Addressing the Consequences of the COVID-19 Lockdown for Children’s Mental Health: Investing in School Mental Health Programs

Existing mental health systems worldwide are unable to meet current needs (12, 13) and will be unable to cope with increased demands for mental health care resulting from the pandemic. Hence, we believe that the large-scale implementation of universal and targeted school mental health interventions should be prioritized to minimize the burden on health care systems. SMHPs should also address the mental health of teachers, who are also affected by the pandemic. In low- and middle-income countries, technology is playing an increasingly important role in providing access to mental health training as well as in health care delivery (14). Schools are one environment where Internet access is quickly becoming a necessity in these countries. By taking advantage of the Internet, programs that integrate online teacher training and support have not only the potential for dissemination at scale but also the ability to be accessible during lockdown. As a result, teacher training is uninterrupted, and the teachers are equipped to meet the mental health needs of students from day 1 of their return to in-person teaching (see Pakistan case study below). Such online portals are highly adaptable and can facilitate delivery of tailored modules to students that may be required when schools reopen with physical distancing requirements. Previous work from our group (by A.R. [15]) has shown that a school-based mental health intervention in a rural setting in Pakistan could raise mental health awareness not only among the schoolchildren but also among their parents, neighbors, and children not attending school. In the context of COVID-19, schoolchildren could therefore serve a vital function when information has to be disseminated rapidly and effectively in the community.

In Pakistan, the WHO SMHP training has been adapted to an online teacher training platform including the use of a chatbot to aid the implementation of intervention strategies in classroom settings (16, 17). By using the online platform, teachers have been trained in implementing universal and targeted intervention strategies in a rural subdistrict of Rawalpindi, Pakistan. With this program, teachers used a chatbot to identify the socioemotional and behavioral problems of children in order to support appropriate strategies for managing these problems in everyday classroom settings (targeted intervention strategies) and to promote mental health among all school children (universal components of the SMHP).

After COVID-19 broke out, online consultations with parents and teachers were conducted to understand the pandemic’s impact on the mental health and psychosocial well-being of both children and teachers. Parents and teachers expressed concern that children might be at higher risk for experiencing mental health problems and might have new underlying causes for their behaviors, which teachers would need to be aware of when school resumed. Teachers may also experience stress from the epidemic, and this stress may affect their ability to carry out their educational and SMHP activities.

The online training system and chatbot have the potential to more readily disseminate COVID-19–specific knowledge and support to teachers in public schools. The online version of SMHP ensures program integrity and quality and can be adapted in response to diverse psychosocial needs of the target population. Because not all students, parents, and teachers have the technologies and finances to access online resources, the school curriculum has been made available on television in Pakistan. Potentially, this platform can also be used for delivering universal school mental health content.

To successfully scale up, school mental health initiatives will require dedicated cross-sectoral implementation teams (including the health and education sectors), sustained policy advocacy and stakeholder’ engagement, and effective coordination among education and health systems, especially at the local level (18). We therefore call for the rapid establishment of cross-sectoral coordination mechanisms and financial and resource investment in establishing the platforms necessary to ensure appropriate and timely support to address the mental health impacts of the COVID-19 pandemic on children and adolescents. We propose increased investment in human and technological resources to support appropriate training of teachers and the provision of the SMHP and that health and education administrators work with parents and children in redesigning school curriculums and the school environment to accommodate SMHP services. We also recommend that service providers and researchers explore the cost-effectiveness and efficiency of delivering SMHP and other child mental health services at scale in diverse global settings.

Acting now to prepare for the reopening of societies and schools across the globe is critical to children’s mental health. Failure to do so could lead to poor mental health outcomes for the next generation that could precipitate long-term social and economic consequences.