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Is A Mental Health Crisis Coming For The World’s Teens? The Risk Is Certainly There.

Bella*, 15, did not fare well in lockdown. Like many people with an anxiety disorder, Bella loves routines. Coronavirus is not a big fan of routines.

Along with the rest of New Zealand, Bella, a student at a high school in the North Island, found out that she was going into lockdown for four weeks on March 23. She “entirely freaked out.”

The COVID-19 situation had been causing stress from the start. “It was all unfamiliar and unknown, I didn’t know what would happen and I didn’t like that,” she said. Bella despised her time in lockdown. “I rely on my routines to keep me sane and distracted and this was going to screw it all up.”

Early this year, schools like Bella’s shut down around the world. By early April, around 1.5 billion young people were staying home. And Bella was definitely not alone in feeling stress due to the coronavirus. Calls to New Zealand’s free mental health call line ‘Need To Talk 1737’ were up by 40 percent in mid-April. Around the world, a growing body of evidence suggested that the pandemic was taking a heavy toll on young people’s mental health.

Nowadays though, Bella thinks less and less about the virus. New Zealand ended all coronavirus restrictions on June 8, after virtually eliminating Covid-19. “I think we have been through the worst and I feel like the government will do what they can to avoid another lockdown,” Bella said in an interview with Affinity.

But the rest of the world has largely not shared that experience, with many countries still requiring some form of social distancing, and some states in the US even reversing reopenings. So what do we know so far about COVID-19’s mental impact on young people like Bella — especially the ones who’ve had to spend many more months locked down? And how do we help?

What we know so far

“Some surveys with young people have indicated that there could be quite damaging consequences to the mental health of young people,” Jack Andrews, a PhD student at the UCL Institute of Cognitive Neuroscience said in an email.

Surveys like one that concluded this month, from Young Minds UK, a mental health charity. The survey was conducted between Friday 6 June and Monday 5 July on young people with a history of mental health needs.

80% of respondents to the survey agreed that the coronavirus pandemic had made their mental health worse; 41% said it had made their mental health “much worse.” That figure was up 32% from a previous survey Young Minds conducted in March.

Matteo Di Maio

Among the more than 1,000 respondents who were accessing mental health support in the three months leading up the crisis, 31% said they were no longer able to access support but still needed it.

Another recent study from University College London carried similar implications. It found that half of the participants (aged 16-24) had reported higher levels of stress since lockdown. Almost one in two respondents who hadn’t experienced previous mental health struggles reported “high levels of depressive symptoms,” with one in three reporting “moderate to severe anxiety symptoms.”

61% of the participants in the UCL study had previous mental health problems.

But while sobering, such surveys are not necessarily indicators of a widespread, long-term onset in chronic mental disorders. “The longer people experience these levels of psychological distress, the more likely they are to present with a diagnosis that would benefit from treatment,” Emma Beth McGinty, an associate professor in the Johns Hopkins Bloomberg School of Public Health, told the New York Times. “But the question of whether that’s really going to happen is an open one.”

However, measures taken to curb the pandemic definitely present mental health risks – to teens in particular. Adolescence is a key time for social brain development, and a period of vulnerability to mental illness.

“The negative effects of physical distancing and social deprivation might be particularly profound for the mental health of adolescents,” said Livia Tomova, a Postdoctoral Fellow at the Department of Brain and Cognitive Sciences at MIT. “Research has shown that adolescents are hypersensitive to social stimuli and to the negative effects of social exclusion.”

Sarah-Jayne Blakemore, a Professor of Cognitive Neuroscience, wrote in a statement on the Reachwell website: “Adolescence is also a period of vulnerability to mental health problems and there is a real risk that the lack of structure, support, social-emotional learning and face-to-face peer interaction due to ongoing school closures will exacerbate this vulnerability, resulting in a mental health crisis amongst the younger generation.”

Increased stress, of the kind reported in surveys of young people, is certainly a predictor of conditions like depression. “It is possible that if someone is experiencing high levels of stress over the course of the pandemic they may be at a greater risk of developing a mental health problem,” Andrews, the PhD student, told Affinity.

“The negative effects of physical distancing and social deprivation might be particularly profound for the mental health of adolescents,” — Livia Tomova

Andrews also said social deprivation had been shown to have negative and long-lasting impacts on mental and physical health in animal and human studies prior to the pandemic.

“Each person will be affected by the pandemic differently,” Andrews said. “In some people, it may limit important sources of social support which are known to be important for maintaining good mental well-being and buffering against conditions such as depression.”

Schools, which many young people have been absent from for months, provide a sense of structure, opportunities for social learning, and physical activity. “Being absent from school not only deprives children and young people of academic learning, but also a number of other opportunities important for their development,” Blakemore wrote in her statement.

