Impact of the pandemic on the mental health of children and clinical practice in Turkey: a narrative review with recommendations

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology Vol. 9:160-162 (2021) DOI 10.21307/sjcapp-2021-017 Letter to the Editor Open Access Impact of the pandemic on the mental health of children and clinical practice in Turkey: a narrative review with recommendations Serkan Turan* & Șafak Eray Child and Adolescent Psychiatry, Uludag University Faculty of Medicine, Bursa, Turkey *Corresponding author: Introduction The novel coronavirus disease COVID-19, which first appeared on November 17, 2019 in the Hubei province of China, was later declared a public health emergency by the World Health Organization (WHO) (1). The pandemic has drastically changed the lives and daily routines of millions of people worldwide. Numerous factors influence the nature and extent of the pandemic’s impact on children, including developmental age, educational status, special needs status, pre-existing mental health conditions, economic disadvantage, and quarantine status (of children or their family members) (2). The following sections discuss the impact of the pandemic on children and assess the effectiveness of various interventions employed to improve their mental health during pandemics (both previous and current) in Turkey. COVID-19 and child mental health in Turkey The first case of COVID-19 in Turkey was announced on March 11, 2020. Strict measures were subsequently enacted, including the suspension of inperson instruction in elementary, middle, and high schools on March 16, 2020. In addition to the strict measures concerning certain age and risk groups, an “age-specific lockdown” was imposed on 25.5 million children and young people under the age of twenty in April 2020, with full closures continuing until June 2020. This constituted a major disruption in the daily routine of children and adolescents, as attending school provides routine and order in their day-to-day lives. In the pre-pandemic period, adhering to school routines represented an important coping mechanism for young people with mental health problems (3). The Child and Adolescent Psychiatry Association of Turkey has updated its psychosocial and mental health support guidelines for families, children, and adolescents during the pandemic. One of its recommendations for school-age children concerns the importance of maintaining a daily routine, including school, sleep, meals, screen time, and family activities (4). The association has also developed a social responsibility project entitled “Fairy Tale Pandemic” in order to increase children’s resilience during the pandemic and strengthen their social bonds, as well as to encourage cooperation between healthcare professionals and the people they serve. Social media posts highlighting the day’s events were prepared and shared every day for three weeks, along with an average of three videos recounting various “tales” starting at 19:00. Over the course of the project, a total of 76 videos were uploaded to the Child and Adolescent Psychiatry Association’s Instagram account, which included the contributions of 25 renowned artists, 15 writers, and 25 healthcare workers. The healthcare workers, who read fairy tales, were chosen from among those who worked under difficult conditions and were therefore unable to see their own children for some time. Many child and adolescent psychiatrists have reduced their patient numbers due to more restricted working hours, while their clinical efforts have been rendered less effective as a result of working in different units. In particular, the inability to admit some psychiatric patients to hospitals as well as time constraints on attending to patients in overcrowded emergency rooms have adversely affected individuals presenting with emergency psychiatric conditions. Furthermore, since the beginning of the pandemic, there has been less focus on mental illness and more © 2021 Authors. This is an Open Access article licensed under the Creative Commons CC BY-NC-ND 4.0 license. https://creativecommons.org/licenses/by-nc-nd/4.0/ Impact of the pandemic on the mental health of children on COVID-19; emergency services for child psychiatry have decreased compared to the previous year (5). As the prevalence of mental diseases has increased during the pandemic, the negative effects of the latter on mental health services merit further discussion. During the current crisis, while mental health services for children and adolescents have been temporarily postponed, inpatient and outpatient treatments continue, albeit in drastically decreased numbers, according to Turkish pandemic policy. Unlike most inpatient health services, communal areas in psychiatric units are also widely utilized by outpatients, who dine together and attend group therapy sessions. When cases were detected in pediatric and adolescent psychiatry inpatient facilities, the facilities were closed one by one. In addition, patients in need of inpatient treatment were adversely affected by the closures of psychiatric facilities in some regions due to the pandemic. In order to cope with the difficulties brought about by this situation, telepsychiatry was adopted as a treatment modality, while other units continued to implement treatment protocols through consultation-liaison psychiatry units. Throughout the course of the pandemic, its effects on mental health and society in general have been investigated. In Turkey, the pandemic’s adverse effects on society prompted the development of policies to deal with them. In cities with large populations, psychosocial support referral networks using telepsychiatry-based applications with volunteer psychiatrists, psychologists, and counselors were established. However, in Turkey, the supply of mental health professionals has not kept up with the continual growth in demand; with this in mind, and especially in light of the need to maintain physical distance during the pandemic, a review of the state of telepsychiatry in Turkey is merited. Some researchers have suggested that telemedicine will help overcome the challenges of psychiatric diagnosis, intervention, and monitoring during the pandemic, while clinicians express concerns about keeping patients safe (6). The treatment and follow-up of children with special needs have presented other challenges. In the first days of the pandemic, the Turkish Ministry of Health implemented solutions for the basic health problems of these individuals, such as facilitating direct access to medicine and extending the validity period of special needs reports. In cases of children with special needs, intervention was considered necessary in anticipation of problems resulting from home isolation and the disruption of daily routines, as well as additional behavioral problems expected with the increased emotional and physical burdens on families. A new approach for individuals with special needs, including an application that can be used on mobile devices, has been developed (7). 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