Children and young people could feel the impact of COVID-19 on their mental health and well-being for many years to come, UNICEF warned in its flagship report on Tuesday.

For the first time in its history, The State of the World’s Children 2021; On My Mind: Promoting, Protecting, and Caring for Children’s Mental Health examines the mental health and well-being of children and adolescents, with a special focus on how risk and protective factors in the home, school, and community shape mental health outcomes.

Against a backdrop of rising awareness of mental health issues and growing demand for action, the report argues that people now have a unique opportunity to promote good mental health for every child, protect vulnerable children, and care for children facing the greatest challenges.

The COVID-19 pandemic has raised significant concerns for the mental health of an entire generation of children and young people as well as parents and caregivers, according to the report.

But the pandemic may represent only the tip of a mental health iceberg – an iceberg that they argue has been ignored for far too long.

The report demands urgent investment in child and adolescent mental health across sectors, not just in health.

It argues for proven interventions in areas like health, education, and social protection, such as parenting and whole-of-school programs.

And it calls for societies to break the silence surrounding mental health, by addressing stigma, promoting understanding, and taking seriously the experiences of children and young people.

According to the latest available estimates, more than one in seven adolescents aged 10-19 is estimated to live with a diagnosed mental disorder globally.

Almost 46,000 adolescents die from suicide each year, among the top five causes of death for their age group.

Meanwhile, wide gaps persist between mental health needs and mental health funding.

The report finds that about two percent of government health budgets are allocated to mental health spending across the world.

“It has been a long, long 18 months for all of us – especially children,” said UNICEF executive director Henrietta Fore.

“With nationwide lockdowns and pandemic-related movement restrictions, children have spent indelible years of their lives away from family, friends, classrooms, play – key elements of childhood itself.

“The impact is significant, and it is just the tip of the iceberg.

“Even before the pandemic, far too many children were burdened under the weight of unaddressed mental health issues.

“Too little investment is being made by governments to address these critical needs.

“Not enough importance is being placed on the relationship between mental health and future life outcomes.”

Children’s mental health during COVID-19

Indeed, the pandemic has taken its toll. According to early findings from an international survey of children and adults in 21 countries conducted by UNICEF and Gallup – which is previewed in The State of the World’s Children 2021 – a median of one in five young people aged 15–24 surveyed said they often feel depressed or have little interest in doing things.

As COVID-19 heads into its third year, the impact on children and young people’s mental health and well-being continues to weigh heavily.

At least one in seven children globally has been directly affected by lockdowns while more than 1.6 billion children have suffered some loss of education, according to the latest available data from UNICEF.

The disruption to routines, education, recreation, as well as a concern for family income and health, is leaving many young people feeling afraid, angry, and concerned for their future.

For example, an online survey in China in early 2020, cited in The State of the World’s Children 2021, indicated that around a third of respondents reported feeling scared or anxious.

Cost to society

Diagnosed mental disorders, including ADHD, anxiety, autism, bipolar disorder, conduct disorder, depression, eating disorders, intellectual disability, and schizophrenia, can significantly harm children and young people’s health, education, life outcomes, and earning capacity.

While the impact on children’s lives is incalculable, a new analysis by the London School of Economics in the report indicates that lost contribution to economies due to mental disorders that lead to disability or death among young people is estimated at nearly US$390 billion a year.

Protective factors

The report notes that a mix of genetics, experience, and environmental factors from the earliest days, including parenting, schooling, quality of relationships, exposure to violence or abuse, discrimination, poverty, humanitarian crises, and health emergencies such as COVID-19, all shape and affect children’s mental health throughout their lifetime.

While protective factors, such as loving caregivers, safe school environments, and positive peer relationships can help reduce the risk of mental disorders, the report warns that significant barriers, including stigma and lack of funding, are preventing too many children from experiencing positive mental health or accessing the support they need.

The State of the World’s Children 2021 calls on governments, and public and private sector partners, to commit, communicate, and act to promote mental health for all children, adolescents and caregivers, protect those in need of help, and care for the most vulnerable, including:

+ Urgent investment in child and adolescent mental health across sectors, not just in health, to support a whole-of-society approach to prevention, promotion, and care.

+ Integrating and scaling up evidence-based interventions across health, education, and social protection sectors – including parenting programs that promote responsive, nurturing caregiving and support parent and caregiver mental health; and ensuring schools support mental health through quality services and positive relationships.

+ Breaking the silence surrounding mental illness, through addressing stigma and promoting better understanding of mental health and taking seriously the experiences of children and young people.

“Mental health, like physical health, is a positive state – it underlies the human capacity to think, to feel, to learn, to work, to build meaningful relationships, and to contribute to communities and the world,” said Rana Flowers, UNICEF representative to Vietnam.  

“There are specific steps and approaches that can be introduced in the family, in schools, and in the community that better promote, protect, and care for the well-being of children and adolescents.

“Our goal as a society must be to change the stigma around our mental health, to do more to nurture well-being, as well as to recognize the factors that threaten our mental health.

“The investment we make today in building a strong mental health foundation in every child pays off in the lifelong mental health of a nation.

“The creation of, and funding to, a national mental health strategy for children and adolescents is essential to build that foundation.”