Youth Mental Health During and After the COVID-19 Pandemic

Photo by  Anthony Tran on Unsplash

By Devanshi Desai, (General member, The Young Canadians Roundtable on Health)

The COVID-19 pandemic has brought a sense of fear and anxiety which has led to short-term and long-term psychological and mental health implications for children and young people. Removal from school and daily routines, social isolation  - and sometimes loss associated with illness – have increased the stress in children’s lives. Youth are experiencing similar effects too. The perceived mental health of Canadian youth has declined during the pandemic, with over half of the participants aged 15-17 reporting that their mental health was somewhat worse than before the implementation of physical distancing measures. In an Association for the Canadian Studies survey conducted in mid-May 2020, more than one-third (37%) of respondents in the youth survey reported that they experienced adverse impacts to their mental health. 

Youth aged 12 to 17 were more likely to report feeling sad and irritable than adults and were more likely to report having trouble sleeping. Another survey of youth and young adults aged 14 to 27 was done in April 2020 by the Centre for Addiction and Mental Health (CAMH).It also found a decline in reported mental health early in the pandemic, both for youth and young adults with pre-existing mental health issues and for those without.

Many younger people feel more vulnerable to the pandemic's specific economic impacts, such as job loss. And for those who do not have access to virtual mental health care, disruptions in care and supports due to physical distancing measures may worsen their mental health challenges. A potential solution is the accessibility of more virtual mental care programs; free and confidential crisis resources can also help you or a loved one connect with a skilled, trained counsellor in your area.

COVID-19 and the Impact on Children’s Mental Health, a report by Simon Fraser University’s Children’s Health Policy Centre, reviews several studies on mental health outcomes for children and youth after earlier pandemics and natural disasters. This research identifies the mental health challenges children and youth can be expected to experience during and after COVID-19, including anxiety, post-traumatic stress, depression and behavioural problems. The report indicates that because untreated mental health problems can persist, even extending into adulthood if left untreated, supports for children and youth will significantly reduce future costs.

The study further finds that some adolescents and teens could be adversely impacted, including those with neuro-diverse needs, pre-existing mental health problems, youth in foster care and those influenced by adversities such as social deprivation and prejudice. It also finds that COVID-19 may have a particular effect on Indigenous peoples, who have unduly experienced co-related damage.

Overall, the pandemic is taking an exhausting toll on mental health of youth across every population in Canada. With the uncertainty over when life will go back to “normal,” it’s imperative that youth have barrier-free access to ample mental health supports for the remainder of the pandemic and beyond, to ensure that Canadian youth are able to lead healthy lives.

Devanshi Desai is currently completing her Master of Science in applied human nutrition at Mount Saint Vincent University in Halifax, Nova Scotia. She is passionate about improving health standards by providing quality of food to every individual, reduce food insecurity, mental health, and safety.

The YCRH Blog: Autism in a Pandemic

A Spectrum of Complications

Interview with an ASD Personal Support Worker

By Nik Jelicic, (Member, The Young Canadians Roundtable on Health)

Even on good, “normal” days, life with Autism Spectrum Disorder (ASD) can be a challenge. For youth with ASD, sudden or unplanned changes - be it a sudden change in the weather or having a different brand of juice box than their usual go-to for lunch - can lead to debilitating confusion, distress, irritation, and even trauma. For lower-functioning children, transitioning from performing one activity to another without proper priming, communication, and strategy can significantly undermine their day.

Within the span of mere weeks, COVID-19 took away outdoor activities, social engagement, and learning opportunities heavily relied upon by children with ASD and their families. In some lucky cases, virtual offerings replaced this programming, although their effectiveness likely cannot compete with the real deal. There is no doubt that the swift and widespread sociological transitions experienced by the entire planet have thrown a pandemic-sized wrench in the routine-based and often meticulously-planned daily lives of youth with ASD, whose wellbeing already lies in a delicate balance.

