Analysis

COVID-19 and mental health: how nurses can support children and young people

Pandemic has created a toxic environment in some families and this will affect children

The pandemic has created a toxic environment in some families, and the effect on children is now coming to light

For children and young people the true impact of the pandemic may only just be beginning to be felt

  • Mental health conditions are on the rise in children aged five to 16 years
  • Many nurses are seeing an increase in referrals for eating disorders and issues associated with mental health

With the COVID-19 vaccination programme surpassing all expectations and a roadmap out of lockdown, the UK is daring to hope the worst of the pandemic is behind us.

But for children and young people the true impact of the

The pandemic has created a toxic environment in some families, and the effect on children is now coming to light

For children and young people the true impact of the pandemic may only just be beginning to be felt

  • Mental health conditions are on the rise in children aged five to 16 years
  • Many nurses are seeing an increase in referrals for eating disorders and issues associated with mental health
The pandemic has created a toxic environment in some families, and the effect on children is now coming to light
Picture: iStock

With the COVID-19 vaccination programme surpassing all expectations and a roadmap out of lockdown, the UK is daring to hope the worst of the pandemic is behind us.

But for children and young people the true impact of the pandemic may only just be beginning to be felt. Even before the most recent lockdown, it was clear mental health was worsening.

In autumn 2020, NHS Digital and the Office for National Statistics published the Mental Health of Children and Young People in England 2020 report. It found mental health conditions were on the rise, with one in six children aged five to 16 years judged to have a probable mental health disorder – up from one in nine seen three years previously.

Referrals of children with eating disorders have tripled in some areas

Older girls had the highest rates, with one in five of those aged 11-16 reported to be struggling.

How this has translated into admissions to hospitals and referrals to services is not yet known from official figures. But already there are anecdotal reports of increasing demand.

The Royal College of Paediatrics and Child Health (RCPCH) says its members are seeing rising numbers of children with eating disorders, with some areas reporting that referrals have tripled during the pandemic.

Meanwhile, the NSPCC has seen rises in the number of children and parents phoning its helplines with mental health problems.

RCN professional lead for children and young people’s nursing Peta Clark says nursing staff working in services such as the Children and Adolescent Mental Health Service (CAMHS) are also beginning to see an increase in referrals. She has been particularly struck by the growing numbers of younger children needing help.

1 in 6

children in England has a probable mental health disorder
Source: NHS

Children are affected by adverse events such as increased stress, including financial or economic strain on their parents, she says.

‘There is also an increased risk of children observing or being subjected to abuse. This has an impact on their mental and physical health later in life. The truth is we are yet to see the real impact of the pandemic – it may be some years down the line before this is seen,’ says Ms Clark.

Again, the data is lagging on this, but what evidence there is suggests things have got worse.

Rise in reports of child deaths and incidents of serious harm

Sharon White, School and Public Health Nursing Association (SAPHNA) chief executive officer
Sharon White Picture: David Gee

Between April and September 2020 the government’s child safeguarding practice review panel received 285 reports from councils of child deaths and incidents of serious harm, including child sexual exploitation, up 27% from the same period the previous year.

School and Public Health Nursing Association (SAPHNA) chief executive officer Sharon White says members have been swamped by child protection cases since schools started reopening for face-to-face teaching in early March. She says cases of abuse and neglect appear to have been hidden from view by the lockdown.

‘Vulnerable children were able to attend, but we know only a minority did. It meant those that have been known – and on the register – have not been monitored as much as they would normally have been as they were not in school and social workers have had limited access outside of school.

‘But we are also seeing new cases – the pandemic has caused a toxic environment in some families.’

Perinatal mental health problems on the increase

Alison Morton, Institute of Health Visiting acting executive director
Alison Morton

About one in five mothers experience mental health problems during pregnancy or the first year of their baby’s life, but there are signs this has increased because of the pandemic. Research published by King’s College London has shown rises in anxiety and depression.

Institute of Health Visiting acting executive director Alison Morton says government restrictions on face-to-face contact have taken their toll in terms of the normal support networks for new families and the help they receive from health visitors.

She says: ‘Health visitors in many areas are prioritising face-to-face contacts for the most vulnerable families, where there is a known safeguarding concern, for example.

‘It means there are many who have not had any face-to-face contact with health visitors at all, particularly those families who had babies at the start of the pandemic. They just had digital contact. But we cannot provide the same level of support via Zoom.

About one in five mothers experience mental health problems during pregnancy or the first year of their baby’s life
Picture: iStock

‘We know from the emerging evidence that perinatal mental health problems are on the increase. For children and families living with adversity there is also going to be abuse and neglect that has been hidden from view – who will be identifying these families if they are not seen?

‘This will have an impact on the long-term future for these families and children. It is why we need to get back to face-to-face contact. District nursing has continued, health visiting should be no different.’

More broadly on mental health, she says school nurses have done their best by providing support to pupils digitally via e-clinics and the ChatHealth text messaging service. She says it will only be in the coming months that the full picture will emerge.

‘It is already looking bleak. I am hearing of hospital wards beginning to fill up with children in mental health crisis. We are even seeing primary school children with eating disorders, anxiety, having self-harmed or having suicidal thoughts. It is really concerning.’

