Impact Report - Tic+

COVID-19 impacton children andyoung people

A tic+

Impact Report

February 2021

https://www.ticplus.org.uk/

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BackgroundTIC+ is a mental health charity which provides counselling andsupport for children, young people and their families. Thanksto the tireless dedication of its entire team from the start ofthe first lockdown in March 2020, TIC+ swiftly transitioned itsface-to-face capacity and was able to offer every youngperson a choice of either online-text, video or telephonecounselling. Consequently, with virtually no break in servicedelivery, more sessions were delivered between March andDecember 2020 than in the previous year. Worryinglyhowever, a few months into lockdown it became apparentthat there was a pronounced increase in the number of youngpeople presenting with suicidal thoughts, plans or attempts.This study aimed to explore reasons for this increase byasking members of the TIC+ clinical team to feedback theirobservations of the impact the COVID-19 pandemic has hadon the children and young people receiving counselling.

MethodThis was an explorative, qualitative piece of research, usingfocus groups with 38 members of the TIC+ clinical team.Results are based on reports from clinicians about the viewsof their clients; however, this method allowed easy and timelyaccess to the presenting experiences of around 300 childrenand young people. Each focus group was conducted inOctober 2020 with five to eight clinicians, and lasted between45 minutes to one hour.

Overview of findingsThere were five key themes, each with several sub-themes,summarising the views of clinicians about the impact of theCOVID-19 pandemic on children and young people. It is worthnoting that some children, particularly those of primary-age,seemed not to have been obviously impacted, and there werealso reports of some positive impacts.

Executive Summary

Copyright ©tic+ 2021


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The uncertainty of the future,resulting in existential crises, areissues we are also currently seeingyoung people struggling with, a lotwho are trying to comprehend‘what’s the point?'

Overview of findings

Existential issues was akey theme, with isolationand loneliness being oneof the most commonlyreported difficulties, andthis persisted even after areturn to school or college.Young people were alsoexperiencing loss anduncertainty around theirlife and their plans.



Education-based issues are usually a common reason forpresentation to TIC+; this became a major issue for youngpeople as the first lockdown ended, with a combination ofworries about keeping up with work, and re-buildingfriendships and social interaction in the new context ofthe COVID-19 rules and restrictions.

Having spent so long inlockdown she found it reallyhard to re-engage withfriendship groups at school

Implications

This study provides a window into some of the additionalpressures and issues young people are facing as a resultof the COVID-19 pandemic, that may be resulting in theincrease in suicidal thoughts, plans and attempts seen inyoung people presenting to TIC+. The study wasconducted prior to news about, and roll-out of, effectivevaccines and prior to second and third lockdowns;however, the findings are still relevant in understandingthe support young people might need as a result of thepandemic. TIC+ provides a person-centred, integrativemodel of counselling, allowing young people to explorethe issues noted above, in a way that can help them cometo terms with their new experiences and build resilience.The continued support provided by TIC+ to young peopleis vital at this time.

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COVID-19 impact on children and young people

From June 2020 we began to notice moreyoung people than usual were disclosing totheir counsellor and in their referral formsthat they had thoughts of suicide, hadformed plans and had made attempts totake their own life. There was also anincrease in serious self-harm, compulsivebehaviours and unhealthy eating patterns.

"Nearly every young person I see ispresenting with suicidal thoughts."

In an attempt to better understand whatwas causing this increase, we conductedan informal, explorative, qualitative studywith our clinical team. During October2020 a total of 38 TIC+ counsellors andmental health support practitioners tookpart in six focus groups, with five to eightclinicians in each. With an averageworkload of approximately eight youngpeople to each practitioner, thisstudy represents the counsellor’sperspectives of the presentingexperiences of approximately 300 childrenand young people between the ages of 9-21 living across the county ofGloucestershire. The discussions in eachgroup lasted between 45 minutes to onehour. Notably the discussions took placebefore news about an effective vaccine.

Each group began with the question,"What impact has the COVID-19 pandemichad on the children and young people youhave seen for counselling."

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"The intensity ofsuicidal thoughts andtheir likelihood to actused to be 4/10 it’snow 8/10."

"It seems as if moreyoung people are using self-harm andunhealthy eatingpatterns in an attemptto control their liveswhen everything else isuncontrollable."

"More youngpeople haveattempted

suicide."