In the best cases, youth affected by ASD understand the bases of new COVID-related policies and respect the concept of a worldwide pandemic. They may transition from in-person to online schooling with some success, continue to develop social skills through interactions limited to family members only, and persevere through this unparalleled chapter of history. In other cases, youth may be unable to grasp the reasons for what may feel like a prolonged detention or punishment. These children may become increasingly irritated and aggressive with limited time outdoors, rendering a safety risk to themselves and others. Regardless, COVID-19 has placed a far more taxing burden on this population and their families than that placed on typically-developing youth.

As a consequence, with group services and respite programs being moved online or completely repealed, demands have increased for personal support workers (PSWs). These individuals, who are often required to “bubble” with their client and respective family rather than their own, care for youth with ASD on a one-on-one basis for days or weeks at a time. This allows family members to refocus attention to their work, tending to other children, and other responsibilities.

I interviewed Annie Douglas, an experienced ASD youth personal service worker, over the phone. We discussed some of her experiences working with youth and families during the COVID-19 pandemic:

For those who don’t know, what exactly are the responsibilities of a PSW for youth with ASD? What would a day on the job look like?

Generally, PSWs dedicate their time to providing hands-on direct care for anyone that might need it. As a PSW, your job can consist of a strict regimen of various healthcare and personal hygiene tasks to keep your client healthy and functioning. Or, it can really just be a supervisory or companionship role for clients who are relatively independent but require more assistance than what can be provided by public services or daycares. Since autism is such a diverse spectrum, no two PSW jobs for clients with ASD will look the same.

This summer, I worked with John [true name and identity retained to maintain confidentiality], a young man whose symptoms place him somewhere around the middle of the spectrum. He was relatively verbal, was very energetic, and I quickly found out he had a fascination for trains and buses. His parents wanted someone around to keep him calm and safe while completing his daily tasks since his excitement often led to loud yelling, running, and sometimes aggressive head-pumping. His parents were great and they gave him a checklist with daily chores to complete, so I’d try to fill any gaps with excursions or other engaging programming based on his attitudes that day and how much sleep he had the night before.

How would you describe your time as a personal care worker this summer relative to other experiences in such placements outside of a worldwide pandemic?

At first while restrictions were pretty intense, it was definitely an adjustment. John understood that it was unsafe to go out in public but would get really concerned and agitated when his mom would leave to go to her office downtown. It took him a bit of time every day to calm down after his mom left, and then things would be pretty normal. I couldn’t take him on any excursions around town and he was getting more aggressive the more we were cooped up at home. I tried some train-related crafts that took up some time.

Once restrictions were slightly lifted, about a month into working with him, we went to his favourite train station and we hung out there for a few hours making sure to obey distancing regulations and wear masks. His mood immediately lifted and from then on, we went outside every day which helped a lot. His weekly group social skills lessons have been cancelled, which was a big blow since they were really valuable, and he especially benefitted from the - albeit forced – social interactions with his peers

In terms of my bubbling, John and his family were my bubble, so when I wasn’t with them I was isolating for most of the summer, which was really tough. Last month things got a bit more relaxed so I could see my family and some close friends.

Like you mentioned, programs are getting cancelled. Do you think more families are looking for personal care workers this year than previously?

Definitely. I actually had four families that I knew previously reach out to me within a span of eight days this spring asking for me to be a PSW for their children after their different planned programming had been cancelled. Since it’s a full-time commitment, I only took on the first family that asked me. Families really rely on governmentally-funded programs for their children, and most, if not all, programs were halted in their tracks.

Things were looking kind of desperate for a bit right after COVID hit Canada. Since these families need more than just babysitters, not only did the cancellation or postponement of these programs prevent them from being able to work, but it also increased the cost of child care. From what I know, 3 of the 4 families ended up finding a PSW, while the father of the other child had to take an official leave from work since there was no one in their area able to provide the care they needed.

How would you suggest someone interested in getting involved with youth with ASD does so during this pandemic?

