Six months ago, as classrooms emptied and the island braced for COVID-19, students began to confront a new normal. For many, this would test their mettle unlike ever before. For others already grappling with mental health issues, the adjustments would be even more difficult.
“A lot of the children are fearful. They are really fearful,” says Theresa Wallace, Coordinator of Counselling Services for the Child Guidance Clinics in Kingston and St. Andrew.
“They worry about their caregivers being harmed and about loss of income for the household. There are also post-traumatic stress symptoms, as children know people who have died. And not being able to interact with their peers – that sensory deprivation can cause pre-disposed disorders to manifest. Some even start abusing substances.”
Follows UNICEF-backed pilot in 60 schools
Since schools were closed in March, Theresa and her team of counsellors – including social workers, psychologists and psychiatrists – have been providing telephone counselling, or tele-therapy. Over the past four months, 829 sessions have been conducted in the two Child Guidance Clinics of Kingston and St. Andrew Health Department.
Of these, 62 were from referral through the Schoolwide Positive Behaviour Intervention and Support (SWPBIS) framework, which has been piloted by the Ministry of Education, Youth and Information (MOEYI) in some 60 schools across Jamaica, with support from UNICEF.
SWPBIS is a whole-school approach that aims to increase positive values and behaviours in students and to curb in-school violence. Some students who don’t respond well to the SWPBIS interventions or who need professional help are referred to external services.
Ensuring children still access clinical support
The closure of schools due to the COVID-19 pandemic created an opportunity to help ensure that students who needed clinical support could still get it – without having to risk exposure to the virus by visiting their counsellors in person.
UNICEF provided 50 mobile phones – with monthly unlimited data and telephone service plans – through the Guidance and Counselling Unit of the MOEYI to the Ministry of Health and Wellness. This gave referred students the opportunity to access tele-mental health services via Child Guidance Clinics island-wide. Some of these students have displayed violent behaviour. Many struggle with mental health issues such as depression, suicidal thoughts and post-traumatic stress disorder (PTSD).
The scale of mental health challenges affecting young Jamaicans is alarming.
“Over 800,000 children live in Jamaica, and even taking a conservative figure of 15 per cent, nearly 120,000 of them may have a mental disorder and 5 per cent or 40,000 of them may be suffering from a severe mental disorder,” explains Dr. Ganesh Shetty, a child and adolescent psychiatrist.
110,000 children may have mental disorder
“Approximately 3,500 children access the facilities offered through the 20 Child Guidance Clinic sites island-wide. Hence, over 95 per cent – or just over 110,000 children and adolescents with a mental disorder – may be going unrecognised and untreated in government settings,” he says. “There are only a handful of child and adolescent psychiatrists, psychologists, clinical social workers and child and play therapists to assess and treat these children. And only a few of them work in private settings, which may not be affordable for many parents.”
For the Child Guidance Clinics, tele-therapy for students is a new way of reaching children that removes some of the barriers they faced with traditional forms of in-person counselling.
“With the telephone sessions, we help students and their parents to minimise unnecessary exposure by coming to the clinic, and it also reduces transportation cost – some of them travel from far and are not necessarily able to afford bus fare. That was a barrier before,” says Theresa. “We are also able to begin sessions on time. When they need to take the bus, they might get there late. Children also don’t need miss school to come to the session – before COVID this would happen.”
Tele-therapy helps reduce missed appointments
In general, around 40 per cent of children who are registered to attend the Child Guidance Clinics do not keep their appointments. Early evidence from the two child guidance clinics in Kingston and St. Andrew indicates that the number of appointments missed has reduced by half to about 20 per cent. This means 20 per cent more children are able to receive mental health services, thanks to the introduction of UNICEF-supported tele-mental health services.
One drawback, Theresa notes, is that some parents can’t afford the data charges to take advantage of video conferencing options like WhatsApp audio and video calls and video conferencing with Zoom, Skype and Google Meet, which would help to improve the impact of tele-therapy.
With the pandemic continuing for the foreseeable future, the need for tele-therapy may surge.
“You will find alot more mental health issues coming up now,” says Theresa. “Children can be pre-disposed to some disorders but without significant pressure, they can be fine and functional. But with the stress of cases going up, a lot more persons are having diagnoses that need urgent attention.”