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Families holding on: how will they bounce back after Covid?

21 May 2021

Young families have been under tremendous pressure from all directions during the Covid-19 pandemic. Journalist Jo Waters investigates what new parents, babies and toddlers, and parents of young children have been experiencing and asks what support they will need. 

The last 15 months may just have been one of the most stressful times in many decades to bring up a young family in the UK.

The list of lockdown stressors for new parents has been endless: mothers giving birth in hospital with midwives in PPE, sometimes without their partners (Ostlere, 2020), and limited hands-on support from friends and grandparents due to social distancing. Health visitors made fewer home visits (National Institute for Health Research Policy Research Unit, 2020) and there were fewer visits to GP surgeries – in one English surgery, visits to GPs fell by 92.5% during March 2020 (Gray et al, 2020). Parent and baby groups have retreated online, millions of jobs are hanging by a thread, and domestic violence has increased (Office for National Statistics, 2020).

Amid this torrent of worries and isolation, how have new parents and their babies, parents with toddlers and parents with primary school age children coped – and what can be done to support them?

Impact on mental health

A report from the Maternal Mental Health Alliance (MMHA)found that women and their families have faced extra pressures on their mental health during lockdown, including anxiety about giving birth during lockdown or catching Covid, fears about rising unemployment and increasing levels of domestic violence. It found some groups of women faced a higher-than-average risk of poor mental health, including women from specific racial groups and those experiencing economic deprivation (MMHA, 2021).

Luciana Berger, chair of the MMHA, says the report should serve as an ‘ear-splitting warning siren about the dangers to women’s maternal mental health and potential risks to the wellbeing of their babies.’

‘The pandemic has placed additional challenges on new and expectant mums getting the care and support they need, taking many already-stretched services to the point of breaking,’ she says. ‘Women of colour and women from disadvantaged backgrounds have been particularly impacted, and ministers must address this injustice with urgency.’

The MMHA report recommends assessing levels of need for perinatal mental health, future-proofing perinatal mental services against future pandemics, routinely publishing data on the mental and physical health of women in the perinatal period, tackling race discrimination in health services and outcomes, recognising the importance of voluntary and community organisations, and supporting the mental health of all health and care staff.

Meanwhile, the Royal College of Psychiatrists (RCPsych) used NHS Digital figures to confirm the devastating impact the Covid pandemic and lockdowns have had on mental health – 2.2 million adults and 400,000 children have sought help and the NHS provided 1.64 million extra mental health sessions (RCPsych, 2021). The College also found that 80,226 more children and young people were referred to specialist mental health services between April and December last year, an increase of 28% on 2019 (RCPsych, 2021).

Dr Bernadka Dubicka, chair of the child and adolescent faculty at RCPsych, says: ‘ As a frontline psychiatrist I’ve seen the devastating effect that school closures, disrupted friendships and the uncertainty caused by the pandemic have had on the mental health of our children and young people.’

The crisis is affecting adults as well as children. Over one million more treatment sessions were given to adults between April and December last year (1,078,539), an increase of 8% on 2019. There was also 159,347 urgent or emergency crisis referrals made for adults, an all-time high, and an increase of 2% on 2019.

Bursting the bubble

Jenny Weeks, helpline supporter with the Association for Post-Natal Illness, says call volumes are up, and that more funding for perinatal mental health is needed. ‘HVs need to check in with mothers as much as they can to fill the gaps face to face if possible. No one has evaluated telephone support – it doesn’t suit everyone, they may not have the devices, data or privacy sometimes.’

A report by the pressure group Pregnant then Screwed (2020), which surveyed 19,950 mothers and pregnant women in July last year, found that 81% of the employed mothers said they needed childcare to work but 51% didn’t have the necessary childcare in place. Chair of the CPHVA Executive Janet Taylor says much of the burden of home schooling during lockdown has fallen on women, and this was especially hard if they were also working from home. In all, 72% of mothers have had to work fewer hours because of childcare issues, and 65% of mothers who have been furloughed say a lack of childcare was the reason (Pregnant then Screwed, 2020).

