Young people's mental health and COVID-19: an update from Dr Remy Barbe, child psychiatrist at HUG

Dr Remy Barbe is a child psychiatrist and head of the Inpatient Unit of the Child and Adolescent Psychiatry Department at Geneva University Hospitals. He is also co-investigator of SEROCoV-KIDSa study assessing the impact of COVID-19 on the health of children and adolescents in the canton of Geneva. We asked him a few questions to help us better understand the influence of the pandemic on young people's mental health.

• Good morning, Dr Remy Barbe. Has the COVID-19 pandemic led to an increase in requests for psychological help from young people?

In Geneva, there was initially a drop in the number of child psychiatric consultations during the first period of confinement, which has been confirmed in other studies outside Switzerland. Then, from the start of the autumn term in 2020, our services saw a 30-40% increase in consultations, with a peak in the spring of 2021. We received a lot of young patients in emergency. Our colleagues were probably already overworked in the city before this happened in hospital. In a global context where mental health resources are still lacking - even if Geneva remains a relatively well-endowed area in this field - we were not organised to deal with so much psychological distress, both in outpatient clinics and in emergency departments.

• How did they express their suffering?

A lot of the young people's problems were anxiety disorders, eating disorders and, for the older ones, concerns about the future. Depressive behaviour and suicidality have also increased by around 30 to 40%, which is a lot. Along with other child psychiatrist colleagues, we have also observed language delays in the youngest children. It's interesting to see that for these children, who are in the middle of a developmental phase, the changes in the way they interact with their social environment have had a concrete impact on their language function.

• What factors do you think may have affected young people more specifically during the health crisis?

Like adults, they have undergone a radical change in the way their lives are organised, including a major break with the usual means of socialisation. And yet we know that links with friends and peers are crucial at this age for the construction of the self, identity and points of reference. The loss of leisure activities and the fact that they find themselves at home in spaces that are not necessarily suited to such a situation can create a great deal of tension and conflict. There has been talk of family or domestic violence. There has also been a marked increase in divorce cases. Young people are very sensitive to their environment, to what they perceive of the adults around them. So the combination of these factors may have encouraged the emergence of disorders, especially in young patients who are already vulnerable, more anxious or more sensitive to change.

• On the other hand, can the context of the reopening of the centre be anxiety-provoking in terms of rehabilitation?

It's true that some young people were delighted to be home. The context may have encouraged a tendency to withdraw. Now, some of them are in the starting-blocks, just waiting to get back to "normal" life. But for others, there may be real difficulties, fears of returning to a new rhythm and activities. In these cases, there may be ambivalence, and escaping from relative "comfort" will require a certain amount of support to return to the outside world with peace of mind and look to the future. This is a major challenge, the scale of which is difficult to gauge at the moment. The crisis has also had an impact on the issue of school and learning, as well as on the over-consumption of screens. I say this without demonising them. The use of screens was also an opportunity to maintain links with others. In some situations, an addiction may develop that needs to be weaned off.

• As a therapist, what recommendations do you have for teenagers and their families facing difficulties?

During the pandemic, we noticed that getting involved and making an investment in others was an important factor in resilience. This is particularly true during a large-scale shared experience. Generally speaking, I think we need to remain attentive and vigilant with regard to the concerns of young people, encouraging them to remain focused on others and on the future. But also to trust them. We tend to focus a lot on teenagers and children, but they are in fact mirrors of what's going on around them. Their suffering is also a reflection of the suffering around them. The way in which adults position themselves is therefore essential, because despite appearances, young people are turned towards the adult world: they look at us, listen to us and observe how we position ourselves in relation to the various rules. The important concepts of "risk" and "individual and collective responsibility" have become more urgent at the heart of our social life. We need to continue to raise awareness among teenagers, children and adults alike. Because in such an exceptional situation, the teenage part of everyone can be mobilised...

• Do you have the impression that this unprecedented crisis will have a long-term impact on young people?

When we go through events that affect the whole of society, it has a major impact on the values of a generation. These generational phenomena have effects. For example, before and after 11 September 2001, our relationship with the world changed. With the pandemic, something will have marked and affected this generation in a specific and decisive way. One of the major issues for the generation that will have grown up during the pandemic - for all of us, of course, but certainly even more so for those who were in the process of developing their relationship with the world - is the question of distance from each other, the change in our social practices, which may sometimes have led to distrust of others. We're going to have to help them through this crisis of confidence, which is also expressed in the face of authority.

• You mean in relation to public authority?

We have lived through a period of acute tension in which decisions and measures were constantly being taken. They led to either support or distrust among the population. The link with authority was questioned, and sometimes disqualified, raising doubts about whether this authority was truly protective. Or a doubt about "who decides? who is the authority? This questioning of authority is nothing new. In fact, it is a particularly central issue in adolescence. But when the very young witness this crisis of authority on the part of adults themselves with regard to political decisions, for example (positions on vaccines, health measures, etc.), it is not insignificant. That's why I insist on the importance of the fact that they are watching us. So in terms of how they position themselves in relation to authority, this will certainly have an impact on how they see themselves, both within the family and in society as a whole.

• Do you think that the issue of mental health was sufficiently discussed during the pandemic?

Initially there was a sense of shock and institutions had to prioritise the fight against COVID-19. This is perfectly normal. But interest in the psychological health of individuals came very late. Even within the Task Force, at the outset, there was no psychologist. I hope there will be a rethink of these priorities in the future. On the one hand, mental health was not a major concern at first, but then the media discourse on the health of young people tended to focus on them in an alarmist way. So I'm sometimes concerned about the resonance that can be created by implying that young people are in particularly bad shape. We have to be very careful how we portray them, especially when we talk about suicidality. We have to be careful not to generalise or create a Werther effectIn other words, we have to avoid creating an incentive effect, known as "contagion" by the experts. It seems to me essential today to pay attention not only to how we address them but also to how we talk about them.

Some mental health resources for young people in Geneva:

La Main Tendue - call 143, free and anonymous, 7 days a week, 24 hours a day, or ask for help by e-mail

Pro Juventute Switzerland - Listening service for young people, call 147, 24 hours a day

MALATAVIE- Teen crisis unit, HUG- teen line, 022 372 42 42, 24 hours a day, 7 days a week

SOS-enfants - Professional, confidential and free psychological help for children, teenagers and parents, 022 312 11 12

Point Jeunes - Point Jeunes information and prevention centre for 17-25 year olds, Monday to Friday, 1pm to 5pm (no appointment necessary), 022 420 59 59

ciao.ch - For 11-20 year-olds, answers questions online only (in complete confidentiality), offers a discussion forum and provides telephone numbers.