Mental health services in UK are in a mess. Provision has declined in recent years, as government cuts bite – the Royal College of Nursing reports that more than 1,000 beds have been lost in this area.
Waiting lists are long and lengthening: our deputy prime minister has highlighted the fact that there is no target for how soon a patient with mental health issues should be offered treatment – and his proposal of a new 18-week target seems modest. Eighteen weeks is a very long time for the anxious or depressed, let alone the suicidal or psychotic.
Teenagers in particular are badly served. The exact scale of the problem is unclear, since (shockingly) no good data on teenage mental health have been collected since 2004. But it is clear that experts in the field are worried.
In an interview for the BBC’s Newsnight, Professor Tanya Byron commented that adolescents, some with very serious mental health issues, are turned away by the NHS every day.
In some parts of the UK a teenager won’t even get referred to the waiting list until he or she has already made a credible suicide attempt. And even if the authorities take action, it may well not be appropriate: Prof Byron noted that the lack of adequate provision means that there are hundreds of disturbed teenagers held in prison cells rather than hospitals, or inappropriately placed in adult wards, or in hospitals hundreds of miles away from family and friends.
The general belief among practitioners is that the number of adolescents presenting with mental health issues is rising. This reflects several different factors.
One is that society as a whole is far more aware of mental health issues today than was the case a decade or so ago – and we have far better, more sensitive diagnostic methods now, so that more problems will be identified.
Another is that people are much more willing to disclose emotional or psychological problems nowadays, and so more likely to come forward asking for help. And then, there is no doubt that the pressures on our young are far greater now than in the past, making such psychological problems more likely to occur.
It has always been tough being a teenager. Each generation faces challenges. But there are strong grounds for supposing that the young today really are under greater pressure than previous generations, and really are more prone to mental health problems as a consequence.
A first and obvious stress comes from the emphasis on exam grades as a means of assessing schools, which has ratcheted up the pressure on individual pupils to succeed academically, not always in helpful ways.
This pressure has been growing for years but is now exacerbated by the constant media refrain of this as a “lost generation” who will struggle to find jobs unless they are excellent (and even then) in these times of economic uncertainty. It’s no longer okay to do “well enough” – the pressure is to excel.
Social pressures too have created new stresses. Popular culture demands that the young should look perfect, be interesting and successful and live exciting lives. And in a life lived on Facebook, everyone can judge your success. The pressures of social media are relentless: where previous generations could go home, shut the door and take a break from peer pressures, today’s youth are “connected” all the time, everywhere.
Of course, this has some up-sides, especially for those who, in previous generations, might have been isolated. But there are also negatives and even abuses. Cyber-bullying is insidious, invidious and inescapable.
As if these things weren’t enough, today’s teenagers are affected by the general anxiety of society. The economic situation creates strong pressures on families, which affect the young. And we are probably one of the most risk-averse cultures in human history, worrying about all sorts of risks that did not bother previous generations.
Efforts to keep the young safe tether children to their parents’ sides, denying them the experiences that, in the past, let more “free range” children learn to navigate the complex environment of the roads and the community for themselves. Too often the apron string is untied abruptly as children cross the threshold into adolescence, leaving the young ill-prepared to handle a world that their parents evidently regard as dangerous. It’s a scary prospect.
Pressures of these kinds have the potential to create high levels of stress, which can in turn trigger all sorts of mental health problems. Such pressures are very likely to trigger anxiety disorders of one sort or another, to be a factor in rising levels of self-harm, anorexia, depression and suicidal despair. Stress may also play a role in tipping the susceptible over into more intractable psychotic illness.
What’s to be done about this? Something needs to be done, and urgently. Addressed at once, many mental health problems can be nipped in the bud. But left to fester, it is estimated that there is around a 90 per cent chance that the problem will become chronic and very much harder to treat. Swift action is vital, not just to relieve the burden of misery endured by individuals, but for the sake of society as a whole. Around half of all the mental health problems the NHS must deal with begin in youngsters under 15 years of age: how much better to nip those in the bud than to fund treatment for chronic conditions for a lifetime.
It is not that the authorities are unaware of the problem. A government taskforce addressing the issues is due to report in the spring of. And already, an extra £7 million has been earmarked to improve provision of beds for those with acute mental heath problems, with many millions more promised over the next five years. But it would be optimistic in the extreme to imagine that better funding alone will fix the problem.
Another key issue is that there is no effective infrastructure for addressing adolescent mental health.
There are no clear lines of responsibility, and communication between different agencies (police, NHS, schools) is poor, or non-existent. Will the government taskforce propose adequate solutions to these issues? Will it provide resources to enact those proposals?
Whatever the taskforce recommends, whatever the government implements, schools are, and inevitably will remain, on the frontline when it comes to managing adolescent mental health issues.
It is teachers who see the young every day, know them individually, and so are best placed to spot a teenager who is in distress, or going off the rails in some way.
It is teachers who are best placed to liaise with the family in working out how to intervene, and how and when to call for expert help. It is schools that are going to have the day-to-day responsibility of providing support as these youngsters learn to cope and recover.
These are hefty responsibilities, for which teachers are not properly trained, and for which schools don’t have adequate resources. The Welsh authorities have acknowledged this – and plan to assign a mental health counsellor to every primary and secondary school in that country.
No plan for such support for schools in other parts of the UK has been announced. The run-up to the taskforce report, and more importantly, the run-up to the General Election may be the right time for teachers to take a lead in demanding better mental health provision for all our schools.
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Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development.