COVID-19 Webinar 9: The mental health of children, youth and carers
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Niall Boyce, Lancet Journal Psychiatry
Panellists:
Chiara Servili, WHO
Zeinab Hijazi, UNICEF
Matias Irarrazabal, Chilean Ministry of Health
Aimee Wade, youth mental health campaigner, Belize
Josiah Tualamali’i, youth mental health campaigner, New Zealand
Niall Boyce, Lancet Journal Psychiatry
Aimee - what are the mental health needs of young people from your perspective during COVID-19 and beyond?
Aimee Wade, youth mental health campaigner
Right now during lockdown countries like Belize do not have enough professional resources and support for young people. They need support: tell them their feelings are OK; acknowledge these feelings are new and OK to have these emotions. Belize doesn’t have a lot of services available.
Niall Boyce
What kinds of support do young people need?
Aimee Wade
One to one chats, group discussions.
Niall Boyce
Therefore a theme of sharing and support. To what extent does this chime with you at WHO?
Chiara Servili, WHO
Youth across different countries and regions are reporting a deterioration of mental health and wellbeing. This can be very different according to their exposure in different situations. Some are more vulnerable than others. I am referring to 42 to 66 million young people that may fall into extreme poverty in the next year; others may experience violence or stress in their families; and there is a lack of support due to being out of schools. One thing that is common across all settings is the stigma that hampers young people from accessing services and young people are unhappy with the lack of services available to them.
Niall Boyce
So there are both common experiences and common problems, and at the same time specific groups require additional or more novel forms of support. What kind of help can be accessed by young people at the moment?
Chiara Servili
There has been a surge in innovations and doing things differently through exploiting technology to reach adolescents. But there has not been enough investment in services. There needs to be a transformation of services and care systems across different platforms [digital and non-digital]. Together these need to promote good mental health, prevent poor mental health and provide care for people.
Niall Boyce
Donald Winnicot said there is “no such thing as a child” - infants and children always exist in the context of their carers. How has lockdown affected relationships between parents and children? What about the impact of restricted movement, closed schools and social isolation?
Zeinab Hijazi, UNICEF
Parents are under increased levels of stress - there is the hyper vigilance of protecting children; the lack of access to social support; caring for vulnerable parents; homeschooling kids; and facing potential economic difficulties. This leads to tension within the family and between partners and children. But even though they may be experiencing this there are opportunities to strengthen family dynamics.
Niall Boyce
Are there ways to do this remotely?
Zeinab Hijazi
At UNICEF we have been considering this given the restriction on movement and the situation particularly for those working in emergencies. We have tried to support communities and front line workers with key guidance and resources to ensure continuity of services e.g. child protection. There remain gaps on how to support parents with children with developmental problems e.g. autism.
Niall Boyce
So we are learning inequalities already exist in the system and these have been perpetuated?
Zeinab Hijazi
Yes self care and self help tips exist but we need those for caregivers. One in four children is living with a parent with a mental disorder - and this is pre-COVID. We know there are linkages between mental health and child development. It is impossible to separate child and parent mental health since one shapes the other.
Niall Boyce
Mattias - we have discussed the right to access care. How has COVID-19 affected access to care for young people?
Matias Irarrazabal, Chilean Ministry of Health
It is important to know that young people belong to groups that are already marginalised and particularly at risk of not getting services e.g. migrants, refugees, or those living in slums. They live in conditions that put them at greater risk of contracting COVID-19 and also can have limited access to technology. There is a huge inequality in access to technology. Many young people who were receiving some support are now receiving no support at all. The needs of youth and children have increased but access to services has decreased. We need to improve preventive action and lower the treatment gap for youth. With restrictions to access to schools, there is uncertainty on how and when to access support. We need to improve communication with youth and find other ways to improve treatment. Many have lost their coping mechanisms to help them manage their mental health. We need to improve their education on mental health and how their coping mechanisms can help them. We also need to look at how to enable social reintegration of groups affected by COVID-19 crisis.
Niall Boyce
A lot of mental health intervention programmes have been based around where young people congregate e.g. school-based and universities. If young people are being homeschooled or receiving education online how can that kind of support be delivered?
Matias Irarrazabal
School closures have fractured social networks. We were using schools to help deliver mental health services. Most youth don’t have a good relationship with their family but they use their peers to help them improve their mental health and increase resilience. We have had disruptions to formal and informal ways of communicating with youth. And there are new pressures on young people such as [a rise in] violence. Therefore it is important to try and build some programmes and educate the youth population at home. We have to use social networks, the internet and TV, and in some regions radio stations. In all cases we need to use those platforms which are mainly run by youth - not run by adults - and do use interventions designed by youth so we can communicate effectively. There are many good initiatives from youth for example the COVID19 youth platform. Youth groups can give visibility to youth initiatives responding to COVID-19. In Chile we have a group that is rewarding creativity in the midst of the COVID-19 environment; we can look at how to help neighbours and families to expand this group. In Peru - Youth at Home - uses digital tools to support youth mental health. We are more restricted in terms of communication but there are many ways to improve mental health, do some prevention of mental ill health and improve the willingness of the youth population to access mental health services.
