Stephen Colegrave compares the failure to prepare for the mental health impact of COVID-19, especially on the young, to the Government’s neglect of care homes.
The COVID-19 mortality rate has predominantly affected the older generation. Young people seem mainly immune to it and when a young person does die, it makes headlines. However, the toll on children and young people’s mental health is very real and widespread. Its true impact is unlikely to be properly assessed until much later and its legacy is likely to last many years. Unlike the economy, the young people affected are probably not going to ‘bounce back’ to good mental health and are likely to be disadvantaged for a generation.
The NSPCC Childline service is receiving an average of 67 calls a day from children who need help as they struggle with suicidal thoughts and feelings. Half the callers under 11 are worried about COVID-19. Often, they feel they cannot talk to their parents about their fears and worries.
The problem is that, with 24-hour rolling news and social media, it is impossible to get away from COVID-19. For those under 11, it is especially hard as with less established friendship groups they have less of a virtual network outside their families. If they are already in an abusive family this is probably only exacerbated by the pandemic.
Those children that already face problems, such as poverty or a difficult early childhood are finding it especially difficult and the impact likely to be far-reaching. All children are suffering upheaval and interruption to their schooling, but for children who have experienced care in their early years, the problems are more severe.
The charity Adoption UK ran a study on the impact of school closures experienced by care-experienced children on 4 May. Half of the parents of these vulnerable children said that their children were experiencing emotional distress and anxiety. 31% said that they were experiencing an increase in violence and aggression from their child. More concerning, 85% were not receiving any additional support in respect of their care-experienced status
“School closures and lockdowns are exacerbating learning and emotional problems, including an increase in violent behaviour,” author of the Adoption UK report, Rebecca Brooks, emphasised: “Schools are struggling to support their pupils with highest needs.”
The Rise in Loneliness
Early on in the pandemic, 25 March, the mental health charity for young people, Young Minds, conducted research amongst young people generally and found they were just as stressed as children. 32% of respondents said that COVID-19 had made their mental health much worse and a further 51% a little worse. Even more worryingly, 26% of young people who had previously been accessing mental health services were not currently able to.
In pre-pandemic times, loneliness was seen as a major issue of the over-70 age group, but once the pandemic started young people started to feel very lonely because of COVID-19. The 18-14 age group found loneliness due to the COVID-19 much worse than any other age group in the Mental Health Foundation Study on 22 April. 44% of 18 to 24-year-olds felt lonely because of the pandemic versus 24% of all adults.
“Our data reveal that millions of people in the UK are experiencing feelings of loneliness,” director of the Mental Health Foundation, Dr Antonis Kousoulis, explained “which is a key risk factor for developing of worsening mental health problems. The concern is that the longer the pandemic goes on, the more feelings become long term. The impact of long-term loneliness on mental health can be very hard to manage.”
As many middle-aged and middle-class people share pictures on FaceBook of their gardens, dog walks and lockdown hobbies, it is worth remembering that many young people are not so lucky. The link between poverty and mental health is well known.
The Mental Health Foundation study in 2017, found 73% of people living in the lowest household income bracket (less than £1,200 per month) reported having experienced mental health problems in their lifetime. This disadvantage starts young. Socioeconomically disadvantaged children and adults are two to three times more likely to develop mental health problems.
Problems Accessing Services
During Lockdown, young people are also suffering from the problem of accessing mental health services. ‘In perso’ services have been disrupted by the priority for COVID-19 and also psychiatrists and mental health nurses have often had to put up with a lack of personal protective equipment (PPE), which is essential for them to be able to do their job.
The result has been that many young people have been able to access the services they need which means that too many of them are suffering an escalation of issues that are leading to acute problems.
A vast number of us have seen our mental health deteriorate during the Coronavirus crisisPaul Farmer, Chief Executive, MIND
The leading mental health charity MIND conducted a survey to investigate this on 6 May. and found that one in four people who tried to access help to deal with mental issues in the previous two weeks had been unable to do so.
“A vast number of us have seen our mental health deteriorate during the Coronavirus crisis” MIND’s chief executive, Paul Farmer said. “Evidence shows that when people do not get support early enough, they end up in crisis. We are particularly concerned that some are being discharged too early from hospital, while others have been left languishing on mental health wards because of the current limited availability of community support. Being sent home at the wrong time can delay recovery and at worst. Puts people at risk of suicide.”
There is anecdotal evidence that the police are attending more acute and violent incidents that have been caused by the additional mental health pressures of Lockdown. MPs at the Home Affairs parliamentary select committee hearing on 6 April were told by police that there were early signs of increased suicides and attempted suicides in lockdown, but it was too early to be sure.
The Government has amended the Mental Health Act to make detention easier with just one psychiatrist required. It is impossible to find data yet on any increases in detentions or indeed incidents of self- harm or suicide, but the Government is worried that there will be as they have put prevention plans in place, including an ‘unprecedented’ national suicide prevention plan announced on 17 April in the HSJ.
“This is a serious attempt, in some senses an unprecedented attempt to prevent a crisis turning into a mental health crisis,” chair of the national suicide prevention group, Professor Louis Appleby tried to reassure MPs. “There are risks in the current situation but there’s a whole batch of experts and agencies and frontline people, all of whom will be thinking about how best protect vulnerable people.”
Considering this plan rather than any action was only announced on the 17 April, more than three weeks after lockdown when the damage to young people was already severe, it doesn’t look as if the Government group of the experts and agencies are likely to actually do anything until well after the lockdown finishes. One of its priorities was to issue real time data on suicides and self-harm, neither of which it appears to have done.
The Government, like the NHS and health services, is generally is obsessed with physical health, hospital-based services. Mental health services were the poor relation even before the pandemic and had been underfunded even more than the rest of the NHS over the past decade of austerity. As the data about admissions, detentions, self-harm and suicides during lockdown is still not available we have no idea of the true scale of the price that people with mental health issues and especially the young are paying for the Government’s neglect.
Unlike most of the physical sufferers of COVID-19, many of the consequences of the mental health impacts will last for years and sometimes for lifetimes. The Mental Health Foundation found that people with an existing psychiatric diagnosis are at greater risk of financial inequality and less likely to be in employment fuelling their experience of multiple disadvantage. This is likely to be even worse if they were not able to access the right services.
Mental health feels like care homes were at the beginning of the pandemic – a neglected sector that was not given enough priority to prevent an impending crisis.
This article was corrected on 15/05/2020 to corrected attribute comments to Professor Louis Appleby