In Ontario, becoming a PSW requires a college certificate, so there’s less of short-term option. But if people are interested in caring for ASD clients specifically, many families and programs don’t require you to have a diploma. In fact, I got most of my experience caring for children with ASD without my PSW certificate. There are many ASD-specific certifications including Applied Behaviour Analysis (ABA) and Crisis Prevention Intervention (CPI) that are generally enough to get your foot in the door, along with some experience working with vulnerable populations.

Ms. Douglas ended the conversation noting that although PSWs are in demand now, resources for families impacted by ASD in Ontario had major gaps in both availability and accessibility long before the COVID-19 pandemic.

Nik is a senior at Dalhousie University, and will be completing his Hons.B.Sc in Kinesiology in 2021. He is involved in the Autism Canada community, having worked full time as a respite worker at the Geneva Center for Autism, and volunteering for numerous Special Olympics organizations. Nik aspires to be attend medical school in the future.

The YCRH Blog: Greener on the other side – inequitable access to green spaces impacts children’s health

By Umayangga Yogalingam (Co-Executive Director, The Young Canadians Roundtable on Health)

Restrictions under the COVID-19 pandemic are forcing more and more Canadians to discover the public green spaces in their neighbourhoods, cities and beyond. Green spaces are areas with vegetation that is specifically for aesthetic and/or recreational purposes and include parks, gardens, public facilities, and ecological reserves. Green spaces can offer a sense of respite from the newfound stressors associated with school and community centre closures, social isolation and the tedium of being stuck at home, mitigating the pandemic’s negative impact on health and quality of life. For children especially, green spaces can be a blessing as it is a space to engage in physical activity and access learning related to nature and the environment, all while maintaining physical distancing.

The link between green spaces and positive health has been well-established. Increased access to green spaces has been associated with decreased risk of death from common illnesses such as heart diseases, diabetes, and respiratory illnesses, according to a national cohort study in The Lancet. The pathways through which green spaces impact children’s health are numerous. Green spaces enhance physical activity which is a protective factor against the development of illnesses in childhood such as obesity, diabetes and cancer. In urban settings, green spaces can mitigate air pollution, noise and heat, all of which can lead to adverse, long-term health consequences especially during fetal growth and childhood. Green spaces can also improve immunological functioning due to exposure to beneficial microbiota.

A review in the Journal of Pediatric Nursing has highlighted a body of research that shows how green spaces can positively impact mental health, reduce behavioural problems and improve academic performance within children. Specifically, it can lead to improved mental well-being, positive behaviours, improved attention deficit hyperactivity disorder (ADHD) symptoms, and better standardized test scores. It can also protect against high stress levels, depression, and mood disorders via increased physical activity, increased social contact and the change in environment that green spaces provide.

However, not all those who live in Canada are able to reap the benefits of high-quality green spaces. According to Statistics Canada’s 2017 Households and Environment Survey, Canadian households (85%) indicated that there is a park ten-minutes away from their home. However, there are many factors that impact access to these green spaces including walkability, availability of play facilities, perceived safety, and aesthetics. Several studies have shown that individuals and families with higher income and higher education levels are more likely to have greater access to high-quality green spaces. As such, wealthier neighbourhoods are more likely to benefit from green spaces in comparison to underserved neighbourhoods.

Inequities in access to green spaces have been reinforced during the COVID-19 pandemic. The pandemic saw the closure or the restricted use of green spaces, namely parks and play facilities, in Canada. For many low-to medium-income households and may be unable to leave cities to access nature, parks offer a way to access green space and its benefits. The lack of access to green spaces further limits the options of activities that underserved populations can engage in during the pandemic, exacerbating stressors and other inequities these populations may already be experiencing.

Unsurprisingly, studies have found correlations between children who have limited access to green spaces and poor health outcomes such as increased risk for neurodevelopmental disorders such as ADHD, and behavioural problems such as aggressive behaviour and conduct problems. Impacts on health include increased sedentary behaviour due to lack of spaces to engage in moderate-to-vigorous physical activity, higher blood pressure, and increased risk of developing psychiatric disorders.

