From the outset of the pandemic experts have been predicting a surge in so-called “deaths of despair” (Case & Deaton, 2017): deaths from substance abuse, self-harm, and suicide.
Early on, there was evidence for an increase in such deaths in adults (Mulligan, 2020). Experts predicted a parallel effect in adolescents (John, 2020) given the radical changes to their lives, the intrinsic frustrations and miseries of lockdowns, and the uncertainties about the future. Did teenage substance abuse and suicide in fact increase through the pandemic?
Substance abuse in the pandemic
It is difficult to get clear data on substance abuse in UK teenagers during the through pandemic. Little research has as yet addressed the issue, and what there is is often methodologically limited or poses serious challenges of interpretation.
For example: a government report (OHID, 2022) about treatment of substance abuse in the young records a 23% reduction in those receiving treatment for substance abuse during the pandemic (April 2020 to March 2021). Did teenage substance abuse fall – or was it just harder to access to treatment? Either interpretation is possible. Lockdown might have reduced access to illicit substances. It certainly reduced access to health services.
Meta-research from other countries and other pandemics suggests that teenage substance abuse probably did rise in UK (Meherali et al, 2021). Research from Canada (Salmon et al, 2022) reported increased substance abuse in teenagers during Covid-19. Research from America (Patrick et al, 2022) suggests alcohol as likely being the main issue – unsurprisingly: alcohol is more accessible for home delivery in lockdown than other substances.
Alcohol sales are measurable. UK official figures on alcohol sales in the pandemic are equivocal. Was more sold to households while the pubs were shut? The answer is “hmm”: apparently no for affluent households and in the South; apparently yes in poorer families and in the North (Anderson et al, 2022).
What we do know is that alcohol-related deaths reached an all-time high in 2021 (ONS, 2022a). High alcohol consumption in the pandemic has created high levels of liver disease (British Liver Trust, 2022) – an on on-going problem for the future. The scale of this issue in adolescents is as yet unclear.
Research suggests that pandemic substance abuse will not have been “across the board” whatever the stressor and individuals from disadvantaged backgrounds are more likely to be adversely affected than those from stable, secure homes (Deng et al, 2021; Hussong et al, 2021; Hutchinson et al, 2021).
Suicide in the pandemic
Early reports on teenage suicide in the pandemic were equivocal (John, 2020). Getting data from UK has taken time. Reporting the death of a child as suicide cuts families to the quick, which delays and can obfuscate such reports. And then, there is said to be lack of paediatric pathologists to identify cause of death, leading, according to reports on the BBC Today programme (January 3, 2023) to delays in autopsy of up to 12 months.
The Office for National Statistics has now reported data, for the UK, suggesting a 35% rise in teenage suicide during the pandemic (ONS, 2022b). The ONS data are tricky to interpret – they conflate deaths by “suicide, self-harm and events of undetermined intent”, collectively reported as the leading cause of death for adolescents in UK during the pandemic. A death of “undetermined intent”: perhaps an accident; perhaps a cry for help that went wrong; perhaps deliberate suicide.
The suicide rate suggested in the ONS data is the highest level ever recorded in this age group. But it is almost certainly just the tip of the iceberg, so far as suicidal feelings go. We have long known that for every individual who carries out a suicide, there are many others (we have no data on how many) who feel suicidal, consult suicide-related helplines, social media and so on.
The future
Will adolescent substance abuse and suicide levels fall now we are “living with Covid”?
Only if the young do not care about the regular evidence of climate change, the appalling devastation Russia has wrought, threats of nuclear war, don’t care that the UK economy has been plunged into woe, don’t care about the cost of living crisis, and that millions are relying on food banks…
But the young do care, which is a blessing, a hope for all of our futures – but it is a curse for their present-day emotional state. We should expect that even as Covid recedes, some (if not all) of these issues will exacerbate feelings of depression, anxiety, hopelessness, and despair in our young.
The world – their world – has radically changed. This risk of “deaths of despair” in the young is almost certainly going to be with us for some time.
How can we respond in schools?
Once, and in an ideal world, a phone call to CAMHS would swiftly bring expert help. Alas: that cavalry is likely not coming. CAMHS has long waiting lists after referral, and shockingly, referrals can be refused even in the young who have made repeated attempts at suicide (Longfield, 2022). Like so much else that has been massively underfunded, the mental health services for the young are buckling.
Like it or not, teachers are on the front-line in this crisis. But what to do if you suspect a teenager is at risk from substance abuse or suicide? Expert opinion offers some suggestions, some old, some new:
Don’t tackle this alone: Every teacher should be part of a structure that can share such worries, get support, and share strategies. Access that. You need support too.
