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  • September 2021
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Children’s Mental Health and COVID-19: Return to School May Not Mean Return to Normal

Children gazing out of window on lockdown
In Brief
Students returning to in-person learning after months of lockdowns face a new set of mental health challenges that only compound COVID-19’s existing toll. RGA's Diana Bosworth discusses the important role life and health insurers have to play in addressing this issue. 

However, readjusting to this new reality presents its own set of mental health challenges that only compound COVID-19’s existing toll. During the pandemic, research shows that children’s mental health suffered from a marked change in routines and the effect of lockdown on how they learn and socialize.

Mental disorders can affect the way children regulate emotions and can contribute to long-term distress. It is important to address this rise in mental health problems early to avoid more serious problems in adulthood.

The challenge will be monitoring children on their return to school and acting quickly so they can get the help they need. Life and health insurers have an important role to play – not just this school year, but also in the years to come. By continually evaluating children’s mental well-being, supporting efforts to address the many challenges they face, and enhancing and refining pediatric mental health product and benefit offerings, insurers can help families overcome any missed cognitive and social development opportunities.

The COVID-19 Mental Health Crisis

The number of children experiencing mental health conditions has grown substantially during the COVID-19 pandemic, according to England’s Mental Health of Children and Young People’s survey.1 The survey shows that in 2020 mental health conditions increased across all age, sex, and ethnic groups from 10.8% in 2017 to 16% in July 2020. The NHS Digital Survey2 found that significant mental health conditions among children were 50% more prevalent in 2020 than in the 2017 survey and that more than 30% of U.K. children and young people feel their well-being is much worse since the pandemic.

A recent survey by a large health insurer, titled “Teen Minds: Living Through a Pandemic and Beyond,”3 revealed that three in four young people have experienced symptoms of poor mental health since the start of the pandemic – many for the first time. Researchers report that the majority of teenagers (57%) are not feeling optimistic about their futures and that 59% are experiencing low self-esteem, anxiousness, depression, insomnia, and/or loneliness. Yet parents struggle to identify these issues: Six in 10 (63%) admit they would be unable to distinguish between teenage mood swings and the symptoms of a mental health condition.

Return to Normal?

Further studies have concentrated on exploring young people’s experiences and feelings about COVID-19 lockdowns and their attitudes towards returning to school. Results indicate that a return to school is not sufficient to address the mental health challenges children are facing. Some children that prefer their lockdown time at home will experience a different sort of trauma. Many children will also have lost the habit of learning and the ability to concentrate and will therefore need an understanding and tolerant teaching staff.

A study by researchers at the University of Bath4 found that such changes as returning to school in-person can trigger anxiety. Researchers there argue that young people need time to readjust to routine to deal with emotions after such a prolonged period at home. The return to school for children comes with major challenges: The pandemic has changed their educational experience, curriculum delivery, and future career prospects. School may be much different for them now than it was before COVID-19, at least at first. Children need to catch up not only academically, but also socially and emotionally.

A survey by Youth Works Northamptonshire5 found that 51% of young respondents had negative feelings about returning to school. However, students identified socializing with peers as one of the positive aspects. Respondents also indicated that maintaining a routine was important and a preferred coping mechanism for the return to school.

The Teen Minds survey found the most common mental health-related physical symptoms for teenagers were headaches/migraines (31%); skin breakouts (26%); lethargy/tiredness (28%); and weight gain (26%), while as many as 13% said they were suffering from panic attacks. This study also found that 52% of teenagers have turned to such harmful coping mechanisms as controlling or restricting food intake, picking their skin (excoriation), pulling out their hair (trichotillomania), and engaging in self-harm. Others admit to smoking, drinking, and taking drugs as their forms of escape.

Resources on the Rise

Fortunately, help is available: Families can access resources through national health systems, mental health agencies, local councils, charities, and schools. Those who have used these resources report greater confidence in their ability to help their children. A well-being survey by a large health insurer found that 83% of respondents are confident in their ability to support their children’s education, and 84% are positive about their ability to take care of their children’s health and well-being.

