Impact of COVID-19 on child mental health in Italy

Orso Muneghina is Head of International Programs and Emergencies at SOS Children’s Villages Italy and Lead of the Global MHPSS Hub of the SOS Children's Villages Federation.

How did you realize that COVID-19 requires more than a healthcare related response?

We knew from previous epidemics in different regions that when they occur, the risk of children and young people experiencing violence increases, along with domestic violence. This means that we must work to reduce levels of stress starting at the very beginning of an epidemic.

Negative mental health impacts can have long-term effects. With a pandemic comes a sense of overall uncertainty that can lead to increased fear, particularly among children, and demands interventions that aim to build resilience and ensure mental well-being.

Now that some time has passed, and many countries have entered a second or third wave, we can see more clearly how the COVID-19 pandemic affects many areas of people’s lives. Millions of children are spending time at home and are missing out on educational and social opportunities. Meanwhile, many of their families are struggling with increased unemployment. Schools play an important role in identifying and reporting possible signs of abuse or maltreatment, as well as providing meals and safe spaces for children. 

COVID-19 has put a burden on the healthcare system that has led to delays in treating other diseases and providing mental health support. There is vast “collateral damage” that has impacted children's and families' mental health.

What has helped children and families?

Children and families are having to change their behaviors to adapt to their "new normal." For example, remote work has been an advantage for some families but for others it has posed new challenges to their daily lives. We need to provide guidance and structural routine to families staying home. Parents are not always able to provide adequate physical, emotional and intellectual activities for their children at home during the lockdown.

We also need to consider the long-term consequences of the pandemic. Moving forward, our family strengthening programs may be an effective tool in countering alarming trends of increased domestic violence and limited child protection.

SOS Children’s Villages Italy has been involved in a series of remote trainings to work towards a brighter future. Piloted with the International Federation of Red Cross and Red Crescent Societies (IFRC), the World Health Organization (WHO) and the City University of New York, these trainings deliver low-intensity, brief psychological interventions. The trainings consist of five sessions and can be delivered by individuals without a background in psychology in order to help individuals affected by adversity. So far, we have been conducting these trainings in Somalia, Somaliland, Ethiopia, Rwanda, Burundi, Nigeria, Italy, Sweden, Belgium and Greece. These revolutionary trainings are the first remote trainings to use this methodology.

Another partnership we launched, called the "Team Up Coalition," works with War Child Holland, Save the Children Netherlands and UNICEF Netherlands to focus on the mental well-being of children and provide resources and guidance to families. It follows the training-of-trainers model so that those who have been trained deliver the movement-based interventions in SOS Children’s Villages’ programs. The intervention is structured around 12 group sessions with children, which have been carried out during the pandemic in Italy. We may apply the program in Lesbos, Greece to provide refugee children a respite from their difficulties.

We have seen positive outcomes by tapping into community resources and training people to fill the gaps in support for children and families. Globally, we see that SOS villages have more control to respond to new challenges and can even provide remote support through helplines and chats.

How can we build resilience and coping skills to improve mental well-being?

We need to give special attention to the resilience and coping mechanisms of children and families during this time. We need to empower people to be able to cope with new challenges, engage their children in activities and spend quality time for the overall well-being of their family. Resilience and coping skills are often already there, however we need to strengthen them. Some individuals who faced challenges before the pandemic may require additional support.

Children and families need to maintain contact with the outside world. It is important for their mental well-being, as well as for child safeguarding purposes. They also need to keep a sense of agency in their everyday lives and feel like they still have choices.

Brief cognitive behavioral exercises and relaxation techniques can also help. There is increased evidence that connection with nature can benefit mental health and build resilience. We deliver interventions that focus on connection with nature that users can access online during quarantine through a collaboration with the University of Derby Nature Connectedness Research Group.

What about the mental well-being of caregivers?

Unfortunately, the mental well-being of caregivers is often neglected. Caregivers need to engage in self-care to improve their own well-being, as well as care for others during times of stress. Those working on the frontline, such as nurses, teachers, volunteers and caregivers, are responsible for ensuring continuity and stability in the care system, but often face alarming levels of internal stress due to COVID-19.

We're seeing once again that this ia a very neglected area of mental health. All care facilities need to closely monitor the symptoms of and identify the well-being needs of their staff. It's important to have a stress management policy that staff can adhere to. Caregivers may be afraid to say that they are near burnout, so organizations need to establish protocols to support them.

Employers need to keep a dialogue going with their staff about their well-being and support needs. At SOS Children’s Villages Italy, we focus on communication, information sharing, protocols and procedures to provide support, as well as build the strength and resilience of those working on the frontlines.

What additional services did SOS Children’s Villages Italy provide?

We set up a helpline that can be reached 24 hours a day, seven days a week. We trained people in the community to respond to calls from the helpline to help facilitate interventions when needed. We also explored remotely accessible communications tools and put a chat in place that allows for more easy and immediate help, if needed.

We also realized that some areas relevant to children in alternative care and children living with their families were not fully covered, such as mental health, psychosocial support (MHPSS) and education, especially for young children under the age of six. Because of this, we partnered with experts at Emmer School to develop resources that are available on our website so that people can structure their day at home to support children's development and education.

Finally, we recently launched a back-to-school webinar where experts interacted with the public to provide answers to their questions on what it means to manage transition back to school during this time.

What has worked and where are improvements needed?

Newly established services and interventions should be set up with a long-term vision beyond COVID-19 as we face new challenges and vulnerabilities. Training community members—even those without a mental health background—to be available at times when government services are stretched has proved to be essential in countries with limited resources.

Collaborating with other organizations helps to provide diversified services, expand the reach of resources and identify children in need. We have also seen positive developments of SOS Children's Villages associations providing space and time for staff to attend trainings, despite increased workloads, so that they can learn to adapt their skills to new situations. The IFRC online training has received a lot of positive feedback and is a great example of distance training success.

Improvements are still needed in some areas—interventions need to be promoted in the current context and adapted to customs, culture and the infrastructure of specific regions. One issue we're facing is that online counseling is not yet widely accepted in some countries. We also need to continue to share learnings and experiences to broaden the knowledge on the situation and possible effective responses.

Learn more about the collaboration of SOS Children's Villages Italy with the University of Derby Nature Connectedness Research Group here.