Senior mental health lead training: A grant of £1,200 for eligible state-funded schools and colleges in England is being offered by the Department for Education to train a senior mental health lead to develop and implement a whole-school or college approach to mental health and wellbeing. This training is not compulsory, but it is part of a government commitment to offer this training to all eligible schools and colleges by 2025 (see DfE, 2021).
Think beyond stereotypes: It is true that children from families facing social and economic problems are at greater risk than those from stable, secure families – and the disadvantaged need more of our support. But family stress is not confined to the socially or economically disadvantaged.
Identify risk: Dangerous substance abuse might well announce itself – perhaps through the appearance or the behaviour of the substance abuser. Look for changes in school engagement and emotional state one way or another.
Busting myths: One popular myth is that suicide “comes out of the blue”. Sometimes, that may be true. More often, there were cues of depression, disengagement. Many individuals make comments indicative of suicidal feelings. The idea that those who talk about a suicidal feeling won’t do it is a dangerous myth (see the Samaritans’ Myths About Suicide resource). Any suicidal comments should be taken very seriously.
Offer a safe space to listen to a troubled individual: Sensitive, confidential listening can be enough to offer life-giving support. It is, after all, the main tool of the Samaritans – who might be an additional source of support to suggest. And of course there is also the NSPCC and its Childline service.
- Samaritans: 116 123 or visit www.samaritans.org
- Childline: 0800 1111 or visit www.childline.org.uk
Engage the issues with all the young: Hope for the future is a practical matter. See my previous SecEd series on rebuilding hope in the young post-Covid (Thornton, 2022). General discussion of what to hope for, and how to achieve it may help all.
Engage the family: Most families would be aghast at school-based fears that their child has substance abuse issues or is suicidal. A few will be enraged by the suggestion; more will be distressed. Is the family co-operative? Can they collaborate with you to support their child? Equally importantly, can the school support the family? The issues the family is presently struggling with could likely be the stressors driving their child to substance abuse or to self-harm/suicide. Can we connect them with agencies or charities that can give support? Some experts suggest that offering sensitive support to the family as a whole may be a crucial tool in supporting the distressed or suicidal child (Ashwin et al, 2022).
- Dr Stephanie Thornton is a chartered psychologist, author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). To read her previous articles for SecEd, visit http://bit.ly/seced-thornton
Further information & resources
- Anderson et al: The Covid-19 alcohol paradox: British household purchases during 2020 compared with 2015-2019, PLoS ONE, (17,1), 2022.
- Ashwin, Cherukuri & Rammohan: Negative effects of Covid-19 pandemic on adolescent health: Insights, perspectives, and recommendations, Journal of Global Health (12), 2022.
- British Liver Trust, New data reveals deadly impact of ‘pandemic drinking culture’ with record rise in alcohol-related liver disease deaths, 2022: http://bit.ly/3iGZOrV
- Case & Deaton: Mortality and morbidity in the 21st century, Brookings Papers on Economic Activity, 2017.
- Deng et al: Predicting negative and positive affect during Covid-19: A daily diary study in youths, Journal of Research on Adolescence (31), 2021.
- DfE: Guidance; Senior mental health lead training, 2021: www.gov.uk/guidance/senior-mental-health-lead-training
- Hussong et al: Adolescence amid a pandemic: Short-and long-term implications, Journal of Research on Adolescence (31), 2021.
- Hutchinson et al: Adolescent and maternal anxiety symptoms decreased but depressive symptoms increased before to during Covid-19 lockdown, Journal of Research on Adolescence (31), 2021.
- John: Trends in suicide during the Covid-19 pandemic, BMJ, 2020.
- Longfield: Heads up: Rethinking mental health services for vulnerable young people, thematic report number 4, Commission on Young Lives, 2022: https://bit.ly/3V9gGok
- Meherali et al: Mental health of children and adolescents amidst Covid-19 and past pandemics, International Journal of Environmental Research and Public Health (18), 2021.
- Mulligan: Deaths of despair and the incidence of excess mortality in 2020 NBER working paper, 2020: www.nber.org/papers/w28303
- Office for Health and Improvement Disparities (OHID): Substance misuse treatment for young people: Statistics 2020 to 2021, 2022: http://bit.ly/3kfIIBZ
- ONS: Alcohol-specific deaths in the UK: registered in 2021, 2022a.
- ONS: Deaths registered in England and Wales: 2021, 2022b: http://bit.ly/3ZyO0sd
- Patrick et al: Using substances to cope with the Covid-19 pandemic: US national data at age 19 years, Journal of Adolescent Health (70), 2022.
- Salmon et al: Pandemic-related experiences, mental health symptoms, substance use, and relationship conflict among older adolescents and young adults from Manitoba, Canada, Psychiatry Research, 2022.
- Samaritans: Myths About Suicide: http://bit.ly/3QDvqLq
- Thornton: Rebuilding hope: helping students to overcome despair, SecEd, 2021: https://bit.ly/3xclhKO