Janet, also a HV in Northern Ireland, says: ‘Mums carry a lot of the responsibility for making sure everyone is happy, well fed and getting their work done. Added to that mothers are worrying about their kids having too much screen time – the better spring weather is a pressure release for many.’

Celia, a young, pregnant working mother in her thirties who lives in south London, says she and her partner found it hard to juggle caring for their two-year-old daughter with both working from home. ‘We each worked a half day and then handed over to each other. We really missed the nursery, which was closed for five months.Our daughter didn’t see any other children, and she missed the social contact – I felt sad we had no playdates. Luckily, we were able to form a childcare support bubble later with my in-laws.’

Mark Williams, the Wales-based founder of the UK-wide pressure group Fathers Reaching Out, says that only 10% of new fathers are routinely asked about their mental health by healthcare staff, yet 91% of them said it would have been useful to receive information on it (Coram Family and Childcare, 2021). And a survey published by Fathers Network Scotland (2020) found that 69% of fathers said their mental health had suffered during the second lockdown in autumn 2020. However 22% said lockdown had positively affected their relationship, and 67% said the change in work/life balance and spending time with children showed them this was how they wanted to parent in the future.

Luciana Berger, chair of the MMHA, said the report should serve as an ‘ear-splitting warning siren about the dangers to women's maternal mental health and potential risks to the wellbeing of their babies’

What are families worried about most?

Mental health, loneliness and child development have emerged as some of the biggest concerns among parents during the pandemic, along with money worries and job insecurity.

Last year, more than 61% of 5000 UK parents surveyed, including pregnant women and mothers of newborns and toddlers, had significant concerns about their mental health and only 32% were confident they could find that help (Best Beginnings et al, 2020). Parents said they were also concerned about the effects of lockdown on their babies with 47% saying their baby had become clingy, and 24% saying their baby was crying more than usual.

Another report from the Royal Foundation and Ipsos MORI (2020) of 500,000 parents with children under five found the number of parents who said they had experienced loneliness had increased from 38% to 63% during the pandemic.

Janet confirms that loneliness and isolation have been major issues. ‘These women haven’t had the face-to-face support from grandparents and friends – some of them have been on their own with their babies all day. Part of having a new baby is showing them off to family and getting out and meeting people, joining mother and toddler groups, but they’ve had none of that support. Zoom calls and WhatsApp groups can help them feel more connected, but it’s just not the same as seeing people.’

Dr Abigail Wright, an educational psychologist specialising in early years development in Wales, says fears about the effects of isolation on their babies are one of the main reasons parents have contacted her.

‘These are valid concerns of course, but I would offer the reassurance to parents that they have all the tools needed for bringing on their baby’s development and that their interaction at this age is one of the most important things,’ she says. ‘Playing with them, talking to them and tuning into their needs and feelings is what is needed. If they form that positive attachment with their baby as a trusted figure, the baby will be in a position to generalise those skills outside the home later.’

However, Abigail acknowledges that the pandemic may have made parent-child interaction more challenging, especially if parents are experiencing additional challenges in their lives and/or are experiencing mental health needs. This could make it more difficult for parents to feel ready or able to interact and engage with children in the way they would like to, due to these challenges.

Dr Andrew Mayers, a principal academic psychologist at Bournemouth University who specialises in perinatal mental health, says the pandemic has had a dramatic effect on parenting and the mental health of mothers and fathers, both those with pre-existing mental health problems and those without. ‘Depression can affect the ability of mothers and fathers to interact with their children, they can be distracted by the extent of their illness. Their resources and mood may be depleted, and concentration affected.’

 

 

Digital limitations

A survey of HVs conducted by University College London (Conti and Dow, 2020) found 96% were concerned they may be missing domestic violence and child abuse (see Pandemic pressures, above).

Janet agrees that some HVs worry about not picking something up. ‘In Northern Ireland we’ve continued with home visits, but a family can easily stop you coming in just by saying that someone in the house has Covid symptoms, so there are worries about safeguarding issues definitely. There may be domestic violence or abuse going on in some families, and they don’t want HVs and social workers coming over their doorsteps.’

