Spotting the signs: 10 mental health challenges post-Covid

Written by: Dr Pooky Knightsmith | Published:
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What kind of wellbeing and mental health issues will some students be presenting with this term and what signs should we be alert for? Dr Pooky Knightsmith considers 10 challenges we are likely to in the coming weeks and months – and what we can do to help

There are a whole series of issues that we can expect to see in our pupils in the coming months. To help you spot the signs and take action, I have outlined a range of potential concerns and for each I advise at which point we should worry and suggested next steps.

This article is designed to arm rather than alarm. I hope it gives you some useful pointers. You do not need to know all the answers to be able to significantly help a child.

For further support, SecEd recently published an eight-page Best Practice Focus in which I discussed spotting and responding to the signs of mental health problems, including how to listen when a child is distressed (Knightsmith, 2020).

STUDENT WELLBEING ADVICE: Dr Pooky Knightsmith features in a recent episode of The SecEd Podcast focused on supporting student wellbeing post-lockdown and as we go back to school. You can listen for free via your streaming service or at This article first appeared in SecEd's free Back to School Guide on Student Wellbeing, one of four 12-page guides we have published. For details, see the end of this article or visit

1, General failure to thrive or feeling stressed

The problem: Everyone is going through a tough time and even the most resilient pupils are likely to find that their wellbeing takes a hit. Pupils might seem more anxious than usual; they may be more irritable, angry or upset than a few months ago, and in some cases they may seem a little directionless, listless, and just generally “not quite themselves”.

When should I worry? It is important to remember that we are in the middle of a pandemic. Things are hard and we have been through a lot. While many children might exhibit some signs that would normally be a red flag for you, as we go through a community-wide process of healing from trauma, our expectations will need to shift a little. However, if there are individual children who stand out as struggling more than their peers, then it will be worth digging a little deeper and putting additional supports in place.

What should I do? The best approach here is one of community healing. Working with pupils, staff and families to create a safe and nurturing environment where children feel safe and seen and where they can begin to reconnect socially and find a sense of purpose and belonging again will really help. It will help too to revisit the wellbeing basics of diet, sleep and exercise. For many people one or more of these will have slipped significantly during lockdown and supporting a gentle reset now will boost both physical and mental health.

Further support: The mentally healthy schools website has some great ideas and resources: Also, try my book The Mentally Healthy Schools Workbook (JKP, 2019), which provides a helpful framework and lots of ideas:

2, OCD around germs and cleanliness

The problem: We expect to see a big rise in health and hygiene-related obsessive compulsive disorder cases, and for many of those who have previously lived with the condition to relapse. Messages about health and cleanliness and the need to keep hands and things we touch clean have been a key focus of public health campaigns. For many, this has resulted in a desired increase in vigilance and handwashing which has helped to curb the spread of the virus. However, for some this gets out of control and resulting OCD behaviours become more harmful than helpful.

When should I worry? Our norms have shifted but we should still be worried about anyone for whom concerns about cleanliness or contamination feel out of kilter. Everyone should be encouraged to follow public health guidelines, but if you have pupils who are spending far longer carrying out activities like handwashing and cleaning than the norm, who seem very pre-occupied by it, or you find that it is preventing them from engaging in activities, then it is time to seek support.

What should I do? The good news about OCD is that it is highly treatable, especially if we catch it early before habits have time to fully form and embed too far. An internal or external referral to someone who can diagnose and treat the pupil should be made rapidly. The pupil will likely be referred for cognitive behavioural therapy which includes exposure and response prevention (CBT with ERP) and the outcomes are often swift and positive.

Further support: OCD UK is a charity run by and for people with OCD offering helpful advice and ideas: Meanwhile, the young people’s workbook and the guide written for therapists by the team at the Institute of Psychiatry – OCD: Tools to help young people fight back! (JKP, 2019) – is excellent:

3, Bereavement

The problem: Sadly, more young people than usual will experience a bereavement in the current context. Bereavement is something that we will all experience at some time and is not in and of itself a cause for concern. But when someone dies, no matter how healthily we process our grief, we all need a little extra support; this may be especially true if there has not been a chance to say goodbye due to visiting or funeral restrictions.

When should I worry? When someone close to us dies, we work through several stages which, may be cause for concern if taken out of context but which are a normal part of grieving.

