey of 678 low-income families found that 90% had seen a significant drop in their living standards due to a combination of a decline in income and a rise in living costs (Child Poverty Action Group, 2020).

Social media campaigns by the Manchester United footballer Marcus Rashford and celebrity chefs have highlighted the ongoing plight of children on free school meals in England whose parents had to resort to foodbanks during the school holidays to feed them, and called for an end to food poverty by the summer holidays (Scott, 2021). The government refused to provide free school meals at the February half-term holiday.

Koulla says the economic fallout of the pandemic has highlighted the fragile state of some families. ‘There were a lot of families who were struggling before the pandemic, but just keeping their heads above water, who are now really feeling it. The idea that some free school meals or even £20 a week extra in Universal Credit can fix this is mistaken. We are going to need sustainable long-term support and services. While I supported the campaign for free school meals in school holidays – and hats off to Marcus Rashford for raising that profile – these were only a sticking plaster for the deep-seated inequalities in our society.’

However, Koulla says that the exposure of these inequalities had changed the debate around poverty. ‘There’s been a shift away from the deserving and undeserving poor debate. I think there is more understanding now how children are disadvantaged by poverty and how precarious their lives are. We need to harness that, so we don’t find ourselves in this position again.’

Child safety

‘We know that children are more at risk of abuse and violence in the home without the safety valve of school,’ says Koulla. ‘During the first lockdown in Northern Ireland, we saw about 100 fewer referrals a week to child protection services. That is a trend replicated across the UK.’

Ofsted also raised fears about the children who were out of sight during school closures with falling referrals to social care (Ofsted, 2020a). The NSPCC reports that calls to the its helpline had risen from an average of 140 contacts a week pre pandemic to 185 between 23 March and 17 May, and Childline delivered an average of 65 counselling sessions a week in the same time period compared to 50 before the pandemic.

In Northern Ireland, Janet says that HVs have been able to maintain home visits and pick up on tensions such as an undercurrent of stress and the risk of domestic violence. ‘One HV told me about a gut feeling she had that things weren’t right in one family; she was able to persevere with the mother and discovered the husband had a bit of a temper and had lost his job, started drinking more and was irritable with the children. She’d lost her part-time job too so there were money problems. She described the situation as a boiling pot of tensions, which hadn’t developed into a crisis yet but easily could,’ recalls Janet.

‘In that case, a social worker came to sort out some benefits and get the children into school – as they were vulnerable – to ease some of the pressures. HVs can use their skills and experience to head off a crisis. But with more pressure on HVs to be redeployed to vaccination centres and hospitals, there’s a risk in some areas that this might not be happening as much.’

Investing in people

Bruce Adamson is sure of one thing. ‘We need to listen to children and young people and involve them in decision-making. Children and young people feel they are not being heard or their views taken into account,’ he says.

‘We also need to invest in the skilled community-based health professionals who work with children and families. They all do an amazing job, but they are massively under-resourced. We needed more HVs, community mental health nurses and school nurses before Covid and we need them even more now.’

Sally Holland, children’s commissioner for Wales, says children will look back on this period in a similar way to how previous generations viewed the Second World War because they will feel its impact for years to come.

‘However, it’s important for young people to know that they have developed other skills during these times,’ she adds. ‘They’ve had to be adaptable and flexible and work independently – some have even got involved in volunteering. I hope that employers will value these qualities; we don’t want young people to feel they’ve been written off.’

Anne says long-term support and investment from government is needed. ‘We’ve got a cohort of children that have had a huge shock to their lives. Parents are telling us that children are becoming withdrawn and fearful of other children. So, all these factors have led me to call for a large-scale recovery plan, which will include mental health support and a catch-up programme in schools, but also help for families.’

Janet says investment in the CP public health professions including health visiting, school nursing and nursery nurses is essential to help children, young people and their families recover from the crisis. ‘They are the linchpins that can pick up problems, support families and call on specialist services where needed. This needs to be reflected in better pay. We need to invest in our specialist workforce.’

Society, warts and all

The Institute of Fiscal Studies says radical solutions such as repeating the whole school year may have to be considered for children to catch up with all the schooling they have missed, or they collectively risk losing £350bn in lost lifetime earnings (Sibieta, 2021).

Koulla says we are at a pivotal moment and is hopeful that the pandemic will lead to the decision to build a fairer society, similar to the postwar era when the foundations of the welfare state and the NHS were laid. ‘The pandemic has exposed society, warts and all. Part of the reason the Clap for Carers campaign didn’t take off in the third wave is that people have realised it’s not enough to just clap for them – frontline workers need to be paid well, supported and valued too.

‘It’s the same with our children. People say that they are our future – and they are – but we need to invest in them and support them now. When they come back to school, we should be wrapping our arms around them and asking them how they are, they’ve been through so much.’

In fact a research review by the universities of Bath, Bristol, University College London, Reading and Edinburgh has found that children and adolescents are likely to experience high rates of depression and anxiety long after lockdown and social isolation ends, and clinical services need to be prepared for a future spike in demand (Loades et al, 2020).

Researchers found that young people who were lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness and depression could last for at least nine years.

The studies highlight an association between loneliness and an increased risk of mental health problems for young people. There is also evidence that duration of loneliness may be more important than the intensity of loneliness in increasing the risk of future depression among young people.

The authors say the findings should act as a warning to policymakers of the expected rise in demand for mental health services from young people and young adults in the years to come - both here in the UK and around the world.

The crisis down the road

Dr Maria Loades, a research fellow in the Bristol Medical School and clinical psychologist from the Department of Psychology at the University of Bath, led the work. She said: ‘From our analysis, it is clear there are strong associations between loneliness and depression in young people, both in the immediate and the longer-term. We know this effect can sometimes be lagged, meaning it can take up to 10 years to really understand the scale of the mental health impact the Covid-19 crisis has created.’

