The coronavirus has been shaping people's daily reality for around a year now. While losses suffered by different sectors of the economy can be calculated and the government asked for compensation, mental health problems of children have piled up without anyone being able to pinpoint just how difficult the situation has become. Schools have been closed and opened again with little or no advance notice, whereas it remains unclear how long children will have to study from home this time around. Children and especially teenagers react to uncertainty with anxiety.

"A child needs a certain routine, to know what tomorrow brings," seventh grade class teachers Helena Raal says. Her students are 13-14 years old.

That is the age in which young people are most susceptible to stress.

"My class has 31 students and we can say that five or six of them have problems, while they are quite serious regarding a few. Problems that one might already call psychiatric. Suicidal and self-injurious risk behavior has become a daily occurrence. The change started last spring," Raal says.

Nine minors committed suicide in Estonia in 2019, while it grew to 14 last year. There has been a single suicide this year. Anxiety disorders, depression and suicide attempts have all become more common among young people.

Number of people in need growing

Young people often first turn to the Lasteabi.ee website for help. Specialists there can be called or sent a text message, while teenagers prefer online messaging.

"Thinking about the COVID-19 period, we have seen an uptick in contacts. We were contacted 10,007 times last year, more than in 2019. This uptick started in March," said Kätlin Servet, consultant for Lasteabi.

Not everyone who contacts us is a minor. We also receive calls from parents, teachers or other adults who notice when someone needs help. Still, most contacts are from children.

If elementary school students mostly report bullying or their mother deciding they have had enough internet for one day, teenagers are suffering from more complicated mental problems. The risk of suicide is highest in the 13-15 age group. They require the most attention and to be noticed by friends and parents.

"Children usually turn to us as a result of strained relationships with parents or friends. If in the past, parents used to go to work and the family got together in the evening, now parents also spend the day at home. There are simply too many people in the same room for too long. Children often turn to us with self-destructive thoughts. Some have already overdosed or injured themselves on purpose. There are a lot of such mental health issues," Servet said.

"The distance we are meant to keep from other people expands to cover pretty much everything. Teenagers and children are especially troubled by not being able to communicate with friends. It is so important for them and if we take away school where they could communicate, they feel like there's nothing left," Servet finds.

Teenagers cut off from their friends called most often last spring when the 2+2 rule was also in effect outside, meaning that children did not see their friends for months on end.

Deciphering the problems of children who seek help is a separate challenge. Servet says that young people often start by talking about a friend having problems.

"Only once you ask them what is troubling their friend, about their relationship and why they are concerned do they admit to having problems of their own," Servet describes. "They can start by talking about something else before admitting that things are very bad, that they've been having troubling thoughts, don't want to live because they're lonely and because no one cares about them."

Situations where children call in the thick of it, where you can hear yelling in the background, where the consultant needs to keep their calm and give the child clear instructions of where to go and what to do are emotionally difficult.

Situations where a teenager's life is in immediate danger have become more frequent over the last year.

"Every day. We get such a signal every day. Or if not quite that, we learn of severe physical or sexual abuse where we need to react the same way, by notifying the Alarm Center," Servet said based on her experience working for the Lasteabi.ee hotline.

Someone in need of immediate aid is very difficult to help in a situation where they refuse to tell you where they are. Here is where the professional skills of consultants really matter.

"Sometimes, you need to start with something else, ask different questions to kind of muddy the focus before asking where the person is, what's around them. Ask them whether they are in the city or country or about their school. You need to talk about something else entirely at first to eventually determine where the child is and relay that information to the Alarm Center," Servet describes.

Employees of the hotline do not know whether they always succeed in preventing the worst as the Alarm Center does not provide them with feedback.

"Looking at statistics, around 4,500-5,000 kids get a first-time psychiatric diagnosis every year. The most common diagnoses are behavioral disorders, anxiety and depression. All of it has been amplified during the coronavirus period," said Käthlin Mikiver, chief specialist for the public health department of the Ministry of Social Affairs.

Parents won't let up

Remote learning has also resulted in additional study pressure children cannot cope with. Students who used to get top grades but are struggling studying from home make up one problematic group.

"Initially, they find it more difficult to concentrate and might ask themselves why bother, which is often the extent of what parents see – the result is that their grades slip to which parents react very painfully," Anu Pärn, member of the Estonian School Psychologists Association, describes.

This leads to parents laying down tough rules for children that have an even more detrimental effect, while what they should do is try and understand, specialists agree. Their message is that children need to be cut some slack.

Parents losing their minds as grades suffer mean that children can no longer cope with pressure from two sides.

Helina Raal saw that many students had lost the habit of studying after remote learning in spring and the summer break.

"I can see 13-14-year-old young men laughing hysterically in class, which clearly is not the result of historical facts I'm presenting but signals that they have just won a round in a computer game," Raal says in terms of the downsides of Zoom classes.

