Appendix 1: Literature review The shortage of specialised mental health staff in schools was also raised in a number of submissions to the Productivity Commission’s Inquiry into Mental Health.120 The Inquiry’s final report found that there were vast differences in the ratios of psychologists to students in government schools.121 The ratios ranged from 1:885 in Western Australia to 1:3090 in the Northern Territory.122 However, they all fell short of the ratio recommended by the Australian Psychological Society of 1:500.123 This shortage of staff significantly impacts the ability of schools to support children’s mental health and wellbeing needs, which are likely to increase in the post-pandemic recovery period.124 UNICEF Australia and ARACY recently surveyed teenagers about their needs post-pandemic. About a quarter of the secondary students reported their teacher or school had not checked in with them during lockdown to find out whether they needed help with learning or how they were feeling. Most secondary students supported voluntary (67%) or compulsory (69%) mental health checks for students upon returning to school.125 In their joint call to action for a National Children’s Plan, UNICEF Australia and ARACY asked for an urgent increase in the number of mental health professionals in schools, including psychologists, and funding and implementation of evidence-based whole-of-school wellbeing and resilience programs.126 There is also some evidence that school-based health care is popular with students and can facilitate access to important mental health services.127 The National Mental Health and Wellbeing Pandemic Response Plan (Response Plan) recommends that educational responses should include long-term education supports for students who may have fallen behind in their learning or disengaged with education, to get them back on track. It states: [T]here may be an expectation that in the post-COVID-19 period students will be at the same level as their peers. Those that have not coped with the transition back to a formal education environment may experience mental health deterioration. The period of home schooling has likely exacerbated disengagement with education for children and young people who were already at risk.128 In Part 2: Immediate Actions of the Response Plan, under the second action item (Outreach: Adapt models of care to changing sites of service delivery), schools are recognised alongside homes as sites where the importance of mental health care has rapidly increased, particularly for individuals with existing, severe or complex mental health challenges. The Response Plan further recommends that mental health services be placed in the centre of communities, closely integrated with other services, and reinforces the importance of flexible service delivery options for supports, including through schools.129 Focus area 3 of the National Children’s Mental Health and Wellbeing Strategy concentrates on education settings. It talks about how important school and early learning environments are for children’s mental health and how these environments can be better set up to support children, including by developing a wellbeing culture in schools and education settings, ensuring targeted responses, and equipping educators to support children in times of need. Under this Strategy, it is recommended that all learning services (including in early childhood) and schools develop and implement wellbeing plans for every student and have designated staff members to support wellbeing in those settings.130 1.7 What is the role of digital technology and social media in understanding mental health? 1.8 What is the relationship between parental mental health and that of their children? Most children and young people today are frequent online users, which is a significant increase from 10 years ago and represents a substantial social change. The role of families and, specifically, parents in supporting children’s and young people’s mental health cannot be overstated. The relationship between parent and child mental health is bidirectional and both need to be addressed.136 In the pandemic, this digital connectedness became a pivotal way for children and their families to access learning, work, friends and family and support services. However, the time spent on screens for entertainment purposes as well as learning has meant on-screen time has greatly increased for a substantial number of children and young people in Australia.131 Increased time on digital media devices has also contributed to increased access to media and information about the pandemic. Children are greatly influenced, not only by what they feel and see, but also by what they hear being said around them. Excessive COVID-19 media exposure has been noted as a factor in worsening mental health outcomes.132 Several commentators and researchers report that a high level of social media use increases the risk of negative mental health outcomes, particularly for girls.133 However, there are other academics who maintain that the relationship is correlational, and that directional causation cannot be applied.134 It is likely that the platform being used and the type of activity influences children’s and young people’s experiences. In 2017, a UK-based organisation conducted an online survey of 1,479 children and young people, with those aged 14 to 24, asking them how they felt about Facebook, Instagram, Snapchat, Twitter and YouTube and how these platforms impact on their wellbeing. This survey found that YouTube was rated as the most positive for wellbeing, while Instagram was the least positive (with Snapchat following).135 Data from the Longitudinal Study of Australian Children suggest that parental mental health issues occurring early in children’s lives may be related to children’s long-term mental health outcomes.137 The National Mental Health and Wellbeing Pandemic Response Plan recognises that the ‘key to child mental wellbeing is the wellbeing and capacities of parents’.138 The National Children’s Mental Health and Wellbeing Strategy also highlights the link between parental mental health and that of their children.139 Research into child, parent and family mental health functioning during the pandemic is only just starting to emerge. One new Australian study investigated patterns of parent and child (0–18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19. This was compared with pre-pandemic data, to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Initial findings indicate that the pandemic and associated restrictions in place across Australia in April 2020 were associated with poorer parent and child mental health, and poorer family functioning.140 The Royal Children’s Hospital National Child Health Poll completed in July 2020 showed that 46% of parents reported that their mental health had worsened, while a further 36% reported their children’s mental health had worsened.141 It remains to be seen what the impact of reliance on screens and technology during the pandemic has had on children and young people. The challenge will be to look for ways to harness its potential while also teaching the idea of balance. 136 | ‘Mental health shapes my life’: COVID-19 & kids’ wellbeing • 2022 | 137