Key problems include loss of education, damage to friendships and harm to job prospects

The charity Young Minds has been tracking the mental health of older children and young people throughout the pandemic. Its latest survey of nearly 2,500 young people aged 13-25, carried out in late January and early February, found two thirds (67%) believed the pandemic would have a long-term impact on their mental health.

67%

of young people aged 13-25 believe the pandemic will have a long-term impact on mental health
Source: Young Minds

The key problems identified were worries about the loss of education, damage to friendships, job prospects harmed and being personally affected by bereavement.

Of those who felt they needed help, just over half had received it, mostly from NHS community services such as CAMHS or via their schools and universities.

Emma Thomas, Young Minds chief executive
Emma Thomas Picture: Young Minds

Young Minds chief executive Emma Thomas says it shows the challenge facing services in supporting children and young people in the coming months. ‘The pandemic has had a devastating impact. Our research highlights significant barriers to getting mental health support.

‘Professionals in the NHS, schools and charities deserve enormous credit for the work they have done to improve and adapt services, but it is clear that many young people are going without the help they need.

‘In some cases this is because of young people not wanting to be a burden on services during the pandemic, while others have struggled to receive support online because of concerns about privacy at home. And despite some improvements in recent years, young people still often face an agonising wait for support in a system that is struggling to keep pace with rising need.’

School nursing service sees greater severity of problems

Walsall's school nursing service – delivered by Walsall Healthcare NHS Trust – has been providing mental health support to children for a number of years.

Before the pandemic this involved group sessions for primary and secondary school pupils and parents for those struggling with anxiety, low self-esteem and low mood.

The sessions are based on cognitive behavioural therapy and focus on confidence-building, problem-solving, resilience and communication. When the pandemic hit, they moved online.

Young girl in school uniform: school nursing service sees greater severity of problems caused by the pandemic
Picture: Alamy

Walsall school nursing professional lead Sallyann Sutton says: ‘This support has been needed now more than ever. We have started to see a significant increase in the severity of problems and are doing more one-to-one work as a result.

‘Our CAMHS service is seeing an increase in referrals too. It has been a very difficult year and families have struggled for a variety of reasons,’ says Ms Sutton, who is a committee member of the School and Public Health Nursing Association.

Walsall has also been one of the pilot areas for the mental health school teams programme. It has been trialled in 12 schools locally, and the school nursing service works closely with those teams in the schools where it is running, sharing referrals.

Ms Sutton says: ‘It is working well. It is important we support children – their lives have been significantly affected by the pandemic. The key is providing early help before problems worsen.’

Lack of focus on young people at particular risk

Ministers say this has already been recognised. In England, the government is investing in mental health support teams in schools and colleges. Pilots of these started before the pandemic and now investment has been promised to set up a network of 400 teams by April 2023.

285 cases

of child deaths and serious incidents of harm reported in April-September 2020
Source: Department for Education

Access to eating disorder services and community mental health services will also be improved, while the Department for Education has invested £8 million in the well-being for education return programme, which includes training for school staff to support pupils emotionally.

Elsewhere in the UK similar steps are being taken. In Scotland, a £15 million fund has been set aside to pay for ‘enhanced’ community teams and counsellors for school.

The extra money is being welcomed, but nurses working with some of the most vulnerable children are concerned there has been a lack of focus on young people at particular risk, such as those in mental health hospitals and caught up in the youth justice system.

Some receiving support in the community have had therapy put on hold

Child and adolescent mental health clinical nurse specialist Melissa Beaumont, who is chair of the London Youth Justice CAMHS Forum, says there has been a notable lack of consideration given to children in these situations. She and others working in the field have produced a report for the British Psychological Society’s Psychologist journal warning about the problems.

Child and adolescent mental health clinical nurse specialist Melissa Beaumont
Melissa Beaumont Picture: Twitter

She says those in secure settings have had to go without contact with families because of restrictions on visiting, while educational help and support post-discharge has been lacking. She is aware of children being kept in cells for 22 hours a day.

Meanwhile, those who receive support in the community have had therapy put on hold or had to make do with online appointments and brief face-to-face meetings ‘on the doorstep’.

Ms Beaumont said: ‘Short-term thinking will have long-term consequences, leading to increased social and personal questions. Not meeting the needs of these young people now may well lead to increases in risk both to themselves and to the public.’

The whole of society will need to make children a priority

RCN children and young people’s staying healthy forum lead for mental health Gemma Trainor says such accounts show just how much children and young people across the spectrum have been affected.

‘The needs of young people and the harm that has been caused has had to be put to one side to deal with the immediate crisis,’ says Dr Trainor.

RCN children and young people’s staying healthy forum lead for mental health Gemma Trainor
Gemma Trainor

‘That may be understandable but we now need a real focus on their emotional and mental health. We need to be proactive. We need to approach it believing that every child is going to need some sort of support.

‘For most it may be low-level emotional support, getting them to talk about how it has affected them. But others – those at risk of self-harm, eating disorders or post-traumatic stress disorder, those where domestic abuse is a concern and those who are or could end up in the youth justice system and as inpatients – will need more intensive help.

‘This goes beyond what nurses and the mental health system can do on their own – it is going to need the whole of society to make children a priority.’


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