Youth in the firing line of COVID-19 mental health pandemic

In response to the impact of the COVID-19 pandemic on children and young people - especially on their mental health - recovery and support strategies need to centre and foreground psychosocial support, writes the University of Cape Town (UCT) School of Education’s Dr Patti Silbert (project manager of the Schools Improvement Initiative (SII) in the Schools Development Unit) and Tembeka Mzozoyana (social worker in the SII).

Dr Patti Silbert is project manager of the Schools Improvement Initiative in the Schools Development Unit at the University of Cape Town. Tembeka Mzozoyana is a social worker in the Schools Improvement Initiative.

This year (2021) has been extremely challenging for South African schooling, due to the profoundly negative impact of the Covid-19 pandemic and the increased transmissibility of the Delta variant. Ongoing isolation, uncertainty, economic strain, bereavement and loss have resulted in heightened anxiety, particularly for schoolgoing young South Africans.

While teachers are expected to support pupils in managing their emotional distress, they themselves are experiencing far higher stress levels. This is linked to much more intense work demands, coupled with illness, loss, anxiety, fatigue and fear associated with the greater possibility of contracting the virus. Increased mental stress and anxiety in the education sector reflects a serious deterioration in mental health in the broader population.

In the weeks following the start of the national lockdown in March 2020, Lifeline South Africa, the South African Depression and Anxiety Group and Childline reported an exponential surge in daily calls.

The impact of emotional and psychological stress on schoolgoing youngsters is a growing concern. This is tied to a number of challenges. First, pupils are deeply worried about their progress and growth at a time when their life patterns have had to alter significantly. Between March 2020 and June 2021, primary school pupils lost almost 70% of a full year of learning.

Second, children in the younger grades have also been regularly absent, leading to serious losses in learning to read and write.

Third, the illness of parents/guardians, staggered schooling times, financial losses at home and parents or caregivers needing to move to other provinces to take care of sick family members, have added to pupils’ burdens. A threefold increase in school dropouts has been reported (roughly 750,000 pupils) since the start of the pandemic, mostly in families already affected by poverty and economic hardship.

Finally, teacher deaths due to Covid-19 have also led to learning losses. Nearly 0.6% of teachers (2,283) across South Africa lost their lives between March 2020 and late May 2021, according to Daily Maverick.

Young people have paid an enormous price in terms of numerous losses, on a personal level and through schooling disruptions. Many children have lost parents, grandparents or close relatives. In South Africa where many grandparents assume the role of primary caregivers, the loss of older family members to Covid-19 has been particularly devastating. The loss or separation from a primary caregiver has a profound impact on a child’s mental health in terms of loss of attachment figures, a safe base from which to explore the world, and heightened anxiety about the future.

Even before the pandemic, schools, irrespective of their level of educational performance, provided much more than formal learning. They represented spaces of structure, routine and predictability where, through daily interaction with others, children learnt relational dynamics and socialisation. These are extremely important aspects of a child’s overall development and contribute towards creating a sense of containment, social boundaries and self-regulation.

Since the start of the pandemic, due to physical distancing regulations, children have not been able to play as usual during break time. The loss — at times absence — of play has resulted in poor concentration and a lack of participation in classroom activities, especially among younger children. Reduced physical development as a result of diminished play has been reported by primary school teachers as a grave concern, while many secondary school teachers say their pupils appear “zombie-like”.

The absence of social interaction through play, connection and appropriate physical contact has already affected the healthy development of children and adolescents in many ways — cognitively, socially, emotionally and physically. Instead of providing structure and routine, the majority of schools in our country have become fragile spaces of uncertainty and unpredictability.

Although the percentage of hospital admissions among children infected with Covid-19 remains relatively low, children and adolescents have suffered the collateral impact of the pandemic. Yet in most instances they have been left out of the public debates on the pandemic and its effects.

With the exception of children-centred organisations, projects and campaigns (such as UCT’s Children’s Institute) that focus on the voices of children, we have not done enough as a society to understand and spotlight what our children are experiencing as a result of the pandemic. Children largely have remained silent with the expectation, in many contexts, that life must continue as normal.

Rather than encouraging a discourse of communication, expression and sharing, in many school communities silence is conflated with coping, with the result that children and adolescents are becoming increasingly disconnected from their personal and collective trauma. For most South African children, the increased risk of abuse and violence and of children having to care for ill or grieving parents, adds a layer of trauma.

It is not surprising that the term “mental health pandemic” has entered Covid-19 discourses.