What should I do? Support the child and their family as they work through their grief. Try to provide a safe space for crying (and laughing) and exploring feelings. The regular support of one or two trusted can help the child to heal. If you have several bereaved children, a peer listening and support group can work well.

Further support: Advice, ideas, activities and resources are available via Child Bereavement UK and Winston’s Wish. Visit and

4, Separation anxiety

The problem: We are likely to see higher than usual numbers of children and adults who become very distressed at being apart. This is due to a combination of children being poorly socialised during lockdown while spending more time than usual with one or two key care-givers, coupled with the fear and uncertainty associated with the return to school which may feel unsafe to children and their families.

When should I worry? It is normal for some children to show intense distress briefly when parted from a primary care-giver, but this usually passes quite quickly as they engage with the adults and activities around them. If this distress does not pass and is affecting their ability to ready themselves for learning or play, additional support may be needed. For most this can come from the adults at school, but in more extreme cases the child may have developed separation anxiety disorder which should be referred to CAMHS, a GP or your mental health support team.

What should I do? Support families in the run up to the return to school so that everyone knows what to expect. Encourage families to engage with positive conversations about school with their child and to develop a goodbye ritual that can be swiftly executed without fanfare. A child being met by a consistent adult at school and having a similar “soft landing” each day, engaging with activities they enjoy, can help and many children find comfort in having access to a tangible reminder of their parent. I am a big fan of children carrying a laminated kiss with a message from their primary care-giver.

Further support: Beacon House has a range of fabulous resources about trauma and attachment:

5, Academic anxiety

The problem: We are likely to see higher than usual levels of academic anxiety as children return to school. There is likely to be great disparity in how much children have accessed and engaged with the curriculum during lockdown and there will be all sorts of difficult feelings mixed up in this, including guilt, shame, fear or worry. Education may feel disjointed and uncertain. More children than usual may be anxious about their school work and this may play-out in shutdowns, meltdowns or a general inability to meaningfully engage.

When should I worry? Most children will be a little uncertain as learning is re-established and everyone attempts to get back up to speed. For a few, this worry will seem more significant and rather than becoming more settled with increasing access to the learning environment, they may become more and more anxious – this may play out through withdrawal, anger or panic.

What should I do? Try to provide reassurance for all children. Be clear in your expectations of the class and of individuals and help children to understand that everyone is in the same boat and that we will all work together to move forwards. Try to build up children’s confidence by providing the chance for success in their learning and build in plenty of nurturing and fun activities to help them settle and re-engage. Clear and consistent communication with families will also help to dispel any myths and ensure a consistency of expectation.

Further support: Young Minds offers excellent support around academic resilience:

6, Emotionally based school avoidance/refusal

The problem: We expect to see a rise in emotionally based school avoidance (EBSA) in the coming months both from children who have struggled with this in the past as well as new cases, perhaps linked with separation anxiety, academic anxiety or social anxiety.

When should I worry? It is time to worry when a child is significantly distressed by attending school and feels unable to engage. This can be accompanied by distressing or challenging behaviour and the child may not be able to articulate the precise reasons for their feelings. It is easily spotted by a change in attendance, punctuality or behaviour.

What should I do? Try to get to the heart of the issue – avoiding school will be meeting a need. Until we can recognise that need, we are unable to support the child to meet it in a more constructive way. There are many potential reasons – bullying, academic, social or health-related anxieties. Work with the family, as where you find a child with EBSA you often find a parent/carer at their wit’s end who feels guilty, ashamed and exhausted but who, with your support, is likely to be the best chance you have. Simple things make a big difference. Small goals, providing a warm welcome each time the child attends, and allowing them regular chances to touch in and emotionally regulate with a trusted adult.

Further support: The West Sussex EBSA toolkit provides leaflets for children and families as well as guidance for schools:

7, Social difficulties and friendship issues

The problem: Friendship issues are part and parcel of school life and supporting children to navigate their social world is part of the job for many school staff. However, things may be unusually fraught as children return to school and as they learn to engage and interact with their peers in Covid-safe ways.

When should I worry? As well as a rise in general day-to-day friendship issues, I am expecting to see a spike in cases of social anxiety. When a child’s anxiety in social situations is stopping them from engaging in regular activities, then it is time to provide additional support. This might present as lack of engagement in class or seeming withdrawn at breaks and lunch. The child might also seem angry, upset or panicky and work hard to avoid certain situations.