Some experts have speculated that technology could alleviate the social costs of lockdowns. And this may well be the case — initial evidence has pointed in that direction, Tomova said. But not every teen has the means to communicate digitally – an example of the likely unequal mental impacts of the pandemic.

“Governments need to address the ‘digital divide’ by supporting access to digital connection in families irrespective of income or location,” followed up Tomova. “…when social connections are mostly digital, not being able to participate in those might contribute to development of mental illnesses.”

“Lockdown was different for everybody,” Peter O’Connor, a professor of education at the University of Auckland said in a phone interview. “We’ve all been in the same storm, but we’ve all been in different waka [Māori boats]”

Some teens, O’Connor said, likely had a great experience during the lockdown. But: “Other kids, they live in parts of New Zealand where there are ten or eight of them, living in a garage at the back of someone’s property, and they’re locked down there for eight weeks. I can tell you that doesn’t do too much for your mental health,” he said.

Matteo Di Maio

“Most children and young people have missed at least 10 weeks of face-to-face schooling, and many students (especially teenagers) are still unable to return to their classrooms. This has created vast inequalities in education … a significant number of students do not have appropriate access to a laptop, wi-fi or a home environment conducive to online school. Children who were already disadvantaged have become more so,” Blakemore, the cognitive professor, wrote.

There is a lot still up in the air, though. “We don’t yet have enough data to know who is at greater risk of the negative effects of the pandemic,” Andrews reminded.

More data is coming. “A large number of studies are being conducted around the world on the mental health effects of COVID-19,” Andrews said. Experts will keep an eye on “longitudinal data” in particular — how teens’ mental health has changed over the course of the pandemic.

But: “We do not know yet who will develop mental health problems from acute stress and why. It is still an open question in research,” Tomova told Affinity.

The reopening question

When, how and should we reopen schools? That’s the biggest question in the youth-sphere right now.

Some countries have begun to devise answers. In New Zealand, where Bella lives, schools have been back open for just over nine weeks. NZ, though, has virtually eliminated any community transmission of the virus. In many European countries, students have also begun to return to school.

In other countries, the picture is very different. The Bangladeshi Prime Minister has said schools will likely stay shut until COVID-19 is no longer a risk, while the Philippines has said in-person schooling will not resume until a vaccine is found. In the United States, planning is under way for a return to school in the fall. School’s plans are scattered, with some opting for online only schooling, and others a more hybrid model, with some days at school, and others at home.

Much of the discussion around the question of reopening schools centers around whether children and teens are vectors for virus spread, or whether community transmission makes schools an unsafe environment.

But, education experts and mental health advocacy groups say, students’ mental health also needs to be at the forefront of the discussion. In New Zealand, experts have drawn on the country’s experience with child and adolescent mental health after the Christchurch earthquakes as a kind of “cautionary tale” around school reopenings after trauma.

Matteo Di Maio

In 2010 and 2011, earthquakes upended the Canterbury region of New Zealand’s South Island. The first, on 4 September 2010, had a magnitude of 7.1. Frequent aftershocks riddled the city for the next six months. On Tuesday, 22 February 2011, the Canterbury city of Christchurch was wrecked by a magnitude 6.3 earthquake. This second big shock killed 185 people, largely because the epicenter was closer to the city.

In the years that followed, students who had been in Canterbury during the quakes showed increased rates of mental illnesses, particularly Post-Traumatic Stress Disorder — which tended to trigger panic at aftershocks and objects like low hanging lighting.

The quakes put huge stress on Christchurch’s mental health services, leading to a funding deficit. Since 2010, demand for child and youth services doubled, with mental-health assessments up by 150%.

Peter O’Connor, the professor of education, told Affinity in a phone interview that “the cautionary tale was that [New Zealand’s] Ministry of Education didn’t provide the advice that schools needed.”

“Rebuilding after a disaster is not just about rebuilding the economy, but it’s also about rebuilding a sense of self” — Peter O’Connor

O’Connor said that what experts had learnt from the Christchurch experience was that sending students back to school after a traumatic incident without a mental health framework for addressing what had just happened was a bad idea. He said the temptation to stress that students “catch back up on learning” was strong, but that schools couldn’t just carry on as per normal on return.

In a report that came out after the quakes, Education Secretary Karen Sewell wrote that the Ministry’s priority “has been to get students back into learning as quickly as possible.”

“What happened was that the Ministry [of Education’s] advice was that what schools needed to do was to focus back on literacy and numeracy,” O’Connor said.  “Essentially, Christchurch schools ignored it. That was important. But at the time, [Christchurch] didn’t have what they’d built since, which are enormous mental health programs for the young people in the city. They were badly unprepared.

“What it meant for teachers was they had to make it up by themselves. There was a cost to that.”