Niall Boyce
Given the Government of New Zealand has so far contained the spread of COVID-19, do young people feel the response to COVID-19 has been a success story?
Josiah Tualamali’i, Youth mental health campaigner
Interesting question. New Zealand was one of the first countries to close its borders. The chief doctor is now a superhero in New Zealand. But there has been a real split among young people. A young woman [Aigagalefili Fepulea'i Tapua'i] made a beautiful speech that talked about a number of young people trying to decide if they go back to school or continue jobs to support their families. The inequality in our society has only got bigger.
Niall Boyce
What are the specific challenges faced by minority youth due to COVID-19?
Josiah Tualamali’i
They are worrying about their parents and not being able to go back to school or work. This weighs on them. This is one of the differences now.
Niall Boyce
It is an example of where these periods of big change in history shift someone's direction in life?
Josiah Tualamali’i
Some of the things our parents and grandparents tell us stories about - this is one of those moments for our generation. Are we making the tough choices that are best for everyone? As we see in the US with the Black Lives Matters campaign - we know whose voices are not normally well listened to and that is where we need to take more care and more love.
Niall Boyce
Question for the panel. Lockdown is easing in some places. What are the future challenges for young people? Aimee what sort of problems do you see?
Aimee Wade
For young people and adults - it is economic issues - a lot of jobs that were lost and now people going back to university or school but are unable to pay fees. Or caregivers are struggling to put food on the table. The economic issue is one thing.
Niall Boyce
The economic situation is difficult already but is it made worse by pandemics?
Chiara Servili
The challenge young people currently face is the uncertainty of the impact of pandemic on their lives and their families’ lives and their life prospects and trajectories. They may be impacted by the affects of COVID-19 already e.g. lost jobs etc. But young people have also stepped up and raised their voice to have their mental health needs expressed. They have highlighted the challenge and the opportunity. They will have an increasing role in advocating for increasing investment and accountability on mental health systems. This is an opportunity to promote and support mental health. And we have seen the capacity of young people to react quickly and support societies, families and peers who are struggling with the consequences of the pandemic.
Niall Boyce
How can governments be held accountable to young people?
Matias Irarrazabal
Governments need to prioritise mental health. The first action is to try to improve the agenda about mental health - provide support and guidance for youth and families and carers. We need to be quick and adapt to the changing landscape. One criticism from youth is we are slow. They are right and we need to move support online. Much of the youth population doesn’t want to go to a medical clinic, they want to try e-mental health and reduce gaps in infrastructure and funding. Governments should take a tiered approach - the COVID-19 recovery plan should enable support. Immediate emergency funding needs to include youth organisations in the design for services during COVID-19 pandemic and launch campaigns to educate people on mental health during COVID-9. The emergency will continue for many months. We need to introduce additional support for youth mental health as we move out of the pandemic and launch a cross-government strategy for youth mental health. And we need to include youth in the design and implementation of this.
Niall Boyce
Question: What do we do for children in areas of armed conflict?
Zeinab Hijazi
We have struggled this quite a bit during the response to COVID - we have relied on digital platforms and services but this doesn't speak to humanitarian settings and those with pre-existing issues. For us [at UNICEF] we are continuing to prioritise humanitarian settings and a transition to some form of normalcy. As I listen to Matias - it is a very different endeavour to transition to normalcy. We need a coalition of educators, mental health professionals, policy makers and young people. It is increasingly difficult in humanitarian settings and we need to work to build some of that [mental health] infrastructure. There is the challenge of transition back to school - such an important thing . We are looking now at the different factors involved e.g. maintaining a learning environment and welcoming peers that are struggling emotionally and with their learning. Adolescents need to support their peers. Schools need to know when to refer to children who need care from professionals. All these services are needed in humanitarian settings.
Niall Boyce
What are young people doing to support one another?
Josiah Tualamali’i
They are providing support in their schools and learning environments, using apps like house party, and creating facebook groups etc. They are helping to maintain wellbeing - this should be acknowledged as part of the COVID-19 outbreak response. Maintaining wellbeing is key. UNICEF has a group of young people who provide inputs on how to respond and collaborate with governments - the Leading Minds programme. Organisations like UnitedGMH support youth advocates to engage with policy makers. Young people are able to convene and to raise awareness of the gaps in support for mental health.
Niall Boyce - what do young people need right now?
Aimee Wade - Reassurance - we will get out of this, we can be great.
Chiara Servili- Governments that place the mental health of the child, families and adolescents at the centre of the COVID-19 response with equity.
Zeinab Hijazi - Children and young people need us to support and nurture their capacities and leadership. If they want change they can deliver their agenda.
Matias Irarrazabal- Participate and be including in public health actions otherwise implementation won’t work.
Josiah Tualamali’i - Hope and more hope and to read her [Aigagalefili Fepulea'i Tapua'i’s] speech.
Thank you to all speakers. This webinar was recorded and is available to watch here. Next week’s session is on COVID-19, mental health and human rights. Sign up via this link.
