Appendix 1: Literature review In older children and young people, depressive symptoms can include feelings of worthlessness, low energy levels and motivation.99 These can be accompanied with changes in behaviour such as withdrawing from friends or family, and changes in appetite or sleep patterns. Teenagers experiencing depression may also experience anger or irritability, oversensitivity to criticism and unexplained aches and pains. During the pandemic, some of these behaviours could be elevated as a result of social isolation due to school closures and physical distancing requirements.100 Symptoms of anxiety in older children and young people can manifest as uncontrollable worry, inability to concentrate, nervousness, and hyperarousal.101 These can be accompanied by physical symptoms such as chest pain, a rapid heartbeat, and insomnia. Uncertainty, disruptions in daily routines, and concerns for the health and well-being of family and loved ones during the pandemic are likely associated with increases in generalised anxiety in youth.102 1.4 What are the threats to mental health and wellbeing and who is most at risk? Mental health and wellbeing outcomes for children are influenced by many factors including family circumstances, access to supportive relationships, feelings of connectedness, knowledge of and access to support services, as well as physical and emotional safety. Risks to mental health can arise from household dysfunction or adverse childhood experiences including abuse, neglect, family and domestic violence, parental separation or substance abuse.103 These risks are compounded by the pandemic lockdowns and restrictions.104 The OECD suggests that the pandemic has affected vulnerable groups disproportionately and is likely to worsen existing inequalities.105 The risk of compound trauma and cumulative harm is increasingly likely in a pandemic. Mission Australia produced a large Youth Survey report in 2020, presenting the views of young people aged between 15 and 19 during COVID-19. The findings from 25,800 respondents suggest that young females were more likely to identify concerns with the impact of COVID-19 on their mental health compared with males. Female respondents comprised over two-thirds (68.9%) of young people that cited mental health concerns.107 Having solid friendships and access to the support of peers is also considered very important to children and young people’s sense of wellbeing. This becomes increasingly important as children progress through their teenage years. Conversely, experiences of bullying, peer rejection and social isolation increase the risk of developing mental health disorders and having a poorer sense of wellbeing.111 Data from headspace also supports this finding. In 2020, one third of Australian young people (34%) reported high or very high levels of psychological distress. This is comparable to the rate in 2018 (32%). As was also seen in 2018, young women consistently report higher rates of distress than young men. However, it is important to note that, in 2020, the rates of psychological distress rose among 15–17 year-old young men, from 20% in 2018 to 29% in 2020, but remain stable among all other groups.108 Being connected to, and engaged in, school and learning is also a factor that protects children and young people from mental health struggles.112 A five-year study of approximately 600 young people in Australia, published by ReachOut, shows the mental health of young people living in country areas is declining. The incidence of serious mental illness among rural young people in Australia increased from 20.9% in 2017 to 27% in 2021.109 1.5 What are the protective factors that help children and young people to be mentally well? Parental and wider family support combined with a warm and consistent parenting style is considered a protective factor in supporting the mental health and wellbeing of children, especially in the pre-teenage years.110 Families who have predictable and consistent routines have also been shown to fare better in relation to child depression and behavioural problems during the pandemic. Wider community connectedness and access to broader societal supports can play an important role in protecting the mental wellbeing and mental health of children and young people.113 Participation in community groups and activities can facilitate a sense of belonging, and some of these have been able to continue virtually throughout the pandemic. 1.6 What role do schools have in the pandemic response? In response to the pandemic, some Australian schools were closed, with children and young people engaging in remote and online learning. Policy decisions to physically send students to school, or not, varied at the state and territory levels, and were generally based on numbers of COVID-19 cases in the community. The main aim of this was to minimise the impact of the virus on their health and that of their communities. However, the impact of this social isolation and disconnection from school routines on children’s and young people’s mental health became of increasing concern. It has now emerged as one of the most contentious issues in Australia’s COVID-19 response. While some argue that schools are primarily responsible for the academic development of children and young people, it is becoming increasingly clear that they play a fundamental role in supporting all aspects of children’s and young people’s lives. The final report on the Productivity Commission’s Inquiry into Mental Health discussed how the role of schools is changing and how they are playing an increasing role in responding to social issues, including mental health and wellbeing matters.114 However, there is ‘limited clarity about the responsibilities of schools and the services they need to deliver or facilitate’.115 Insufficient resources, and overlapping responsibilities present challenges for schools in implementing wellbeing policies.116 UNICEF, in its The State of the World’s Children 2021 report, calls on schools to take a larger role in the post-COVID-19 world on mental health interventions and policy development.117 While it is essential that teachers have a ‘broad understanding of social and emotional development’ and are trained to identify mental health concerns,118 teachers cannot replace specialised mental health professionals at schools. They need to be supported by multidisciplinary teams. In the AHRC’s 2021 consultations for Safe and Supported: The National Framework for Protecting Australia’s Children 2021-2031, children, young people and families raised the need for adequate mental health support at school for children with multiple and complex needs and the need for teachers to receive mental health training. Families expressed a need for specialised mental health staff in schools that is readily available and adequately resourced to support students. Several parents/carers raised concerns about the accessibility of current mental health support in schools and reported a shortage of school counsellors or school psychologists.119 Some recent research has suggested that females and older teenagers are at the greatest risk of developing mental health problems in this pandemic.106 134 | ‘Mental health shapes my life’: COVID-19 & kids’ wellbeing • 2022 | 135