Impact of COVID-19 on Children's Mental Health

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, the Chief Medical Officer at WebMD. We talk about an infectious disease pandemic, but we also have to recognize we have a mental health pandemic. And one group that we haven't spent enough time talking about is kids and the impact of the COVID pandemic and some of the actions we need to taken during the pandemic, such as lockdowns, what impact is that having on kids?

Joining me today to discuss it is Benjamin Perks. Mr. Perks is the Head of Campaign and Advocacy at UNICEF. Thanks for joining me today.

Thank you for the invite. Great to be with you.

Well, I'd love if we took a minute to remind our audience what UNICEF does. Some people might be surprised to learn that it has played a pivotal global role in addressing the pandemic.

Yes, that's right. UNICEF is the United Nations Children's Agency. We have there a mission or an affiliated presence in 190 countries around the world. We've been around since 1946. And we've been very active in facilitating the work of COVAX, which is making sure that in low and middle income countries all around the world that there is vaccine equity, there is access to the vaccine.

But we've also been continuing our work with very vulnerable health systems in those settings to ensure that they maintain all basic services essential for the survival and development of children despite the extra burden on those health systems that the pandemic has brought.

So what has been the burden on kids? How is it impacting their mental health?

I think the first thing to say is that COVID-19 has been a turbo booster for every kind of inequality, risk, and vulnerability that children face in terms of poverty. Here in New York City, we know that 300,000 children have no means of remote learning, for example, so they're completely cut off from school. We know all around the world, children who are affected by adverse childhood experiences, neglect, abuse, dysfunctional parenting have been abruptly cut off from key relationships in schools with teachers and kids and other protection services.

We know children in poverty have been cut off from nutrition programs through schools. And we know that those children that have the most difficulty accessing health systems and health services because they're in poor countries or in poor communities, they have been most affected by the health impacts of COVID-19.

Sure. But we're also seeing the impact that lockdowns have had in terms of loneliness for kids, in terms of having educational setbacks, in terms of their progression. Sadly, seeing increase in abuse in some homes. So Ben, I want to ask you, how do we fix this issue?

There has been a long-term issue and often an under-addressed issue of adverse childhood experiences. We know that neglect, violence, dysfunctional parenting are, very sadly, much more prevalent than we previously thought. We know that often they happen for reasons that are actually unintentional, and it's an intergenerational transmission of trauma.

But we also know that there are really powerful solutions to address these issues at a population level, parenting support, reducing stress on the caregiver, providing parenting programs through home visits in early childhood and throughout the child cycle.

And also schools that provide services for mental health of young people and children, but also, more importantly, that provide a sense of connection and belonging, because these are the things that really soothe children and help children to navigate their way through trauma and other problems.

Social isolation is really bad for all aspects of child development. But now that we know that and we have the science that explains that, we can develop policy solutions and deliver them at low cost, even if it's in the midst of a pandemic.

Well, you and I have talked about these policy solutions. And you brought up this really good point in some previous conversations that I'd love you to expand on. You said, John, we need to have judgment-free public conversations on the topic of mental health in children. So what does that mean in terms of judgment-free?

What we see all over the round-- all the way around the world is that communities have never really had public conversations about mental health. There's a lot of rumor and myth, a lot of judgment, a lot of misunderstanding, and also misinformation. And I think we need to have a public conversation that includes really three key aspects.

The first is to recognize that we are all on a spectrum of mental health and that sometimes our mental health can be flourishing, but sometimes we also have risk for poor mental health. Mental health is not a marginal issue. And when we talk about it, we need to talk about it in a way that recognizes the universality of mental health and that removes judgment, and stigma, and shame, increases understanding, but also helps people to access solutions when they may be feeling they've got poor mental health.

We've talked about this being a pandemic, which clearly shows how it's impacting children around the world. What are some of the differences in terms of the need for investment in countries like the United States and Europe versus those that are in the developing world?

I want to start my answer with one statistic. According to the World Health Organization, there is one mental health professional per 100,000 population on the continent of Africa. In many low-and-middle-income countries around the world, there is the very minimum of a mental health service system. But even in high-income countries like the United States, United Kingdom, France, services have only really begun to evolve at the population level over the past couple of decades.

So there is work to be done everywhere. There's also work to be done on the very critical situation of people in humanitarian crisis. We've all been watching the news from Afghanistan and Syria during the pandemic, seeing them face a double crisis of pandemic and conflict. And so I think we need to have different levels of investment and support in different contexts.

But when we talk about population-level prevention, what we need to be doing uniform across all of those societies is strengthening those local mechanisms that enable parents to give their best to protecting and supporting their children and that enable communities to ensure that every child is connected, that social isolation and the other major risk factors that drive-- preventable risk factors that drive poor mental health are addressed.

Is there any low-hanging fruit in terms of solutions? We can't accomplish everything all at once. But does something come into your mind, one or two projects or initiatives, that could be more readily adapted?

I think that all over the world there are, for example, health home visiting services. In some countries, these have been adapted with huge returns on investment to look beyond the physical health of the child to also look at the mental health of the child, and particularly to support the attachment between a parent and a child. I think these can be adapted and expanded with relatively low cost, particularly when we compare it to the return on investment.

I think also the idea of breaking the taboo on mental health, having public conversations about mental health, putting it into political discourse and cultural discourse, I think that's relatively doable. And I think also making schools just much better places for kids, places where children are seen, safe, soothed, and secure. And I think these are the kind of things that can be real game changers at relatively low cost to communities with a huge return on investment.

What do you say to folks that are suggesting we might be losing a whole generation of young people in terms of what they're able to accomplish, in terms of what they can achieve, in terms of academics, as well as their overall wellness? Do you agree with that? How much time do we have to act to steer this ship back in the right direction?

I think it's definitely true to say that in many parts of the world children have not been thought of enough in the pandemic response. There are 77 million children in the world that have not had one day in school since the pandemic began. There are almost 900 million that remain at least partially out of school today. And we have often opened bars or other social spaces before we've opened schools.

Schools should be the last place to close because children are so dependent on them for not just for learning, but their emotional and social development. Interacting with peers, connecting with teachers, connecting beyond the family is a key part of child development. And having put that on hold for 18 months, really for the first time in recent history, has a real impact on children. And we have to reimagine an education system and a better tomorrow for children and start investing in that right now.

Where can one learn about more of the work that UNICEF is doing?

We have a website. Of course, we have Twitter, Facebook. We are pretty accessible. You can find us very easily online.

Ben, I want to thank you for taking the time today to share your insights in terms of the gravity of the situation of mental health in kids, as well as offering some solutions. As you point out, there is still an opportunity to fix the problem, but that's going to require some action and commitment at population levels.

Absolutely. Absolutely. Well, thank you so much, John. It's been a real pleasure. And we look forward to continuing this important conversation in the future.

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