Teenage Mental Health: Let's Not Go Backwards

Skills Platform product manager Dave Evans explores the issues surrounding mental health support for teenagers.

I have read about the recent funding problems in UK mental health provision with particular sadness.

10 years ago, a family friend in his early 20s took his own life after struggling for years with schizophrenia. His problems emerged in his teenage years, a common occurrence; as 75% of adult mental health issues make their first appearance around this time. Before this, he was a typical happy child from a stable, loving family.

25 years previously, my Uncle followed an almost identical path of teenage schizophrenic symptoms followed by a troubled early adult life before taking his own life in his early twenties.

Would a teenager going through these problems today avoid the same fate?

Despite positive steps being made in recent years through government schemes such as the ‘No Health Without Mental Health’ program, psychological care is once again on the back foot.

Mental Health First to Feel Cuts

A recent King’s Fund study found an alarming reduction in funding for mental health services. The researchers found that over a third of mental health trusts had plans to reduce staffing levels or the skills matrix of its workforce.

Perhaps more damning was the finding that a quarter of trusst were planning to use less qualified staff by replacing nurses with volunteers. The King’s Fund has warned that these large scare changes to mental health services were a ‘leap in the dark’, with a likely negative impact on patient care.

Helen Gilburt author of the report said that “historically mental health services have often been the first to see their funding cut, so many trusts have tried to prevent this transformation programs”.

There has been a knock on effect in areas such as education, with mental health services in schools thought to be so poor that some staff resort to calling emergency services for treatment according to one report from the TES.

Budget cuts and lack of availability are thought to be behind the problem, with the government ring fencing of £1.4bn for children’s mental health criticised as being bare minimum required.

Mental Health charity Young Minds published the results from an FOI request, finding that 74 out of 96 NHS Clinical Commissioning Groups had frozen or cut their Child And Adolescent Mental Health Services budgets between 2014/2015 and 2013/2014, while over half of the local authorities supplying data had frozen or increased below inflation their budgets between 2013/2014 and 2014/2015.

Reducing funding or quality of care could be especially dangerous as teenagers face increasing pressures in the digital age.

Digital Dangers

There have been anecdotal reports that mental health problems are on the rise amongst adolescents in recent years, but hard data demonstrating any casualty thin on the ground. The lack of accurate data is emblematic of the problem according to the 2013 Chief Medical Officer’s annual report last year.

The report found that 5-15 year olds with a psychiatric disorder were three times as likely to have a psychiatric disorder in adulthood. It also highlighted that an “alarming rise” in self-harm presentations to paediatric departments amongst teenagers, particularly girls. Digital media and the rise of cyber bullying were cited as one emerging risk factor.

In many ways, today’s children are facing a brave new world of new social technology that previous generations will never have to go through. The new 24/7 cyber presence can amplify social pressures, particularly in relation to academic achievement.

The 2014 CMO’s report said that cyber-bullying through digital media “may now be the most common type of bullying” with between 8 and 34% of young people experiencing bullying, especially young girls. Similarly, the ONS recently found that Children using social media for over three hours a day were more likely to report mental ill-health symptoms.

What we don’t know is whether this relationship is causal or merely a correlation as vulnerable children feel a greater need to engage in social media into the night, especially those with a so called ‘emotional investment’.

It may be possible that social media stirs the social pot with an increase in hurtful comments due to the detached nature of social technology. Dr Van Zwanberg, from the Priory’s Woodbourne Hospital in Birmingham, believes that social interactions “do not encourage true engagement or empathy”, as the user may not see the immediate impact of their comments on the other person.

“Children’s social skills and abilities to make small talk and actively listen, and develop empathy, are affected,” she said. “They joke and send photos and videos without truly engaging with people or truly listening to one another – and they send and make statements without seeing the immediate impact of their comments on the other person. At the other end of the conversation, these messages can be misconstrued.”

There are natural pressures that we all experience in growing up and finding our place in the world, but the rise of digital media may be exacerbating these issues, especially with Children under increasing pressure at School.

Education: Testing Times

Nancie Atwell won a recent Global Teacher prize earlier this year, earning the nickname ‘World’s Best Teacher’. Atwell warned against an encroaching culture of excessive testing that can “damage standards and decimate morale”. This focus on testing may lie behind the 2015 Good Childhood Study’s finding that children in England tend to report poor relationships with their teachers. England ranked 14/15 for satisfaction with teachers and 14th for children feeling that they were treated fairly by teachers.

A recent study by the NSPCC found that academic worries and exam stress are the biggest problem for children contacting the ChildLine helpline. In 2013/14 there was a 200% increase in counselling about exam stress specifically. The Sutter Health Palo Alto Medical Foundation found similar results in the US, with homework/ school the most common cause of stress above family and social life. 

