The impact of COVID-19 on child and youth mental health

Children are a vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic and the resulting economic downturn: They are directly affected by COVID-19 and the measures taken to prevent and control the spread of this disease.^[1],[2] Although it is difficult to predict the precise number of children and youth who will present with a mental health condition for the first time or whose current conditions will worsen as a result of COVID-19, the prevalence of anxiety disorders and depression in children and youth will likely increase. This increase is especially likely as the prevalence of mental health disorders among children’s caregivers and parents increases and as children and youth experience adverse childhood experiences (ACEs) such as the loss of a parent, caregiver or loved one. Likewise, given that previous economic downturns have been shown to increase ACEs and to affect the mental health and well-being of children and youth,^[3] the economic factors of the pandemic add to the increased risk.

This report addresses COVID-19’s impact on the mental health of children and youth and is presented in two sections.

The first section reviews three areas:

1. Mental health outcomes based on information from previous pandemics and what similar events tell us about changes in the levels of mental health conditions in children and youth,
2. How disruptions to communities and families affect the mental health of children and youth, and
3. How school closures and educational disruption affect student mental health.
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In the second section, we recommend several strategies that Oklahoma can implement to mitigate COVID-19’s impact on the mental health of children, youth and their families.

As the report further details, children and youth mental health are effected by a variety of factors exacerbated by the economic conditions caused by the COVID-19 pandemic. Some of the factors and resulting mental health impacts include:

• Increases in anxiety, stress and fear related to COVID-19;
• Increases in suicide and depression in children and youth;
• Negative effects on children and youth mental health due to social distancing, quarantine and isolation;
• Increased risk for child abuse and intimate partner violence; and
• Increased challenges for children previously struggling with a mental health condition or learning disability.
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The report also details how disruptions to family income can contribute to the following:

• When unemployment among parents increased by 10.8 percentage points (based on recent unemployment claims), children’s risk for a broad array of mental health problems increased by as much as 94%. This does not mean that 94% of children will have a mental health problem. Rather, it means that the average amount of risk for developing a mental health problem across all children would increase by 94%.
• Increases in family poverty, which can impact access to regular health care.
• Housing insecurity, with some Oklahoma families disproportionately impacted. In this report our analysis found that on average, approximately 112,000 households with children are not current or have deferred their rent or mortgage and, of those, almost 12,600 are Black or African American households.
• Greater food insecurity; on average, approximately 26,500 households with children reported that they often do not have enough food and, on average, more than 29,000 households responded that their children do not have enough to eat because they could not afford food.
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Our recommendations

The Healthy Minds Policy Initiative recommends that child-serving systems across Oklahoma partner to prioritize the mental health and wellness needs of children, youth, and their families. We believe a whole-community, integrated response built on communities’ current systems of mental health, education, basic needs, and other psychosocial supports is required to successfully reduce the impact of COVID-19 on the mental health and well-being of Oklahoma’s children and youth, and the adults that care for, teach, and support them. We encourage Oklahoma to use its recovery from this unprecedented event as a means to strengthen children’s mental health services for the future. Our recommendations are organized within the following domains: Family and Community, Schools, and Health Providers.

These recommendations are provided to inform relevant conversations, but do not represent a comprehensive plan or strategy for policy solutions, community services or school-based supports needed to address children’s mental health in the COVID-19 era. In many cases, these recommendations are informed by work occurring now in the state that should be supported, expanded or modeled.

Recommendation 1: Engage the lead child-serving agencies in Oklahoma to develop an integrated community outreach plan that disseminates information and educates parents and caregivers on COVID-19; its impact on the mental health and well-being of children, youth, and families; and the availability of supports and services for mental health and basic needs.

Recommendation 2: Continue to prioritize the implementation of a Multi-Tiered System of Support (MTSS) or Interconnected Systems Framework (ISF) to systematically integrate mental health services and supports into all levels of the framework.

Recommendation 3: Implement an evidence-based, universal mental health screening tool to identify students in need of mental health services and supports.

Recommendation 4: Public schools in Oklahoma should prioritize ongoing implementation of the Oklahoma Prevention and Needs Assessment (OPNA) and use 2019 data to identify schools that are at greater risk for the impact of COVID-19 because of the number of their students who have significant risk factors and limited protective factors.

Recommendation 5: Promote the health and well-being of Oklahoma’s teachers and staff by providing access to self-care resources.

Recommendation 6: Increase the number of pediatric primary care providers in Oklahoma (primary care offices, federally qualified health centers, and emergency departments) that implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify, refer, and treat children and youth with mental health and substance use problems before more severe symptoms emerge.

Recommendation 7: Ensure access to emergency mental health services and psychological support by expanding the crisis continuum.