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The views expressed by clinicianshave been summarised into severalkey themes:

1. Existential Issues

o Isolation and lonelinesso Uncertainty about role and future o Loss of adolescent stageo Bereavemento Questioning life-assumptions 2. Education based issues

o Academic concernso Changed social contacto Additional needs not being meto School refusal

3. Change in Activities

o Lack of exercise, group sports and activitieso Increased online activity

4. Home/Parent issues

o Financial issueso Demands on parentso Parental conflict/Domestic violence 5. Health Anxiety

o Fear of the viruso Fear of passing on the virus



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Many reported that they felt lessanxious because of not having theusual academic work or socialpressures associated with going toschool. Some enjoyed being at home andspending more time with their family. Having no routine or structure was

Several children struggling withbehavioural compulsions, reported theyfelt normal and their fears justified dueto the emphasis on germ/infectioncontrol, hand washing and wearingmasks etc.

It is important to note that the themes arenot representative of all children andyoung people seen; counsellors reportedthat some children, particularly thoseof primary school age, had not beenobviously impacted by the consequencesof the pandemic.

Interestingly, there were several positiveconsequences noted. For instance, somechildren and young people enjoyedtangible benefits during the first lockdown.

appreciated, e.g. not having to get upearly and being able to go to bed latehad given a sense of freedom.



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1. Existential Issues

o Isolation and loneliness

Issues of loneliness and isolationparticularly during the first lockdown weresome of the most commonly reporteddifficulties experienced, it was mentionedin each of the focus groups. There was adegree of anxiety around keeping incontact with friends as the normal meansfor doing this was no longer there e.g.through school and other social or sportingactivities. This led to worries aroundfriendships and maintaining socialstanding within friendship groups.

"There's quite a lot ofloneliness comingacross."

"One girl said - I don't really like being aroundpeople but I've always had a best friend I'veknown since I was little, but I haven't spoken tothem for quite a few months since lockdownbecause we don’t meet up anymore."

"They said that they found itreally hard, they were lonely butthat seems to be carrying onover into school. Even whenpeople might have a supportnetwork at home or closefriends in school, there's anelement of loneliness."

Some have referred back to whenwe had lockdown. They were verylonely but it still seems to be anissue, even though they're back inschool and around people, they don’tknow where they stand socially –they’re unsure if it's affectedfriendships because they couldn'tsee people for a long time.



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o Uncertainty about role and future

One of the key development goals ofadolescence is identity formation. Thesearch to understand what is real andtrue about themselves and the role theyare to take in life is known to be themotivation for experimenting with newrelationships, behaviours, vocations;community involvement; ethnic group andmembership; and to moral, political,spiritual and cultural ideals. This processprimarily takes place in the context ofrelationships with others, and is marked bythe young person gradually detaching fromthe authority of parents and attaching topeers. This period has been likened to abridge between childhood and adulthood.It involves integrating what is known of theself from childhood with dreams about,and anticipating for, the future.

It’s no wonder therefore that many of theyoung people we see are experiencing aform of existential crisis – it’s hard tointegrate from childhood to future whenthe usual transitional vehicles areunavailable and the bridge is at risk ofcollapsing as the land either side can nolonger be trusted or relied on.

Worry about their future– will it affect their jobopportunities, will they evenbe able to get a job…

"There seems to be more worryabout loss and purpose: 'what's

the point?', 'what does ourfuture look like'?"

"...the uncertainty of thefuture, resulting in existentialcrises are issues we are also

currently seeing young peoplestruggling with, a lot who are

trying to comprehend 'What's the point!"

"Concerns about the futureclients feeling hopeless –

uncertainty"



o Loss of adolescent stage

Living through the COVID period hasbeen described as being in a form ofsuspended animation – waiting fornormal life to continue. The problemis, the suspense has been longerthan originally imagined. A year issuch a proportionally big chunk oftheir lives, around 5-10% foradolescents.

"It's no longer something thatthey’ve got to ride through for ashort period of time, it now seemslike this might be an uncertain timefor much, much longer. And theynever know whether next weekthey’ll be in isolation or not and sohow do they plan?"

The period has been marked bymonths spent in isolation with littleface-to-face contact with their peergroups, trapped at home withparents. This, along with uncertaintyover education, exams, universityplaces and worry about futureemployment opportunities etc. hastaken its toll in the lives of youngpeople at such a crucial time in theirdevelopment.

Noticeable is the sense of loss andgrief for what was expected but isno longer.

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There was a lot of lossbeing explored, lossaround not having aproper ending to school,not taking exams.

"Rites of passage havebeen stolen from them e.g.

Exams, Prom, SchoolResidential, End of year

party, Fresher’s etc."

"There is a sadness, asense of grieving for lossof things and normality."