The COVID-19 pandemic has highlighted the importance of green space for children’s health and broader public health. As Canada slowly loosens restrictions, observations and data collected on green space use during the pandemic can be used to equitably invest in green spaces. It is important to apply an equity lens and actively engage community members, families, children and youth across all populations in planning, implementing and enhancing green spaces. High-quality green spaces can serve as an upstream, preventative measure against many negative health outcomes, especially among children. As such, the importance of investing in green spaces must not be understated.

Umayangga Yogalingam is a recent graduate from the Master of Public Health program at the University of Toronto and is passionate about mental health, health equity, environmental health, and the impact of race, culture and ethnicity on health. In addition to being the Executive Director of the YCRH, she is also the Research and Knowledge Translation Lead at The Sandbox Project.

The YCRH Blog: Child and youth well-being during the COVID-19 pandemic

By Stacie Smith (Director of Relations and Outreach, Young Canadians Roundtable on Health)      

The COVID-19 pandemic has had a major impact on many people’s lives, especially children and youth. There are many uncertainties for them, such as wondering when they might be able to play with their friends again and what the upcoming school year may look like. Their fears and worries are just as important as anyone else’s and need to be remembered during this time of uncertainty.

Every single child in Canada deserves the best start in life, no matter where they live in the country. There can be long-term mental health effects of the closures and distancing measures, especially in infants and toddlers who have had their day-to-day routines disrupted and changed. One way of keeping things normal is to always have structured days with regular mealtimes and bedtimes, as they are an essential part of keeping kids happy and healthy. Planning daily walks can be a good way to create structure and ensure physical activity. Overall, children do better when their activities are predictable and therefore, whenever possible, inform them about any change in routine ahead of time.

Kids feel inspired when they know what to do to keep themselves safe. It is always a great step to let children make their own decisions when it comes to staying safe and healthy. It gives them a sense of pride that they made a decision that kept them protected within their limits. Teaching kids that staying healthy and having good hygiene habits can help them stay strong and well. It’s also necessary to set limits. For example, some may need structured and unstructured time, as well as supervised and unsupervised time.

With the most recent release of the ParticipACTION Report Card giving a grade of D+ to Canadian Youth for Physical Activity, it is more important than ever to ensure children are getting enough physical activity during a time when children are not playing with their friends or getting outside as often. We can still do everything we can to ensure our families’ bodies and minds are strong, their moods are boosted and energy levels are prime. ParticipACTION has some great resources to keep everyone moving.

There have also been many questions about how thousands of children who rely on food programs will be able to access those critical meals safely. For example, the Government of Nova Scotia funds school healthy eating and breakfast programs, but some fall short of meeting the needs of students and they rely too heavily on support from volunteers to deliver them.

Since classes ended early in March, Feed Nova Scotia has been delivering meals to students who would normally get them at school through its annual After the Bell program. This year, it received more than 9,000 food packages for kids. It is still unclear how school food programs will look this fall, but there are many factors at play when considering what changes need to be made.

There will need to be changes to communal eating spaces to accommodate for physical distancing, personal protective equipment provided to those who serve food to students, as well as how to best prepare food that may not be prepackaged.

It will become very important to keep children safe and comfortable when coming back together in childcare settings, summer camps, on the playground, and ultimately, back to school this coming fall. While most provincial governments have released their reopening guidelines for schools this fall, Nova Scotia has not. They have indicated that they want to take their time, but many parents and other government parties are calling on the government to provide a plan sooner rather than later. Kids are already worried about what the fall will look like; it doesn’t make sense to make them worry longer than needed.

Stacie Smith is a recent Kinesiology graduate from Saint John, New Brunswick and the founder of the COVID-19 PSE Support Network. She is also the Vice President of the Kinesiology Association of Nova Scotia. She was the recipient of the PHE Canada Student Leadership Award in 2018-2019 for her leadership role in the School of Health & Human Performance.