“We haven’t got enough specialist staff to help the needs we’re seeing coming through": The Covid Mental Health Crisis For Children
One in six children in the UK now have a mental health condition, up 50% on 2017 | Illustration by Tracy Worrall
Mental health support for children and adolescents is falling short, with young people waiting months to access help. As Georgina Bailey reports, mental health provision must be a major part of the recovery programme for children
Washing hands until they’re bleeding for fear of carrying the virus to vulnerable relatives. A loss of social skills, and heightened social anxiety. Refusing to leave the house. Withdrawing from friends and family. Health anxieties, ranging from Covid to cancer fears. Children throwing tantrums or refusing to play with others. Teenagers waking up with nightmares. Anxieties about falling behind in school, failing exams, and future prospects. Self-harm and suicidal thoughts. A doubling in eating disorder referrals.
These are just some examples of the issues that children and adolescent mental health experts have seen during the pandemic; a situation Anne Longfield, the Children’s Commissioner for England, describes as disastrous.
NHS data from July 2020, covering the first period of the pandemic, has shown a 50% rise in children and adolescents with mental health disorders – one in six, compared to one in nine three years ago. In recent years, only one in three children with a mental health disorder in England have managed to get help.
“Of course, that does not bode well at all for these coming months,” Dr Bernadka Dubicka, chair of the Royal College of Psychiatrists’ Child and Adolescent Faculty explains. “We’ve got a pre-existing mental health crisis, we’ve got massive unmet need and demand before the pandemic, which is only going to escalate.”
Childline has reported a monthly 16% increase in mental and emotional health counselling sessions
Dubicka reports anecdotal evidence from her own work in Greater Manchester and colleagues around the country that, following a fall in initial referrals in lockdown, crisis referrals and detentions under the Mental Health Act have increased during the pandemic, the former now superseding pre-pandemic levels. Other professionals report an overall increase in caseloads across the pandemic, spiking around announcements to changes in lockdown restrictions.
In the voluntary sector, Childline has reported a monthly 16% increase in mental and emotional health counselling sessions delivered to those aged 11 and under since lockdown measures were introduced last year.
The teenage mental health charity stem4 has stated that daily downloads of its apps, aimed at managing the urge to self-harm and symptoms of anxiety, rose by 20% in 2020, peaking at 12,000 downloads a day during A-level exam results period and at the start of the autumn school term.
The visibility of children who are struggling with their mental health during lockdown is concerning mental health professionals and teachers alike. Pepe Di’lasio, headteacher at Wales High School in Rotherham and vice-president of the Association of School and College Leaders, is one of those worried, pointing to the rise in incidents of self-harm that his school is seeing.
"Teachers are having to take more of the burden of trying to help students with their mental health"
“Throughout this entire period, we’ve been keeping in touch with all those students that we feel are most vulnerable and most likely to be involved in safeguarding issues … Normally, we’d see them every day at school, and you’d notice a change straight away. Some of those things are hard to notice when you’re virtual. And as a resultof it, they can build up and be harder to deal with after they’ve started almost,” he explains.
At Di’lasio’s school, staff have bolstered their check-in capacity, and are calling hundreds of vulnerable pupils each day, as well as sending minibuses of staff out for home visits. “What we’re doing is trying to make sure that we help and support those people every day… But the way that I’m looking at it is we haven’t got enough trained specialist staff at the right level to help the sorts of needs that we’re seeing coming through.”
Sadie*, a head of year at a London comprehensive, reports that despite the school’s well-resourced mental health provision, with 10 staff exclusively working on mental health, welfare, inclusion and child protection, they are now facing “exceptional difficulty” in managing “a large increase in both the number and severity of cases”, including anxiety, OCD, depression, eating disorders, and a rise in self-harm.
“Teachers are having to take more of the burden of trying to help students with their mental health,” says Sadie, with the school’s mental health team now over capacity and facing delays in the local children and adolescent mental health service (CAMHS). “I am having to make up to 10 phone calls a day to check in with high-risk students, but I’m not a trained psychiatrist – just a young teacher trying to offer good advice ... It is taking quite a big toll on my [own] mental health.”
"I get a lot of parents saying to me, ‘we’ve tried CAMHS, and they’ve said that she’s not suicidal enough’"
Concerns about the capacity and diagnostic threshold of CAMHS are widespread. In 2019-20, a total of 538,564 children in England were referred to CAMHS for help, up 35% on the year prior. Only 391,940 children received treatment, a 4% increase from the previous year. Waiting times also vary across the country, from an eight-day average in Barking and Dagenham, up to 84 days in North Hampshire.
As well as increased delays as the pandemic has progressed, Sadie and Di’Lasio report referrals being rejected for not being serious enough, despite many schools operating a triage system so only the worst cases get referred.
As Stephen Scott, professor of child health and behaviour at King’s College London, explains, CAMHS referrals are unlikely to be successful “if they’re not psychotic or on the verge of killing themselves as it were, or very, very anorexic” due to the strain on CAMHS resources.
On average, clinical commissioning groups spend only 1% of their budget on children’s mental health, 14 times less than adult mental health; the amount varies from £202 per child in Islington to £25 per child in Crawley.
