How lockdown harmed the mental health of our children, from toddlers to teens

As the pandemic unwinds, it’s becoming increasingly clear how the months of anxiety and isolation have affected the nation’s mental health. Every age group has suffered but none, it appears, as much as our young people.

More than 2,000 children a day are being referred to NHS mental health services, twice as many as before the pandemic, official data shows. A record 190,000 under-18s were referred for treatment and support in the three months from April to June this year.

The NHS Child and Adolescent Mental Health Service (CAMHS) – already over-burdened before Covid-19 struck – is struggling to cope. Last week, a group of 50 charities and Royal Colleges signed a petition demanding the establishment of drop-in mental health services for children and adolescents.

They insisted a major investment in help for Britain’s youth was needed amid an “alarming” rise in psychiatric problems following repeated lockdowns. Broadcaster Stephen Fry, president of mental health charity Mind, was among those calling on Chancellor Rishi Sunak to invest in children’s services in the forthcoming Comprehensive Spending Review.

“The mental health fallout among young people is worrying; very much a crisis,” says Dr Jon Goldin, a consultant child and adolescent psychiatrist at Great Ormond Street Hospital. “CAMHS is under pressure. We had 200,000 referrals in from April to June – double pre-pandemic. 8,500 children needed crisis care; that’s two thirds higher than last year,”

The closure of schools to prevent infection to and protect overall health – though necessary – has been harmful, says Dr Goldin. “In homes with an atmosphere of domestic conflict, school is a protective factor: it offers respite and there are safeguarding procedures.” When it comes to child and adolescent mental health, early intervention is key, he says. “Walk-in support and access to trained staff could really help some children before their health deteriorates. This would not be to replace CAMHS, but to reduce the pressure on NHS services.”

Vivian Hill is a professor of educational psychology and part of the British Psychological Society Covid working group, looking at isolation and confinement. “Many of the most vulnerable children were actually at school during the pandemic,” she says. “We are actually more worried about the millions of children who were just above that threshold.”

Professor Hill feels that walk-in centres could particularly help older children. “But it’s the tip of the iceberg, really,” she says. “There also needs to be strategic, psychological help in schools – embedded in a context where staff actually know the child. I would like to see an increase in specialist mental health workers in the school environment.”

How have lockdowns impacted children’s mental wellbeing, from toddlers to teens?

Preschool: Missing vital social skills

“Peer relationships are really important for this age group, who are particularly susceptible to stress in the home environment; parents worried about their bills, or domestic unrest,” says Dr Goldin. “The NSPCC have been especially concerned about unstable home environments and toddlers will really have missed out on nursery.”

Professor Hill agrees. “Pre-school education is key in the development of a child’s social skills,” she says. “Children learn to negotiate: to play, share, and understand language and numbers. We are now looking at something called ‘zones of regulation’ – teaching pre-schoolers to manage their emotions, rather than biting or thumping one another. This requires more investment and should be part of the curriculum at nursery. Kids need to learn how to play again.”

Ages 5 to 12: Anxiety and low self-esteem

According to Professor Hill, the new intake at primary school will have the social and educational skills of a child two years younger. “This age-group has been particularly anxious about Covid and the health of family members,” says Dr Goldin. “They’ll be aware of bereavement and sense the stress if a parent is worried about their job.

“The pandemic will have seen them missing their school friends. When a child is frustrated, behavioural problems can start to occur – especially with boys becoming aggressive or oppositional. Girls often tend to internalise their difficulties and it can manifest with low self-esteem.”

Both experts are delighted that children are finally back at school. “However, there are likely to be ongoing challenges,” says Dr Goldin.

Ages 12 to 15: Self-harm and eating disorders

“At this age, children may start to suffer from depression and self-harm,” says Dr Goldin. “Mental health professionals have particularly been concerned about the rise in eating disorders, partially related to the stress of being stuck at home.”

Eating disorders are linked to anxiety and a lack of structure – and the chaos of the last 18 months has exacerbated these illnesses. “With food intake, teenagers have found something they can at least control,” says Dr Goldin. “And as an adolescent eats less, they can become more impervious to rational arguments.”

According to Goldin, eating disorders – which have the highest mortality rate of all psychiatric disorders – tend to present in the teenage years. But during the pandemic he has also seen them increase in younger children, in rare cases as young and nine or 10.

Ages 16 to 19: Fears for the future

“Even though this cohort is older, they have still missed out on age-appropriate education,” says Professor Hill. “So, ideally – whether at school, university, or training for a vocational career, psychological support needs to be built into the curriculum.”

Dr Goldin says: “This group exhibits the greatest worry about the future, especially if they are leaving home for the first time. Many universities are still only providing online tuition, so that sense of social isolation may remain.”

Later teens are also worried about whether they’ll be able to land a job after they finish education. “Teenagers generally are increasingly suffering from eco anxiety,” says Dr Goldin.