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It was bad enoughthat his Gran died, but with that andeverything going onat home with his mum losing her joband all the changes at school, made itvery distressingand confusing...it’sbeen quite complex… there’s been a lotfor him to processand unpick…

o Questioning life-assumptions

Previously held assumptions about life being relatively safe,healthy and secure have suddenly been called into questionbecause of COVID-19. The pandemic reminds us that life is perhapsnot as certain as we thought it was, that we are, in fact, vulnerable. "I would say that it's linked with mortality. Yeah, and I think it'smainly brought up the idea that he’s going to die - because it's sortof bought things into reality, their mortality."

"He was worried that his parents might die and what will happen tohim if they do die."

The prevalence of ‘Fake News’ on social media, the press and TVcriticism of the government response, has led a lack of trust ingovernment and a sense of insecurity.

"Some are having questions, for example: 'What does this mean forus?', 'Is it even real?', 'Can we trust our leaders?', 'Are we beingcontrolled?'."

o Bereavement

During the first lockdown not many young peoplehad experienced a relative dying as a result ofCOVID-19. As time has gone on, more young peoplehave experienced the death of older familymembers. Counsellors observed that experiencingthe death of a close family member at the currenttime is more traumatic than usual due to the levelof confusion and uncertainty in all other areas of ayoung person’s life. As a result, more young peopleare needing support to process their grief.

"More children I see have experienced abereavement, mainly of grandparents and greatgrandparents… it’s been really difficult for themand their parents, families haven’t had theusual face-to-face rituals and social support."



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2. Education based issues

o Academic Concerns

A large percentage of young people who struggle withanxiety or low mood do so because of school/collegebased issues. Worries about academic work andexams are prevalent, so much so that referrals forcounselling normally reach their peak during the timeof mock exams and then again before the actualexams.

This, along with other school based anxieties such asbullying, fear of ridicule, peer rejection, acceptanceissues etc. mean that referrals are high during termtime and wane significantly during holiday periods.

Just before the end of the lockdown period, manyyoung people were worried about going back toschool. They were highly anxious that they’d fallenbehind and wouldn’t be able to keep up becausethey’d missed so much.

The reasons for this were varied. Some said theyhadn’t been motivated to work in isolation from theirpeers, others had been unable to keep up with lessonsor the level of work because of practical issues and alack of equipment. Some had no quiet space at homewithout distraction or interruption, whereas otherswere having to share laptops/devices with parentsand siblings or had no or limited data.

Counsellors also made the observation that there wasa vast disparity between the quality of the onlineteaching and pastoral support from the schools andcolleges during first lockdown. Some schools had setup access to live (video/telephone) online learning orpastoral support every day, whereas others had senthomework by email with very little or no teacherinteraction.



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From year 10 upwards, young peoplefelt the pressure of GCSE's & ALevels. This was compounded by theconfusion, disappointment andeventual government u-turn aroundexam results in the summer of 2020.This seems to have had opposingreactions – some young peopleworked very hard without break in anattempt to catch up, worried thatevery moment counts; others becamedisillusioned and gave up working,believing that no matter how hardthey tried it wouldn’t make adifference to their exam results.

There was a sense of anger andinjustice about results being based onan apparent random assessmentsystem rather than through thenormal teacher assessment andexams. Some felt this was unfairbelieving it might sabotage theirchances of going to university andbelieving their qualifications wouldn’tbe valued as much by others/futureemployers. Others felt guilty becausethey felt they’d ‘cheated’ the system.

"One boy felt guilty because he’dbeen given good exam results but feltlike he didn't deserve them, he hadn'tbeen revising and yet he'd been givenall these really good results."

There’s anuncertainty, they’renot sure if things willchange again or not!It’s made themappreciate what theyused to have. They’renow worried isuniversity evenpossible?



The level of uncertainty aboutwhether school and exams will bepossible has caused some youngpeople to really value theireducation and helped them torealise how much they hadpreviously taken it for granted.

Furthermore, returning to thelevel of academic work wasexhausting after such a longbreak, particularly for thosetransitioning from GCSE to ALevel. So much work had beenmissed and now they were beingexpected to step up and operateat A Level standard having hadmonths off school or college.

o Changed Social Contact

Even so, many young people saidthey were looking forward togoing back to school/college, andre-connecting with close andwider friendship groups afterlockdown. However, for some whohad been quite content duringlockdown, the thought of havingto re-build friendships andpossibly having to changefriendship groups was causing agreat deal of anxiety.

"With the new structure of schoolthey don't really move around.They don't have that option to justchat and let off steam and sharethings with a friend."