In Canada, the Wellness Together6 program offers resources for youth covering stress, worry, and substance abuse. There is also a Kids Helpline which offers Peer Support. These services are free and available 24/7.

In the U.K., the NHS has recognized children’s mental health7 as the area with the biggest gap between what patients need and what is provided. NHS England offers support to children experiencing anxiety and depression in an attempt to prevent further problems in adulthood. NHS has enough resources to support around 15% of students in England at 3,000 schools and colleges. Also, NHS England mental health support teams offer children one-on-one and group therapy sessions and provide training for parents and workshops for school staff.

In the U.S., Medicaid and Children’s Health Insurance Program (CHIP) coverage includes mental and behavioral health screenings, and mental health services can be delivered in-person or via telehealth. Access to these services varies by state and is dependent on household size and income.

Many agencies, like the U.S. Centers for Disease Control and Prevention (CDC)8 and the Mental Health Foundation (U.K.)9, provide free resources for coping with returning to school. These come in the forms of websites with information and links and resource packs that can be sent directly to parents or schools.

Many digital solutions are also available to address mental health challenges. In the U.K., the NHS now offers a library of approved mental health apps, including WorryTree, a journaling self-help app, and eQuoo, a game designed by psychologists to increase “emotional fitness.” Kooth offers online counseling; Shout provides free confidential support 24/7 by text; and Wysa is a character-based form of artificial intelligence available for anonymous 24/7 text chat. Joon Care in the U.S. is a startup that offers teletherapy teen and young adult services powered by an app and therapist platform.

How can insurers help?

As with other health-related issues, insurers can provide much-needed support. Health insurers are conducting surveys to further understand the problem, providing grants to universities to help train and educate mental health workers, and offering child-focused mental health solutions so that the issues can be confronted early.

As an example, a U.K. carrier now offers a teen mental health page with advice to help families communicate more openly, including a video featuring some famous people sharing their own experiences. A new Family Mental Healthline provides help and support for teens, with counselling and other talking therapies available by video.

In the U.S., a large health insurer has joined forces with Brightline, a California-based digital mental health platform for children and teens. Brightline connects patients with therapists, coaches, and psychiatrists and provides on-demand chat along with other services such as speech therapy. Another major insurer announced a partnership with GoNoodle, an interactive mindfulness and physical activity platform, to help more than two million K-6th grade kids, their parents, and teachers. Yet another insurer now offers Ginger, an on-demand behavioral health coaching service as an in-network benefit to 14 million behavioral health customers. Ginger’s platform provides text-based coaching and virtual therapy and psychiatry sessions, in addition to other self-help training tools.

Insurers are also stepping up philanthropic efforts focused on addressing longer-term mental health challenges. One major carrier has announced two grants, totaling $8 million, to California universities that will build a greater pipeline of child and adolescent psychiatry clinicians. Through this initiative, universities are creating new clinical learning opportunities, new curricula, and more student mentoring opportunities for child and adolescent psychiatry fellows and mental health nurse practitioners. Another insurer and its regional health plans that serve Idaho, Oregon, Utah, and Washington are donating more than $11.5 million to help meet the urgent mental and behavioral health needs in local rural communities.

The Road Ahead

Mental health in children and teens presented a serious challenge even before COVID-19: The CDC10 found that prior to the pandemic, one in six children age two to eight had been diagnosed with a mental, developmental, or behavioral disorder. Studies show that the COVID-19 crisis has significantly exacerbated this problem, and on its own, a return to school and to other pre-pandemic activities is not the solution for these children.

Moving forward, we must work to fully understand the issue and to identify and support effective solutions. Insurers can contribute to improving mental health in children through proactive outreach, partnerships with complementary organizations, and innovative product expansion. By helping meet the need for mental health services and providing support for young people, insurers can help create a better future for our customers, communities, and industry.

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Meet the Authors & Experts

Diana Bosworth
Diana Bosworth
Senior Research Analyst, Strategic Research