Educational studies show that remote learning is a good fit four a third of students, while it is a disaster also for a third. Failure to keep up with classmates results in defeatism and losing heart.

"I can say that never before in my career have I had to deal with so many difficult and deep topics," Raal admits.

As children are stuck between four walls during remote learning, relationships at home become key. If they are bad, children have no one to see them through anxious times.

"A close relationship with parents can ward off school stress, suicidal thoughts, depression and other risk behavior. Good relations add a protective layer," Pärn says.

"If you maintain a good relationship with your child and talk about everyday life and problems often, if the child feels they can discuss anything with you, it means there is no real loneliness in the family," child psychiatrist Anne Kleinberg adds.

Even though problems mainly arise in families with single parents where children have to spend the entire remote learning day by themselves, psychiatrists have also seen children seemingly from model families. It turns out upon closer inspection that there is no emotional warmth between family members and communication is purely formal.

"While child protection specialists report back and say everything is perfect after visiting such a home, it just lacks that warmth and connection between people, "Kleinberg adds.

Problems do not develop overnight but tend to become more serious if left unaddressed. School psychologists do not see children as often during remote learning. Teachers also cannot see what might be happening at home and do not know to intervene in time.

"The more we push them toward computers, the more we are really pushing them into loneliness. I can only see when the student has been absent in the e-school system and contact parents when these absences start piling up," class teacher Helina Raal says.

What comes next depends on cooperation between the school and the household – the result is better if parents trust the teacher. Homes do not always trust mental health specialists either.

"It may be a Soviet vestige, this conviction that psychologists are quacks and should not be seen – I have met such resistance from parents," Raal finds.

Coronavirus period has seen existing problems flare up

Covid is not a cause in itself, while it has amplified existing problems and left people without timely care.

"The pandemic came when it did, while children's mental problems have gone unsolved for years. They just coincided. Children who were neglected before are still neglected. Families already in the risk group are even more at risk now. Parents have even less time and energy for children as they have other challenges to face," Kleinberg, who works at the Tallinn Children's Hospital's Mental Health Center, says.

The center has 16 beds and five day treatment places. All 21 places are always full and that has been the situation for the past five years.

"The wave of self-injurious behavior began in 2016. It has gradually become more intense. In a situation where we had 30 attempted suicides last year, we have already seen 20 this year. A sharp increase, Kleinberg says.

We also had more elementary school students, she adds. "We saw quite a few third- and fourth-graders with anxiety issues."

Getting help quickly is difficult because of long treatment queues.

"I can tell you from personal experience that parents who started looking for psychiatric help and really had urgent problems called in February and did not get an appointment before April," class teacher Helina Raal says.

Kleinberg says that problems that require immediate intervention, such as cutting oneself or suicide attempts, can be reported to emergency response and children will be admitted immediately.

"The rest will have to wait for an appointment," she says.

Help largely on paper

The waiting period for psychiatric period can officially be no longer than 42 days. The Ministry of Social Affairs admits that treatment queues have become even longer in the coronavirus crisis.

The state has no plan for adding psychiatric beds.

"Ideally, we need to have better early intervention capacity instead of adding beds," Käthlin Mikiver says. "Availability of help could always be better. I do not think we will ever be able to say things are very well. One avenue we need to pursue is having more specialists."

For example, only 43 percent of schools have psychologists. The aim is to have one in every school. They are also underpaid compared to the national average salary and that of teachers, while their work is arguably more stressful.

"The problem today is that school psychologists burn out in the first two years and we need to convince them to stay on," Anu Pärn says.

Estonia wants to complement all family medicine centers with mental health nurses of clinical psychologists to make sure mental health begins on the first contact level. That would also reduce the workload of specialists.

Anne Kleinberg supports all of these initiatives but says that solutions have remained on paper so far.

"What I'm expecting is for all the things included in child mental health or mental wellbeing development plans – need for specialists, training, different services and funding – to manifest in reality instead of remaining a declaration that we will help children," she says.

Mikiver admits that mental health has been underfunded for the past 10-20 years as it has not made the list of government priorities. That is also why suicide attempts statistics is not satisfactory in Estonia.

"This has brought us to a dead end where the house is on fire from every angle so to speak and support is needed on all levels," Mikiver says.

How many specialists does the ministry have in the field?

"Let us say that we have a single chief specialist position as individuals go," Mikiver says, admitting she is the only one.

How should one help their children until then?

"What people should not do is try to give advice themselves and tell children it will pass or that they'll feel better," Lasteabi.ee consultant Kätlin Servet recommends. "Just be there, help the child reflect and take an interest."

Adults can also seek advice by calling the 116 111 Lasteabi hotline. Recommendations for supporting mental health can also be found at the peaasi.ee portal run by clinical psychologists.

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