Once young people returned toschool and college new issuesbegan to emerge. They weredisappointed because things hadchanged a lot. Many of them feltthe fun had gone out of being atschool/college. This was causedby the confusion and uncertaintyof the new structures, rules androutines for socially distancingand adhering to the new hygienemeasures. All of which meant lesssocial interaction and freedomand more time spent in theclassroom. Some reported havingto do additional time in class eachday to catch up on lost work time.

"A boy at primary school wasreally upset because he didn’thave as much time to play withfriends, the break times have beencut short because everythingtakes so much longer with all thehand washing."

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Having spent so long inlockdown she found itreally hard to re-engagewith friendship groups atschool, it was stressfulhaving to re-establishfriendship groups.



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o Additional needs not being met

With the schools and colleges being sooverwhelmed trying to manage the COVIDsituation several young people with physicaland learning differences had been impacted bythe lack of pastoral support at their school andcollege.

"One young person was very angry because hisproblem wasn’t being dealt with, he couldn’tget an appointment to sort it out."

"The pastoral support at school wasoverwhelmed and she felt she wasn’t gettingas much attention as before." o School refusal

For some the return to school had increasedtheir social anxiety to the extent that theywere now refusing to go to school.

I’ve noticed more young peoplerefusing to go back to schoolbecause they feel so anxious aboutreturning after such a long break.



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3. Change in Activities

o Lack of exercise, group sports andactivities

It was observed that young peoplewere generally having less exercise.Even when they were able to seefriends again, it was limited due to the'bubbles' they had to be in at school.Several young people had mentionedhow much they missed playing sportsand other social physical activities,and that not having this normal outlethad caused their mental health todeteriorate.

One young person struggled morewith body image issues as a result ofnot being able to play sport.

"He said he’d kind of been thinkingabout how he looked more duringlockdown because he’d just had moretime to think in general. He said it’shard because you can’t do sportingactivities in teams."

"When he said he felt sad Iwanted to know what makeshim happy - he said, ‘well I usedto like meet up with my friendsand play football and go out onour bikes, but my mum doesn'tlet me do that anymore, becauseshe's a nurse, and she doesn'twant me to be in contact withlots of people."

"Even though he's going toschool in the day she still put acurfew on him going out. It wascausing him to have less socialopportunities and more time toworry at home."

She said that playing netballallowed her to switch offbecause she was fully in thegame and when you playyou've no time to worry.



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o Increased online activity

We recognise that social media, gaming and internet use canhave both a positive and negative effect on young people’smental health. Using technology to keep in touch withfriends and family, and for online learning and keeping up todate with news etc. has been so important for children,young people and adults alike during the COVID-19pandemic. Normally, the overuse of social media and gaming etc. isattributed to lack of sleep, emotional and psychologicalstruggles such as anxiety and depression in children andyoung people. It was surprising, therefore, that during thediscussions, the counsellors rarely mentioned the impact ofthe virus on technology use. Although nothing significantcan necessarily be deduced from this, perhaps the othermatters mentioned took precedent and were therefore moredominant in their minds. Another possibility is that, becauseeveryone (even the high profile influencers and esteemedcelebrities) has temporarily been in the same boat – it hashad a levelling effect, leading to fewer adverse effects ofsocial media use, such as the negative self-comparisons andfear of missing out that so often result in low self-esteem,jealousy, dissatisfaction with life, rejection etc.

It was observed that young people were generally gamingmore and were even more attached to various social mediachannels e.g. YouTube, Netflix etc. There was also aworrying account of being desensitized to the materialbeing watched.

A young person was telling me aboutthis horrific video she was watching.She said she was really surprised that itdidn't affect her at all, she’d seen somany things like that on social media.



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4. Home/Parent Issues

o Financial Issues

Nearly 50% of all issues young people normallybring to counselling are related to familydifficulties. These include family relationshipissues, domestic violence, interfamilial conflict,parental separation and divorce.

We have seen a number of new issuessurfacing as a result of the pandemic. Someparents for the first time in their working livesare experiencing unemployment, reducedincome or loss of business. This has causedstress and anxiety for the parents andtherefore for their children, some of whom arereluctant to share their own worries for fear ofbeing an added burden to their parents.

"The client’s parents were self-employed andquite well off, but they now have no income andare having to sell the family home and it’s notselling. The client is stressed and worried aboutthe future because they can tell their parentsare stressed."

