Mental health and risk of suicide in young people during the pandemic

The Covid-19 pandemic has led to serious illness, bereavements, social isolation including physical separation from loved ones and peers, school closures, zoom lessons, an increasingly online world with escalating cyberbullying, financial pressures, as well as worries about contracting the virus and an uncertain future. It has had a profound impact on the mental health and wellbeing of the nation and led to an escalation in domestic abuse and violence. Kooth, an online mental wellbeing community, currently has 167, 000 active service users, and in 2020 saw a rise in service users of 37% compared to 2019.

Children and young people have been significantly affected, leading to deteriorating mental health and, in some cases, self-harm and suicidal thoughts, with heartbreakingly tragic outcomes. In July 2020, an NHS survey found that 1 in 6 children and young people had a likely mental health disorder, a marked increase compared to 1 in 9 in 2017 (which also showed a 49% increase in emotional disorders since 2004). During the pandemic Kooth noted a 24% increase in children and young people presenting with self- harm, a 35% increase in suicidal thoughts, 77.7% increase in sleep difficulties, and a 100% increase in school/college worries. Furthermore, the service has observed a 57% increase in eating related difficulties compared to 2019.

It may be difficult to detect and acknowledge that someone close to you is struggling with their mental health. The signs can be subtle but there are some features which can alert us to the need to provide support and appropriately share our concerns. This could mean that help is accessed sooner by those who are suffering. It can be challenging to know how to talk to someone about their mental health or notice that they may be struggling. Young people in particular may be guarded about sharing their feelings, so deteriorating mental health may seem to be normal behaviour. A change in behaviour may be a sign that help and support are needed.

• Dr Lisa Racussen and Daniel Mills-Da’Bell contributed to this article.

Parents and carers may feel guilty or seek to understand why this is happening. The priority is to avoid judging the child or young person, and focus on open communication and reassurance. Steer clear of blaming yourself and try to be optimistic about the prospects for recovery. Remaining hopeful is important as hopelessness can act as a potent trigger for increasing suicidal thoughts and behaviours.

Anxiety in children and young people may be indicated by any of the following signs: avoidance of anxiety- provoking situations; often appearing tense; panic attacks; episodes of being angry or upset; needing constant reassurance; excessive worrying; asking “what if” questions; medically unexplained symptoms (such as headaches, a sore tummy, nausea); altered eating habits and difficulty sleeping.

Features of depression in children and young people may include: social withdrawal and isolation; persistent lack of motivation or low mood; often feeling upset ; lack of pleasure in doing things they once enjoyed; low self-esteem; altered eating or sleep habits.

If a child or young person shares thoughts about self- harming or suicide, this should always be taken seriously. The signs of a risk of suicide may include worsening depression or social isolation; increased risk taking behaviours (such as drinking alcohol and drug taking), a preoccupation with suicide and death, demonstrated by online searches and making comments such as they wish they were dead.

Approaches to supporting a child or young person struggling with their mental health include reassuring them that you are there for them and understand that they may be struggling, especially given how difficult the past year has been. Although their behaviour may upset you, be patient and remain calm and approachable; acknowledge that their feelings are valid and reassure them that they can be open about what they are going through.

Children and young people may often feel guilty for feeling bad, and worry about being a burden to their loved ones, so they may try to protect their loved ones from the severity of what they are feeling. This can be particularly challenging during adolescence, when young people may confide less in their loved ones and more in their friends. If they prefer to avoid talking face to face, communicate by text or phone. If they don’t wish to talk to you ask who they may feel more comfortable talking to.

Access support from the registered GP or a 111 clinician and CAMHS (Child and adolescent mental health services). In an emergency, call 999 or go to your nearest Accident and Emergency department.

Additional help can be accessed from the school/college, and services and online resources such as Childline, Samaritans, SOS Suicide of Silence, Papyrus,  The Mix, Young Minds, Shout, Headspace, CalmHarm, Staying Safe, Mind and Kooth.

Supporting a loved one or peer struggling with their mental health can be hard and self- care and appropriate support are important.