Rejection by CAMHS and subsequent lack of treatment often means the situation becomes worse. Helen Spiers is a former primary school teacher and now head of counselling at Mable Therapy. In her experience, schools are turning to her service because they’ve given up on CAMHS. Since the pandemic, her company has also started offering private counselling, as parent desperation grows. “I get a lot of parents saying to me, ‘we’ve tried CAMHS, and they’ve said that she’s not suicidal enough’,” Spiers explains.
Experts identify several reasons why children and adolescents’ mental health is worsening during the pandemic. Poverty and deprivation is a major driver, as are parental stress and arguments within the home – all of which have been compounded by Covid, along with a lack of access to learning resources and adequate space inside and out.
For children living in homes with limited digital access, these pressures can be exacerbated by arguments between family members over devices and broadband, fears about falling behind in school, increased social isolation, and lack of access to online mental health support.
As the Covid death toll increases, grief can also have a serious impact on mental health, with Kadra Abdinasir from the Centre for Mental Health and the Children & Young People’s Mental Health Coalition pointing to reports that children from BAME communities are increasingly seeking support to help deal with the impact of higher case and death rates.
As well as increased health anxiety, other challenges include a lack of sense of control and routine, being ill-prepared for educational transitions and exams, and concerns about future life chances. Loneliness, limits on social interaction, playing and exercise, and the difficulties of navigating online social spaces are also proving difficult.
Professor Scott reports a range of challenges – from teenagers refusing to leave the house out of fear, to young children who have forgotten how to play or socialise with other children, and teenagers who are becoming increasingly anxious about their social standing, unable to interact normally or read their peers’ behaviour in person.
Separate from the immediate impact on children and families’ wellbeing, the long-term impact of the pandemic on development and life-long mental health is still unknown. In terms of education, Dr Dubicka describes the impact of mental health on young people’s ability to learn as “absolutely devastating”, with children with mental health issues falling into a cycle of being unable to focus on work or self-motivate, and then having lower self-esteem because they are “underachieving”, therefore becoming more unwell.
Across the board, there is a recognition that more needs to be done to improve access to mental health services and centre the wellbeing of children as schools return, starting with an orderly transition back to in-person teaching to reduce anxiety.
Although the government has announced a £650m academic ‘catch-up’ fund, and an £8m Wellbeing for Education Return programme, many experts would like to see more funding and/or clear direction from government that this money should be spent on bolstering mental health provision, personal, social, health and economic (PSHE) and wellbeing education for children, and greater training for staff.
"There’s such a shortage of health visitors, psychiatrists and counsellors in schools, so who are the people who would be expected to pick up the pieces"
“If [children] are in a state of heightened anxiety, they’re not going to be able to narrow the gap and catch up on what they’ve missed, regardless of how much money is spent on it,” Spiers explains.
As well as Gavin Williamson’s newly announced mental health in education ministerial group, and Ofsted’s increased focus on wellbeing in school inspections, the government also has a long-term plan for rolling out better mental health provisions, including in-school counsellors.
However for many this is too slow. “The programme we have at the moment will only [reach] 20-25% of schools by 2023. So knowing it works, knowing it is very popular with children and absolutely needed now, I would like that to be tripled in a very short period of time as part of the recovery programme for children,” says Anne Longfield.
In terms of CAMHS, while the government’s plan for every child to have access to the mental health support they need by 2028 is also widely welcomed, it is currently lacking clear details for how it will be achieved. “It’s not just about pumping money in the system, you actually need to spend time to invest and grow the workforce. Because that’s where I would say there is the biggest challenge. Even if you put money into the system, there’s such a shortage of health visitors, psychiatrists and counsellors in schools, so who are the people who would be expected to pick up the pieces?” Abdinasir says.
A Department of Health & Social Care spokesperson said: “We are absolutely committed to supporting the mental wellbeing of children and young people who have been particularly impacted by this pandemic.
“Early intervention and treatment are vital. We are providing an extra £2.3bn a year to NHS mental health services by 2023-24 which will allow us to help 345,000 more children and young people access NHS-funded services, or school and college-based support.
“We are also training a new dedicated mental health workforce to support children in schools and colleges across the country, as well as giving staff the resources to teach young people what good mental and physical health looks like, backed by £8m in funding.”
A Department for Education spokesperson added: “We are training a new dedicated mental health workforce for schools and colleges across the country as well as teaching what good mental and physical health looks like. In September, we launched a campaign through the Every Mind Matters website to raise awareness of the guidance and tools available to support children and young people’s mental wellbeing.”
*Names have been changed
Get support if you or someone you know is struggling with their mental health:
If you are in need of urgent help for yourself or someone else please contact 999 or the Samaritans on 116 123 if you or someone else is in immediate danger.
If you are a child or young person, you can call Childline on 0800 1111 for free from 9am - 3:30am, or get support online with 1-2-1 online chat, resources for mental health, or emails at www.childline.org.uk/get-support/.
YoungMinds also has information and support for children and young people struggling with their mental health, and a 24/7 crisis messenger at www.youngminds.org.uk/find-help/looking-after-yourself/coronavirus-and-mental-health/
For parents and carers: YoungMinds has tips, advice and where to get support for your child's mental health during the coronavirus pandemic at www.youngminds.org.uk/find-help/for-parents/supporting-your-child-during-the-coronavirus-pandemic/