Some of their parents have losttheir job and the kids aren't silly,they know that their parents aregoing through difficult times, sothey don't want to bring theirown troubles on top.



o Demands on parents

During the lockdown families havebeen forced to spend much moretime together than usual withfewer distractions. Some childrenhave enjoyed having their parentsworking from home as it’s meantspending more quality timetogether. Others have reportedthis as a difficulty, mentioning thatthey think their parents seem towork longer hours and find it moredifficult to switch off from work.Conflict was reported during thefirst lockdown when parentstrying to work were interrupted byyoung people wanting attention.Some young people were told offfor making a noise in the housewhen their parents wereconcentrating or trying to dovideo calls and meetings. "Feeling disconnected andunsupported at home due toparents working from home andalways busy and unavailable."

"He felt there was no time tospeak to his parents who arealready stressed, he didn’t want tobe an added pressure to them."

o Parental conflict/Domesticviolence

The stress of living together in aconfined space for long periods oftime, without the usualdistractions, meant parents’relationships have come underpressure. In some circumstances,this has caused parental conflictand incidents of domesticviolence.

"Some young peoplestruggling at home with familyissues including domesticviolence, were using schoolas a sanctuary, but this has beentaken away from them."

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Several client’s parentssplit up over lockdownbut can’t separate forfinancial reasons, thisis causing the youngpeople a great deal ofdistress, they areanxious and unhappy,having to live with theconflict at home.



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5. Health Anxiety

o Fear of the virus

Counsellors reported theirsurprise that relatively fewchildren and young peopleseemed to be concerned with thephysical effect of the viruscompared to their concerns aboutits impact on their social life andeducation.

However, there were some whowere extremely anxious aboutcatching the virus. In someinstances, it had triggered panicattacks and anxieties aroundgerms, food and hygiene.

"One young person had recentlybeen diagnosed with a chronicillness and was very anxiousabout getting the virus and oftransmitting to others – theywere highly anxious about collegeand angry that students weren’twearing masks – so much so theyrefused to go to college."

o Fear of passing on the virus

The majority of children andyoung people seemed notconcerned so much with catchingthe virus, or becoming ill, as theywere with being a “breeder” ofthe virus and passing it onto oldermembers of their family,particularly grandparents. Thiswas heightened when mediareports appeared to be blamingyoung people for their lack ofcare and irresponsible behaviour.Many young people reportedfeeling worried and anxious thatthey could be blamed for causingothers to die.

"He was so concerned withspreading it to his vulnerableparents he changed and washedhis clothes each day when hecame home from school."

"She cancelled her counsellingsessions at the community centrebecause she was worried she’dpass the virus on to her parentsand they’d become seriously illand die."

When the research was publishedabout the effects of Long Covidand its impact on younger people,some were more anxious aboutthe consequences for themselvesand their parents.

She kept thinking shewas having a heartattack and thought thatit was linked to COVID.So then had lots of feararound illness, and herphysical health.



Context

The study conducted has obvious limitations in that it is a third handaccount of children and young people’s experiences, and that it took place inOctober 2020 and so preceded the news about the vaccine and the secondand third lockdown. Undoubtedly, as time goes on the issues young peopleare facing along with their perspectives and expectations will change.However, whilst it will certainly not have captured every issue and does notattempt to give weight to the issues described, it does perhaps go some wayto explain the additional pressures and issues young people are facing whichmay be resulting in the increase we are seeing in young people presentingwith suicidal thoughts, plans and actual suicide attempts.

In the context of a genuine, trusting, caring, empathic, therapeuticrelationship, children and young people have the opportunity to expresstheir thoughts and feelings without judgement, no matter how big or small.As they try to make sense of the new world they find themselves in, grief,loss, disappointment, fear, uncertainty and confusion can be expressedwithout being met with superficial explanations or formulaic solutions thatwould otherwise shut the process down. This is a gift which enables thecoming to terms with a new reality and addresses the fact that life may notbe as certain as it once was. This process has a grounding effect whichhelps build and increase resilience. If needed, the space can also be used tocollaboratively explore and develop healthy coping strategies, and to workout how to respond to choices within a young person’s control.

All of this is underpinned by the transformational relationship betweencounsellor and young person, with the implicit hope of positive changeempowering the imagining of a different future. Whilst this hope becomes areality, TIC+ is here to make sure that every young person has someone totalk to. The need for continued funding is vital for mental health services toensure the capacity to respond remains in place.

Implications for practice - supporting children andyoung people during the COVID-19 pandemic and its aftermath

Counselling is needed now more than ever before. At such a time as thisTIC+ is privileged to be able to continue to be there for the children andyoung people who reach out to us for support. Ninety-seven percent of allyoung people we see tell us their counselling helped, confirming that theperson-centred, integrative model we provide is ideal for this current time.

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