ChildLine advises that young people:

  • take regular breaks from revising and do some exercise
  • go to bed at a reasonable time and try and get some sleep
  • try to think positively – even if you don't feel like it, a positive attitude will help you during your revision
  • take some water into the test with you if you can — keeping hydrated by drinking water will help you concentrate.

Parents can also help by creating an atmosphere where there is not undue pressure on their children to perform and avoiding the impression that bad exam results are the end of the world.

Karen Sullivan, a natural health expert and author of 'Kids under Pressure', said that, “No child should be pressured to perform for anyone other than himself. In other words, school standings in league tables, and working for parental approval, leave a child not only susceptible to failure, but likely to fail.”

Caring & Preventing

The change in funding focus, high teenage digital take up and increased school pressure could result in the UK storing up problems for the future.

The 2015 Good Childhood Report found that English Children experienced the highest levels of emotional bully out of the 15 nations studied. The ONS also found that children who have been bullied are more likely to have low personal well-being which could lead to mental health issues in the future.

Challenging the current status quo therefore must remain a priority for parents, carers and education figures.

Beyond this, increasing our understanding of mental health issues is something we call all strive for as individuals.

Caring:

Understanding teenagers is a challenge for most parents and a common struggle is spotting the difference between normal teenage behaviour and potential mental health issues.

YoungMinds operates the Parent’s Helpline which is an advice service for any adult with concerns about the emotional well-being or mental health a young person. They also provide training and consultancy for schools, commissioners and professionals in the youth workforce, and run awareness raising campaigns. In addition YoungMinds own HeadMeds.org.uk, a website about mental health medication, giving accessible, down to earth information on the topic.

Advice from YoungMinds includes:

  • Be honest about your feelings – you don’t have to be perfect. We all get things wrong and shout or say unkind things from time to time. If this happens, say sorry to your child afterwards and explain why it happened, They will learn from you that it’s OK to make mistakes and that it doesn’t make you a bad person
  • Ask your child what they think would help – they often have good ideas about solving their own problems
  • Don’t be too hard on yourself - If your child is having problems, don’t be too hard on yourself or blame yourself. Although it can be upsetting and worrying if your child is having a bad time, and it makes your relationship with them feel more stressful, you are not a bad parent.. Children often take it out on those closest to them, so you might be feeling the effect of their very powerful emotions.
Preventing:

Like any disease, identifying and treating mental health problems early is a far more effective than dealing problems when they become more acute.

Helping children and adolescents to work with their problems could help prevent cases escalating with a recent study from Rethink Mental Illness finding that Early Intervention in Psychosis reduces the risk of a young person taking their own life, from up to 15% to 1%.

Early intervention might need to start before these symptoms appear however.

Most mental health problems from depression to schizophrenia involve a complex interplay of genetics and a child’s environment. Just as familial history needs to be taken into account with physical health, mental health risk factors could be identified from birth. Outside of inherited tendencies, early life environments also play their part, with Post Natal Depression having a lasting impact on the child’s physical and psychological development.

Parents can bring their awareness of their own history to help their children in collaboration with medical and education professionals.  

Understanding & Skills

With mental health services facing ongoing financial pressures, the onus of responsibility will increasingly fall on primary and secondary carers to improve their understanding of mental health.

Dedicated charities such as Rethink Mental Illness, offer help for parents and children based on symptoms, conditions or available treatment. As mentioned, Young Minds offer specific help for parents, as well as training for schools, commissioners and people youth workforce.

Using the Skills Platform, you can also search for face to face mental health training or eLearning courses.

The future

Many areas of mental health provision have moved forward in recent years, but are now in danger of standing still or even falling back in the face of funding cuts and restructures. This comes at a time when, anecdotally at least, teenage mental health pressures are increasing.

So would a teenager experiencing acute mental health problems today avoid the same fate as my friend and relative?

Quite possibly, yes.

Despite recent cuts to services, there are some positive indicators emerging. Personal Social, Health & Economic education (PSHE) is firmly on the agenda for many schools. Most schools have tutor time where children can and do discuss issues. Pastoral care appears to be readily available, and parents are often encouraged to raise any concerns directly with the school.

No doubt there will be regional variations in standards of this care and much will also depend on the child/ teenager being fortunate enough to have parents or teachers with the right knowledgeable and skills. 

The real danger now is that mental health provision stands still or moves backwards at a time when anecdotally at least, teenage mental health problems are on the rise.

Dave Evans can be contacted via the Skills Platform or on Twitter @Skillsplatform