Background and context
To paraphrase the evolutionary psychologist Randolph Nesse , sometimes there are good reasons for bad feelings. Such is the case during COVID-19 lockdown. The emotional legacy of COVID-19 in CYP is likely to give rise to increased cases of panic disorders, general anxiety and social anxiety disorders. There are few healthcare systems in the global north which would be able to cope with the demand for post-COVID-19 mental health support for young people. In the case of Zambia and Sierra Leone, young people’s mental health needs have long been woefully under-researched and under-resourced [29, 30]. Yet still, CYP of African heritage are often denied a human face for their plight, and are instead characterised as being somehow genetically predisposed to emotionally cope with the intersecting trauma of civil unrest, disease and poverty. They need their voices heard, understanding and the right timely support. This makes good economic sense because most, if not all, mental health problems in adulthood start in childhood , and they will remain a persistent problem in Zambia and Sierra Leone, constituting a hidden burden of diseases if left unaddressed. Facing the current COVID-19 pandemic, mental health is thought to affect all young people, serving to exacerbate the social and structural determinants of health experienced by disadvantaged and disabled CYP. The UK Global Challenge Research Fund (GCRF) Youth Empowerment and community capacity building project was designed to empower disabled young people in the labour market and within their communities, but it was later repurposed to a Kick Out COVID-19 campaign in order to support CYP during the pandemic, specifically, disabled and disadvantaged CYP. The project distributed over 17,000 items of COVID-19 personal protective equipment (PPE) in Zambia and Sierra Leone, directly supported over 5,000 vulnerable and disadvantaged children, young people and families, and co-produced and disseminated public health messages on social media that have reached over 428,000 citizens in the global south, increasing their COVID-19 health literacy.
Research suggests that the greatest challenges in addressing young people’s mental healthcare in the global south are to do with legislation, human resource, stigma and infrastructure . Dealing with some of these challenges may be helpful for these countries in addressing the effects of COVID-19, thereby reducing the increasing number of cases of mental illness. The Kick Out COVID-19 initiatives have also proven very productive in promoting mental health and wellbeing in individuals affected by the global pandemic. It is, however, noted from this research that mental health issues have been downgraded in Zambia and Sierra Leone, even as the situation is very much worsening. The economic and social situation is predicted to be even worse in Zambia and Sierra Leone than in the global north, due to the COVID-19 pandemic increasing the burden on weak healthcare systems and the human resources available in these countries. In the global north, there is growing recognition in the fields of social care, health and education that the psychosocial nature of CYP’s lives have changed, and that practice in relation to mental health protection and promotion is still trying to catch up with these changes. The changes relate to both higher levels of need resulting from chronic and severe mental disorder (schizophrenia, bipolar disorder, eating disorder etc.) and wider societal issues (e.g. high exposure to information communications technology, families living in poverty, unemployment, poor body image, radicalisation, anxiety and depression), which have an effect on receiving the right care, at the right time.
Research also suggests that CYP living in disadvantaged communities and/or living through a lot of adversity are more likely to experience lower degrees of social capital than their middle-class peers, as both a cause and effect of their set of circumstances. As a way of seeing this complex dynamic, this paper’s conceptual framework links human agency, resilience and capital as capacities, or processes, to explain how participants make choices, bounce back from wrong choice and adversities, and use their soft skills and social networks as a resource to support their mental health and wellbeing.
Zambian and Sierra Leonean CYP face all, if not most, of these challenges. These challenges take place in a context of current economic stagnation, gravely aggravated by the pandemic. From a perspective of economic growth, Zambia has encountered a number of setbacks in the past decade, which have contributed to straining its national budget. According to the African Development Bank (ADB), real GDP growth slowed to an estimated 2% in 2019, down from 4% in 2018. Moreover, according to the updated IMF forecasts from April 2020, the outbreak of COVID-19 will cause a fall in GDP growth of -3.5% in 2020. To avoid stigmatisation of mental illness in the country, a lot must be done by conducting more research about the problem and well equipping the human resources within the country for handling more cases.
In Sierra Leone, young people under the age of 35 years comprise about 72% of the population. These young people are already facing challenges such as health inequalities, lack of access to education and skills training development, unemployment and underemployment. It is particularly important to present opportunities to establish a solid foundation for young people’s development and wellbeing. There are no existing services that provide tailor-made interventions for young people. Currently, there is no social support system for young people who are facing extreme poverty and vulnerability. Sierra Leone’s poverty is deeply entrenched, with an estimated 70% of the working population absorbed in the informal sector . Poverty has escalated the risk of mental health problems, and this is compounded by disenchantment with a system that is characterised by social inequalities and poor economic and physical living conditions.
Mental ill health is considered to be a silent epidemic in Sierra Leone; a large proportion of the population are experiencing mental health issues as a result of various factors, including the 11-year civil war (1991–2002), the Ebola outbreak (2014–2015) and the mudslide (2017) [34–36]. The elements of social inequality, drug and substance abuse, and – more importantly – the current COVID-19 pandemic and its lockdown and restrictions on movement, have all posed serious threats to public mental health in the country, particularly amongst CYP, including those living with disabilities.
A survey conducted by the Ministry of Health and Sanitation and the World Health Organization , showed that about 700,000 people in Sierra Leone are suffering from serious mental health challenges and need medical attention. Of this figure, 350,000 have psychotic-related drug and alcohol abuse problems or illnesses such as cerebral malaria, more than 20,000 are suffering from bipolar manic depression disorder, and about 175,000 are experiencing epilepsy or schizophrenia. Most recently, Bah et al.  emphasised the seriousness of post-traumatic stress disorder (PTSD), psychosis and depression amongst victims of the civil war, Ebola and substance abuse. It has been estimated that 10% of the country’s population, including children and young people, are suffering from PTSD.
Correspondingly, the Zambia mental health country profile identifies that the high level of poverty in the country was already one of the major causes of mental health problems prior to the pandemic, especially for unemployed youth and people with disabilities . The pandemic has had globally serious negative effects on the economy and on the labour market, and Zambia is no exception. Following the pandemic, mental health related problems for individuals and communities are expected to increase significantly, especially if no effective policies are implemented to assist the people affected by the lockdown.
The social and economic challenges for Zambia and Sierra Leone in tackling the growth of mental ill health in CYP concern legislation, human resource, stigma and infrastructure . This paper does not have the space to address each in turn, and instead it focuses on the social challenge of COVID-19, thereby reducing the increasing number of COVID-19-related mental illnesses. Both research sites have paid little attention to the issue of childhood mental illness, which may impact these countries greatly, adding to the burden of disease.
To recap, the aim of this study was to administer a planning tool to better understand the emerging mental health and wellbeing needs of CYP during lockdown. The international importance of this study is illustrated in the ‘protective’ and ‘risk’ factors highlighted by participants, which originate from, but are not exclusive to, the fragile health systems and persistent vulnerability that participants face in their social settings. Ebola, civil conflict and natural disasters have provided important instructions on how CYP build resilience to better cope with such personal and social uncertainty caused by the pandemic. In a reversal of roles, the global south provides valuable lessons in the role that resilience and competencies play in CYP’s mental health and wellbeing. As social distancing restrictions loosen around the world, we will need to address the mental health and wellbeing challenge for CYP who have been seriously impacted by this pandemic.