Barbara Evans, a Healthy Child Programme practitioner in the Midlands, says digital and phone consultations have their limitations.

‘Digital has its place, but I don’t think it’s the answer and I do worry that is the road we are going down,’ she says. ‘You just can’t beat human contact – you can pick up on body language and other cues you might otherwise miss. I can’t wait to work face to face again.

‘I do two-year checks but as I currently do them on the phone, I’m reliant on what the family tell me and conscious that I may be missing opportunities to spot or notice something to raise it or offer advice.’

Slipping through the net

The NSPCC has reported 3604 contacts from adults about parental mental health between April 2020 and January 2021, a worrying 44% monthly average increase compared with the previous year (NSPCC, 2021). NSPCC senior policy officer Vicky Nevin says: ‘We know that when families are overloaded with worries, they find it harder to give their baby the consistent care and attention they need to thrive. This can have a detrimental effect on the baby and the whole family.

‘One caller who rang was concerned about her friend who was depressed and barely able to get out of bed. This meant her toddler was left to fend for himself, unsupervised. It was clear this family had slipped through the net. That’s why the government must urgently restore the health visiting provision to its previous strength and invest in services that help parents to manage their mental health and support their child’s development.’

Vicky also says: ‘Younger children have been calling Childline during the pandemic, and mental health remains their top concern. Sadly, home isn’t always a safe place, and counselling sessions with children about domestic abuse have also increased. That’s why it’s so important that school catch-up programmes focus not only on education, but on children’s wellbeing and safety.’

‘These are valid concerns of course, but I would offer the reassurance to parents that they have all the tools needed for bringing on their baby’s development and that their interaction at this age is one of the most important things’ 

Positives and negatives

Wendy Nicholson, deputy chief nurse with Public Health England, acknowledges the pandemic has had a huge impact on families by increasing anxiety among parents. ‘We know that some of the support is not the same as it would have been,’ she says. ‘We know there have been issues around maternal mental health and wellbeing and family mental health. There have been a lot of stressors on “pressure cooker” families who are feeling isolated or living in close promixity and not able to get out, so we know there has been a lot of potential for conflict and anxiety, as well as changes in people’s financial situation. For some families, job security has been a real worry.’

However there have been some unexpected positives, Wendy adds. ‘Mums have been able to spend more time with their babies, they have been at home and their partners have been able to be more involved, they’ve not been able to go out as much, but when they have, they’ve picked their time and done it as a family.

‘HVs have also responded positively by changing their delivery model, focusing on the most vulnerable families so that where they’ve identified needs, they’ve been able to drill down to make sure they do get that individual support.

‘But I guess the biggest impact has been that the universal offer hasn’t been as universal as we would want it to be, and we need to change that as we continue to restore services.’

Wendy says the pandemic has also shone a light on the important work of HVs, school nurses and nursery nurses. There’s now recognition in the media and among many leaders that there is more than one frontline in public health.

How can you help families?

Barbara says it’s early days, but for the parents who have struggled during the pandemic the problems are very real. ‘I think we could be facing more cases of children with developmental delay, speech delay and behaviour problems. If parents have suffered from low mood then there’s lot of evidence this can have a direct effect on the child’s emotional health and wellbeing – so I’m concerned that’s something that will hit us at some point.

‘Being able to spend some extra time with a family who are struggling can help nip future problems in the bud – preventative work definitely pays off.’

Andrew says the full impact of the pressures families have been under may not be seen for some time. Parents could have a delayed traumatic response to their experience or the ways they have interacted with their child may have impaired their child’s development.

‘I truly hope that HVs will be vigilant about looking out for the signs – mums and dads will be returning to the workplace soon and then how will we find them then? I think this is something waiting to happen, so we need to fundamentally rethink how NHS services are operating at this time and how much additional support we need to put into the community and the workplace.’

Time for a fair start

The NSPCC has launched its Fight for a Fair Start campaign, to make sure every new parent gets the mental health support they need and community-based services are available to help families bond with their babies. And Wendy says her message is for community practitioners to carry on doing what they do well. ‘They’ve all done a fantastic job during the pandemic and held families together and sought out those in greatest need and provided tailored support for the most vulnerable families.