We need to address the prevalence of accumulated adverse childhood experiences by attending to the mental health of our children and young people in and beyond the context of the pandemic — not only to mitigate learning losses and strengthen academic performance, but to foster optimal youth development. In line with the United Nations Convention on the Rights of the Child, children have a right not only to survive, but to thrive. In the current Covid-19 context there is little hope of them thriving.

To reach their full potential children need nurturing care at all stages of development — at the very least they need to be able to express their fears and vulnerabilities without stigma or shame. They need to learn the language of self-expression and be taught the skills of emotional literacy. This is particularly critical in a demographically young country such as ours, with its postcolonial, post-apartheid and wealth-race inequality.

Long before the pandemic, pupils in most South African schools carried heavy psychosocial burdens because of our unequal and socioeconomically burdened landscape, from macro issues as highlighted above to micro and meso issues like community health, domestic and gender-based violence, unemployment, gangsterism and many more.

Even before the pandemic it was estimated that one in three people would be affected by mental health illness in their lifetime.Typically, these issues manifest in poor academic performance, with the schooling system mostly unable (not necessarily unwilling) to help youngsters address underlying issues of depression and anxiety. It is important that teachers have a basic understanding of mental illness in order to grasp how trauma affects self-esteem, behaviour and interpersonal relationships. We need to move away from the stigma and ignorance of trauma, towards normalising children’s experiences associated with mental illness.

From the start of the pandemic, we in the Schools Development Unit at the University of Cape Town have held the view that all teaching and learning recovery and support strategies need to centre and foreground psychosocial support, as children who are hungry, anxious and traumatised cannot learn effectively.

Given the ongoing impact of the pandemic, this need has become critical, especially in communities that face numerous and constant crises. We know first-hand via the Schools Wellness Centre, an initiative of the Schools Improvement Initiative in the unit, that we need to find ways to support children and adolescents in facing trauma and loss as a result of the pandemic by developing their resilience and coping mechanisms and by involving teachers, parents and family.

Building a network of connections helps children understand that their bio-psychosocial experiences and challenges matter, and that ultimately, this is crucial in discovering themselves and understanding how to develop healthy relationships with others.

If vulnerability is defined as “the emotion we experience during times of uncertainty, risk and emotional exposure” (Brené Brown, Dare to Lead, 2018), then teaching children the tools to express themselves should, from the earliest stage of schooling, be introduced through age-appropriate, context-sensitive methods. Research done in countries across the world during and after large-scale situational crises has shown that in schools that encouraged immediate adult-led discussion of the crisis, children had measurably better signs of behavioural health than those in schools that avoided adult-led discussion.

The use of, for example, interactive, guided activity workbooks for children and adolescents who are supported by their teachers and families in facing disaster honestly, rather than avoiding it, has been found to decrease post-traumatic symptoms. The absence of adult leadership, absence of adult initiation of discussion and absence of social support have been shown to be harmful in crises (Kliman et al, 14th Ed, My Pandemic Story, 2020).

Apart from the interactive workbooks mentioned above, other practical examples that encourage children to express their feelings include the introduction of classroom-led discussions on issues related to the pandemic; visual aids depicting children’s feelings; and child-centred YouTube clips that help them recognise and express their full range of emotions. We need to create supportive, enabling school environments to effectively and consistently implement these types of strategies.

Universities have a key role to play in partnering with schools and community-based organisations to minimise the risk of mental health issues and help young people reach their full potential. Developing strategies that encourage children to express their vulnerability will help build resilience and develop their agency to shift negative behavioural patterns. Through the Schools Wellness Centre, opportunities are provided in safe, protected spaces for young people to break the silence that all too often masks the challenges they face and the fears that come to define them.

Promoting health and wellbeing in our schools requires that children learn to express their anxieties and fears. This is critical for young people to thrive and fundamental in creating safe, supportive, nurturing environments. The importance of good health and wellbeing represents the third goal for sustainable development. Given the absence of psychosocial support for the majority of young South Africans, particularly during this period of heightened adversity, the school becomes critical to mainstream and promote mental health and for young people to be given the skills to express their vulnerability.

As Tomlinson et al remind us, “the foundations of mental wellbeing lie in healthy relationships. When children and adolescents are listened to, and their feelings are acknowledged and accepted, then they are likely to experience fewer symptoms of psychological distress.”

Child and adolescent mental health require evidence-based programmes and multisectoral strategies that promote psychosocial support within schools. We need to ensure that every school embraces a culture of care and compassion and that mechanisms are put in place to normalise vulnerability and reduce the risk of mental health so that we help our young people reach their full potential.

Over and above addressing learning gaps at the level of the curriculum, it is our responsibility as educationists to develop self-aware, integrated and emotionally literate young adults who will become active, fully engaged members of their community and the broader South Africa.

Silence is not an option. Survival is not enough.