Hand sanitizers on school desks. Schools closed, then opened, and, in some places, closed again. Parents and carers working from home, or not at all. Masked adults at the supermarket. An omnipresent tally of sickness and death in the news and conversations around them.
The emotional and physical world of children is vastly different to the one they once knew, or that the adults around them expected.
“The ground’s been ripped from under them,” says professor Harriet Hiscock, a pediatrician at Murdoch Children’s Research Institute in Melbourne, Australia.
Illustration: Yusha
For many children, life is expected to return to normal once the shadow of the COVID-19 pandemic and economic crisis lifts. For many others, particularly those vulnerable due to preexisting mental health conditions or difficult family situations, the disruption, stress and uncertainty of growing up during this crisis threatens to have mental health consequences that might trail them into adulthood — unless they can access mental health support early. That support is not yet there.
“I think the system as it is won’t cope with the demand. We have to do something about that,” Hiscock says.
COVID-19 has hit the Australian mental health care system already under strain. Even before the crisis, many children with mental health problems were not receiving the level of care they needed. Research by Hiscock and others at the institute found that just one in four children with a mental health condition had last year accessed professional help.Now early signs are that demand for mental health support across the board is increasing as a result of the pandemic and its fallout. Services such as Kids Helpline have reported a 28 percent year-on-year increase in calls over the last three months.
This week, the Australian Psychological Society, as it welcomed the Australian government doubling the number of subsidized psychological care sessions that residents of the southeastern state of Victoria can access, reported that psychologists are experiencing unprecedented levels of demand for their services and that clients were quickly running out of sessions on their mental health plans.
“This [crisis] will see an increase in mental health problems in children and adolescents,” Hiscock says. “If we look at data from previous major events around the world, whether they’re natural disasters or pandemics previously, there are groups of children who go on to have lasting mental health effects into adulthood.”
Hiscock says that for children with preexisting mental health issues or for those already struggling with learning or connection with friends, “it’s all got a lot worse for them.”
Hiscock says she is seeing children and adolescents who are “on the edge” to retreat from learning and socializing.
“Some are just withdrawing to their bedrooms,” she adds.
“The mental health challenge is one of the most significant challenges COVID is going to cause,” says Ian Hickie, co-director of the Brain and Mind Institute at Sydney University. “The mental health effects will, at the end of the day, be much bigger than the physical health effects.”
Before COVID-19, anxiety was already the number one mental health issue for children in Australia, Hickie says.
“That depends on the world around them. Do we know where we’re going? Have we got this under control? Is it safe for me to experiment with the world? For everyone’s world at the moment the answer is that, in truth, we don’t know,” Hickie says.
“Chronic stress is much harder to cope with than acute stress. Chronic uncertainty is much worse for mental health. It’s affecting parents and teachers, and it may be transmitting to children. We don’t really know what happens,” he says.
However, the mental health impacts of the crisis does not fall evenly.
“It is likely that there will be groups of kids who will be more affected, more anxious kids by temperament, those exposed to more challenging circumstances because of what happens in their families and elsewhere, are likely to have more concerns,” Hickie says.
Economic insecurity alone can lead to negative mental health outcomes in children. A 2016 study, co-authored by Nancy Kong, a health economist at the Queensland University of Technology, tracked Canadian children over eight years to determine the impact of family financial instability. The researchers found that in households with economic instability, girls were more likely to develop anxious behavior, while boys were more likely to become hyperactive than children in financially stable households.
This impact is likely the result of children mirroring their carers’ worry, or changes in parental behavior, Kong says, adding that parents experiencing economic instability were found to be more likely to be inconsistent with parenting, interact less with their children and more likely to use punitive methods of discipline.
Kong says that there is limited research into the effects of economic anxiety on children, but what her study has shown is that intervention needs to be early and specific, and girls and boys might need different interventions, while specific support should be available for single-parent households. Without such intervention, the impacts could be long term.
“Imagine a kid is very anxious or hyperactive. They’re less likely to sit down in a room and have a productive day of study. So once they develop the bad habits, it’s more likely to carry on and later affects their scores in school, their educational attainment and their labor market outcome,” Kong says.
However, the trajectory is not unavoidable. Half of all mental health problems begin before a person is 14, Hiscock says.
Three-quarters of adults who experience poor mental health first had problems before they were 25. In Australia, about 14 percent of children in 2013 and 2014 were reported to have experienced mental health problems.
However, early intervention and treatment can prevent problems developing and lingering into later life.
“Mental health problems are preventable and tractable. It needs rapid service change,” Hickie says, adding that the current system cannot meet the present and coming challenges, and a lot needs to change, preferably quickly.
“We don’t want it to be like aged care” where problems were known, but not addressed, Hickie says.
“Government needs to take action now, in the next six months, so that much better services are in place by early 2021 as we see a surge in demand. Children and young people have been two groups least well served by the existing mental health system,” he says, adding that there is a known undersupply of child and adolescent psychiatrists in Australia.
“We also have a shortage of psychologists who see children under the age of 12 years — even though they say they are child psychologists, they tend to see adolescents,” Hiscock says.
Local governments around Australia have made a priority of mental health during the COVID-19 crisis and the summer’s catastrophic bush fires. Since the pandemic began, money has been allocated to supporting coronavirus-specific mental health phone lines and funding for psychological care sessions increased.
The Australian federal government has also funded a national pandemic mental health response plan, although Hickie criticizes the plan as lacking in practical steps.
Both Hickie and Hiscock say much more needs to be done.
Hiscock says Australia needs to increase its mental health workforce, but also use the existing workforce better. She points to models in the UK and the US whereby general practitioners, pediatricians and maternal and child nurses are trained and supported by mental health professionals to address and assess child mental health problems.
A productivity commission report into mental health submitted at the end of June is currently with the federal government. In the commission’s draft report from last October, it warned that children with mental health problems often fall behind in school. It recommended that all schools in Australia have a senior teacher dedicated to student mental health and well-being, and charged with linking in to local mental health support systems. There is not yet a date fixed for the release of the final report.
Hickie advocates for better use of technology in identifying the risks and needs of young people, and signposting appropriate care pathways. The government could help reduce anxiety by providing longer term assurances about income support, and parents and teachers could be supported to guide children through these uncharted waters, Hickie says.
“A lot of what needs to be done with COVID and mental health is in jobs, education and social cohesion. But just like the COVID physical health crisis you need to have a mental health system that works, and it particularly needs to work for children and young people because in a situation of chronic uncertainty and difficulty, they will be two of the groups that will be most affected, and they are where the system itself is often very dysfunctional,” Hickie says.
“We’ve been talking about [reform] for 25 years. So now’s the test. If you push it down the road, well, you’ve failed the test,” he adds.
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