O’Connor said that New Zealand has largely grasped the importance of mental health provisions in the years since Christchurch. “I think we’ve learnt, and largely from the Christchurch experience, that rebuilding after a disaster is not just about rebuilding the economy, but it’s also about rebuilding a sense of self, a sense of our relationships with others,” he said.

However, he worried for the situation in other countries. “I was looking at the papers this morning,” he said. “They’re saying: ‘Schools need to get back!’, ‘schools need…’ There will be nothing, absolutely nothing in place for American children,” he warned.

(According to a 2016 study by the university of New Hampshire, only 17.8% of American school districts meet the recommended counselor to student ration of 250:1)

What is needed to protect student mental health when schools do head back? O’Connor said the key thing was to focus on rebuilding students’ relationships again and helping students to discuss how they feel.

“We have traditionally, especially with young men, not helped them say how they feel about the world… to be shamed if they feel afraid,” O’Connor said. “…We can’t afford to do that at a time where anxiety levels are high.”

To help teachers and principals manage the return to school, O’Connor and a team of education experts have created a program called Te Rito Toi, which is designed to help “teachers work with children when they first return to school following major traumatic or life-changing events.”

Matteo Di Maio

The program builds a curriculum around getting students to express and learn to cope with how they feel about the present through the arts. “Sometimes getting young people to talk about how they feel is really tricky. But you can ask them to paint it. To dance it. To sing it. To do all those other kinds of ways,” O’Connor said. The program is already being used in 120 countries, with 300,000 downloads and 40,000 teachers using it at any one time.

Thanks to Te Rito Toi, teachers “went back not focusing on catching up on work, they went back catching up on relationships,” he said. “They went back catching up on ways young people can talk about, think about, express about how they felt. And once they’d done that, they could get back to the business of learning.”

O’Connor urged schools to be lenient on students’ academic status. “It’s the human thing… when the world’s going to hell in a handbasket, let’s not focus on algebra,” he said.

“It’s not about catching up on missed assessments. The least important thing happening in schools at the moment, is assessments. And I’m saying that as a professor of education.”

The UK Young Minds Organization has recently called for better mental health funding for students, a COVID-19 wellbeing campaign, and a “transition period” when students head back to school. The “transition period” would make allowances for the mental toll of the pandemic; entailing schools reviewing “behaviour policies, attendance policies and accountability measures, including suspending the reintroduction of fines related to attendance,” as a notice on the organization’s website reads.

At the end of March, The UK government allocated 5 million pounds to mental health charities, but critics have called this “embarrassingly low.” In NZ, in contrast, the government has shovelled $NZD 25 million into mental health services for tertiary level students.

“There’s a real need for governments to focus on the mental health needs of young people,” O’Connor warned. “Otherwise we’ll carry the cost of that for generations.”

On the flip side…

COVID-19 has not been all bad for teens, though. Some students have reported improved concentration when away from noisy classrooms, and principals have lauded the possibilities of recorded lessons that students can rewind and revise to.

“I’m quite an internally motivated person, and once I’m immersed in something I can keep going for a while, which has helped me recently … as I’m able to begin working from the start, rather than wait for the teacher to finish instructing and answering questions before diving into it. If I do need help I can ask, but I’ve always felt an overload of help does nothing but overload me,” Angela*, 16, a teen from New Zealand with anxiety, said.

“We’ve got no idea of what the future is,” he said. “That’s really tricky if you’re 16.” – Peter O’Connor

Peter O’Connor, the education expert, was also optimistic. “[During lockdown] Mums and dads did all these cool things with their kids. Learning became more organic, more real. And that might be the best learning from this in terms of how we rethink learning [for the better after COVID-19]… learning that is more connected to everyday life… I think that’s something we could really pick up on,” O’Connor said.

Inline with Angela’s experience, 11% of respondents to the Young Minds survey said that their mental health had actually improved during the crisis. “This was often because they felt it was beneficial to be away from the pressures of their normal life (e.g. bullying or academic pressure at school),” according to the charity.

It’s hard to predict how the pandemic will affect teens with pre-COVID mental illnesses, Tomova, the postdoctoral fellow at MIT, said. Teens that feel isolated during the pandemic might experience a negative blow to their mental health. “But there might also be teens who actually feel less stressed now, for example if they were victims of bullying at school, they might experience being at home more positive,” she said.

So how will young people’s mental health be impacted by the pandemic, in general? Short answer: we still don’t really know. For a conclusive picture, we still need to wait. But the potential risk is already clear, and preventative action — in the form of government-sponsored mental health programs and guidelines as teens head back to school — will need to come sooner, rather than later.

O’Connor summed it up: “We’ve got no idea of what the future is,” he said. “That’s really tricky if you’re 16.”

*Names changed to protect privacy.

Featured image: Matteo Di Maio

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