But Koulla is optimistic about the future, and says it’s not inevitable young people will suffer – provided there is investment in services to support them.

‘There needs to be a long-term plan. We have to integrate the Covid response into mainstream services. We need continued investment in public services, health and education and come up with sustainable responses to poverty to make sure children, young people and families are supported.’


‘The pandemic is affecting children and young people in so many ways’
Kathryn Manifold is a health visitor and manager of a Flying Start team in north Wales.

Lockdown has been a real struggle for new parents – it’s hard to be so isolated when you have a new baby, and you are cut off from family, social support and mixing with other mothers. Yes, there are online Zoom groups – but they’re not the same. Breastfeeding rates have also declined.

The isolation is also affecting children’s development – we’ve heard of children regressing from being toilet trained back to nappies, or their speech being delayed because they use a dummy too much and not getting enough interaction. We rely on what parents are telling us about their child’s development, but if they are not mixing with children of their age, they may not realise their child has fallen behind. We feel there will be an awful lot of developmental delay issues that will spike when social isolation measures lift.

There are also safeguarding issues that are probably being missed as we aren’t going into family homes as much. On a home visit, you are much more likely to pick up on issues and atmospheres. There are lots of pressures in families – particularly if they are together 24/7, and there’s a worry that they might not be handling things as well as usual with no routine, and may snap more easily. Lots of families are relying on foodbanks; I work in a deprived area and most are in the same boat, so there’s no shame.

Mental health problems in teenagers are very common. They are cooped up indoors and it’s lonely for them.

I think it’s important that HVs and school nurses are well resourced so we have enough time to spend with families during this crisis and afterwards. As part of the Welsh Government’s Flying Start team, we have caseloads of 110, much smaller than those in England. This means we can offer intensive support to a population that is feeling the effects of the pandemic acutely.


Resources

  • Childline’s Calm Zone gives practical advice on coping mechanisms for children, including breathing experiences, yoga, games and advice childline.org.uk/toolbox/calm-zone
  • Support for parents can be found at Parenting and Family Support – Family Lives (Parentline Plus) has an online forum for parents to chat plus practical advice on teaching children at home and building resilience in children and teens. Call Parentline on 0808 800 2222 or visit familylives.org.uk
  • stem4 is a teenage mental health charity that provides four downloadable apps for teenagers in need of support stem4.org.uk
  • The Children and Young People’s Commissioner in Scotland is looking for 14- to 17-year-olds to join the Young Advisers Group. For more information, see bit.ly/CYPCS_young_adviser
  • ChatHealth is invaluable for CPs and young people: read more about it on page 48.

References

Child Poverty Action Group. (2020) Poverty in the pandemic: an update on the impact of coronavirus on low-income families. See: https://cpag.org.uk/policy-and-campaigns/report/poverty-pandemic-update-impact-coronavirus-low-income-families-and (accessed 8 February 2021).

Children’s Commissioner for England. (2020) Some sort of normal. See: childrenscommissioner.gov.uk/report/some-sort-of-normal (accessed 8 February 2021).

Cottrell Boyce F. (2021) A brutal Covid legacy awaits our children. We need the will and ambition to tackle it. The Guardian. See:theguardian.com/commentisfree/2021/jan/17/a-brutal-covid-legacy-awaits-our-children-we-need-the-will-and-ambition-to-tackle-it (accessed 5 February 2021).

DfE. (2020) One million laptops and tablets for disadvantaged children and young people. See: gov.uk/government/news/one-million-laptops-and-tablets-for-disadvantaged-children-and-young-people (accessed 8 February 2021).

Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, Linney C, McManus MN, Borwick C, Crawley E. (2020) Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry 59(11): 1218-39. 

NHS Digital. (2020) Mental health of children and young people in England in 2020. Wave 1 follow up to the 2017 survey. See: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up (accessed 8 February 2021).

Ofsted. (2020a) Children hardest hit by COVID-19 pandemic are regressing in basic skills and learning. See: gov.uk/government/news/ofsted-children-hardest-hit-by-covid-19-pandemic-are-regressing-in-basic-skills-and-learning (accessed 8 February 2021).

Ofsted. (2020b) COVID-19 isolation having detrimental impact on children’s education and welfare, particularly the most vulnerable. See: gov.uk/government/news/covid-19-isolation-having-detrimental-impact-on-childrens-education-and-welfare-particularly-the-most-vulnerable (accessed 8 February 2021).

Prince’s Trust. The Prince’s Trust Tesco youth index 2021. See: https://www.princes-trust.org.uk/about-the-trust/news-views/tesco-youth-index-2021?utm_source=facebook&utm_medium=social&utm_campaign=YouthIndex2021&utm_content=national (accessed 8 February 2021).

RCPCH. (2020) Paediatricians warn patients to be alert to signs of eating disorders over holidays. See: rcpch.ac.uk/news-events/news/paediatricians-warn-parents-be-alert-signs-eating-disorders-over-holidays (accessed 8 February 2021).

Scott J. (2021) Marcus Rashford and top chefs demand free school meals review. BBC News. See: bbc.co.uk/news/uk-politics-55670096 (accessed 8 February 2021).

NSPCC. (2020) The impact of the coronavirus pandemic on child welfare: domestic abuse June 2020. See: https://learning.nspcc.org.uk/media/2241/impact-of-coronavirus-pandemic-on-child-welfare-domestic-abuse.pdf (accessed 8 February 2021).

Sibieta L. (2021) The crisis in lost learning calls for a massive national response. See: https://www.ifs.org.uk/publications/15291 (accessed 8 February 2021). 

Image Credit | Shutterstock

Top