What should I do? For all children, it is important to be clear in our guidance about how it is appropriate to interact to remove any uncertainty or worry. It will also be helpful to provide a little support to help children emotionally regulate around break times. Calming activities or a few minutes when worries can be worked through after breaks can help ready pupils for learning. For those who appear to be developing more debilitating social anxiety, individual support will be necessary.

Further support: Young minds has information and support on the different types of anxiety:

8, Gaming addiction

The problem: Gaming provides a fun way to escape from a sometimes-tricky reality, an easy way to fill time and our online personas are not subject to the same restrictions as our “IRL” (in real life) versions. For many children, their online lives will have become more real than their offline lives. This is not a new phenomenon – but I expect to see an increase in this post-lockdown.

When should I worry? I am a big fan of gaming as a way for kids to connect, relax and have fun right now, but for some who will have spent a lot of time gaming, the segue into offline life might feel hard. They may struggle more than others to interact; becoming irritable, anxious or emotional as they miss the “hit” that gaming provides – a form of withdrawal. We may also find that their online life is so integral right now that post-lockdown they will forfeit sleep to get their hit. Like with many issues, the point at which to worry is the point at which the issue begins to affect children’s ability to thrive and engage each day – and if it does not abate with time.

What should I do? Helping all children to understand how to manage their online lives healthily is a good starting point. Help them to understand about the importance of regular sleep and thinking about what reasonable limits in terms of gaming are. Having an open conversation about their gaming and picking apart what it is they love about it and what keeps them hooked will help you to find some ways forward. It is important to involve the family and not to minimise the issue. Saying “no” may make things worse. Be inquisitive, involve the child and take it slowly.

Further support: The Parent Zone has resources about digital life and gaming:

9, Sleep difficulties

The problem: It is likely that many children will not be getting optimal sleep, either because of the loss of the school routine or because they are too worried. Good sleep is a fundamental underpinning of good mental and physical health. Making small changes to sleep can often make a big difference to how we feel and our ability to cope with things.

When should I worry? It is to be expected that as children settle back into school they will be more tired than usual due to the change of routine and because school requires a lot of us. So a bit of lethargy is not cause for concern. However, we may need to put in place support for children whose tiredness does eventually dissipate or who seem anxious, hopeless or tearful.

What should I do? Revisit the basics of good sleep hygiene with all children. Everyone will benefit – as will you. Consider what a good sleep routine looks like and help children understand the fundamental importance of sleep for good mental and physical health. Children who are really struggling, or not trying, to return to usual sleep patterns will often benefit from mentoring or supportive listening, as will those who have low mood or anxiety.

Further support: The Sleep Foundation has good advice and ideas:

10, Domestic abuse

The problem: We expect more children to have experienced or witnessed domestic abuse during lockdown and that relatively few of these cases will have been picked up (see article opposite).

When should I worry? Look out for signs that a child has experienced or witnessed abuse of any form. Remember that it is almost as damaging for a child to witness abuse as to be the victim and that abuse is not always physical. Some children will also work hard to hide what is going on but we may pick up on signs of withdrawal, aggression, other changes in behaviour or children taking care to keep their body covered.

What should I do? Ensure that safeguarding training is up-to-date for all staff and that everyone is alert to the potential rise in cases. Teach children about abuse too and give them clear pathways to ask for support. Anytime you suspect things are not right for a child, either reach out to them or escalate the concern. An amazing number of cases go undetected because adults do not follow their gut or they assume that someone else is managing the situation. Follow school procedures. Raise any concerns, no matter how small, with your designated safeguarding lead.

Further support: The NSPCC has advice, resources and support:

  • Dr Pooky Knightsmith a passionate ambassador for mental health, wellbeing and PSHE. Her work is backed up both by a PhD in child and
    adolescent mental health and her own lived experience of PTSD, anorexia, self-harm, anxiety and depression. Read her previous articles via For practical support, visit

The SecEd Podcast

Dr Pooky Knightsmith also features in a recent episode of the SecEd Podcast focused on supporting student wellbeing post-lockdown. You can listen for free via your streaming service or at:

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