‘Part of our role now is making sure we have a clear catch-up programme for the Healthy Child Programme and those reviews that children have missed. We have published the revised HV and school nurse model recently and suggested there could be two additional contacts for HVs for families in England – from five to seven visits, depending on the family. I think these will be crucially important as we do the catch-up reviews.’


Resources  


References:

Best Beginnings, HomeStart, Parent-Infant Foundation. (2020) Babies in Lockdown report: listening to parents to build back better. See: parentinfantfoundation.org.uk/our-work/campaigning/babies-in-lockdown/#fullreport (accessed 13 April 2021). 

Centre for Mental Health. (2021) Maternal mental health during a pandemic. See: centreformentalhealth.org.uk/publications/maternal-mental-health-during-pandemic (accessed 13 April 2021). 

Conti G, Dow A. (2020) The impact of Covid 19 on health visiting in England: first results. University College London. See:  discovery.ucl.ac.uk/id/eprint/10106430/8/Conti_Dow_The%20impacts%20of%20COVID-19%20on%20Health%20Visiting%20in%20England%20250920.pdf (accessed 13 April 2021).   

Coram Family and Childcare. Consultation with fathers. See: https://www.familyandchildcaretrust.org/sites/default/files/Resource%20Library/Fathers%20consultation_Coram%20Family%20and%20Childcare_SSBC.pdf (accessed 23 April 2021).

Fathers Network Scotland. (2021) Dad’s Survey 2021. See: fathersnetwork.org.uk/dads_survey_2021 (accessed 13 April 2021).  

Gray DP, Sidaway-Lee K, Harding A, Evans P. (2020) Reduction in face-to-face GP consultations British Journal of General Practice. 70(696): 328.  bjgp.org/content/70/696/328 

National Institute for Health Research Policy Research Unit. (2020) The impact of the COVID-19 pandemic on services from pregnancy through age 5 years for families who are high risk or have complex social needs: interim findings. See: https://www.ucl.ac.uk/children-policy-research/sites/children-policy-research/files/the_impact_of_the_covid-19_pandemic_on_services_from_pregnancy_through_age_5_years_interim_report_june_2020_0.pdf (accessed 22 April 2021).

NHS Digital. (2021) Mental health service monthly statistics. See:  digital.nhs.uk/data-and-information/publications/statistical/mental-health-services-monthly-statistics (accessed 13 April 2021). 

NSPCC. (2021) Parents’ mental health issues could be missed due to pandemic. See: https://www.nspcc.org.uk/about-us/news-opinion/2021/pandemic-parent-mental-health (accessed 23 April 2021).

Office for National Statistics. (2020) Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales: November 2020. See: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseduringthecoronaviruscovid19pandemicenglandandwales/november2020#main-points (accessed 22 April 2021).

Ostlere L. (2020)  ‘I am an NHS midwife in the coronavirus crisis. New mothers are scared – the focus has moved to Covid-19’. The Independent. See: independent.co.uk/life-style/health-and-families/midwife-nhs-ppe-lockdown-coronavirus-covid-19-a9493171.html (accessed 13 April 2021). 

Pregnant Then Screwed. (2020) The impact of Covid-19. See: docdroid.net/joYdZsN/the-impact-of-covid-19docx-pdf (accessed 13 April 2021).   

Royal College of Psychiatrists. (2021) Country in the grip of a mental health crisis with children worst affected, new analysis finds. See: rcpsych.ac.uk/news-and-features/latest-news/detail/2021/04/08/country-in-the-grip-of-a-mental-health-crisis-with-children-worst-affected-new-analysis-finds (accessed 13 April 2021).   

Royal Foundation of the Duke and Duchess of Cambridge. (2020) State of the nation understanding public attitudes to the early years. See: mk0royalfoundatcnhl0.kinstacdn.com/wp-content/uploads/2020/11/Ipsos-MORI-SON_report_FINAL_V2.4.pdf (accessed 13 April 2021).   

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