Young people are not mentally ill

‘We know that young people face a huge range of pressures, including exam stress, bullying and concerns about body image’, says Jade Zelkowicz, community fundraising manager for YoungMinds. As part of the charity’s #HelloYellow campaign, timed to coincide with World Mental Health Day, thousands of young people will wear yellow to spread the word that ‘whatever you’re going through, you can talk to someone if you’re struggling to cope’.

So how big is the mental-health problem? According to YoungMinds, the ‘research shows’ that three children in every class have a diagnosable mental-health condition; 90 per cent of schools have reported a rise in anxiety, stress or depression among their students; and the number of children arriving at A&E with a diagnosable condition is twice what it was in 2010. A rise in hospital admissions and growing pressure on schools are certainly a cause for concern. These figures aren’t to be taken lightly — but nor should they be taken at face value.

I wrote a piece two years ago questioning the extraordinary claim that 1 in 10 children – or 3 in every class as YoungMinds put it – have a diagnosable mental-health condition. The claim is based on a study in which diagnoses were made by clinicians who never even met the children concerned. I remain unconvinced.

Besides, if the results could be trusted at all, they only confirmed that whatever the mental-health problems young people are supposedly suffering, there is no mass outbreak of serious neuroses and psychoses in our schools. Rather, it is emotional and behavioural problems like anxiety, ADHD and so-called ‘defiance disorder’ that predominate. This could tell us that something is going badly wrong with the way children are being educated and socialised – not to mention diagnosed – but it doesn’t necessarily point to a mental-health crisis.

YoungMinds is part of the Heads Together campaign, fronted by the Duke and Duchess of Cambridge and Prince Harry, with the stated aim of ending ‘the stigma around mental health’. The young royals want us to open up and get talking about our mental health. But in truth, we seem to talk about little else these days.

Mental health is no longer the taboo it is made out to be. Celebrities have long flaunted their traumas, addictions and syndromes. Mental health is in the frontline of the culture war against the stiff upper lip, ‘toxic masculinity’, and – the biggest crime of all – bottling it up. It is one of the main drivers of therapeutic policymaking, from schools to the workplace.

But far from helping those struggling with serious mental illness, spreading ‘awareness’ of the nation’s mental-health issues diverts resources away from those that need it most. Children and adolescent mental-health services have long been in crisis. Young people, some with life-threatening conditions, are sitting on waiting lists for months on end before they see anyone.

This is in the context of what Javed Khan, chief executive of Barnardo’s, describes as a ‘perfect storm’ in children’s services. The UK’s children’s commissioner recently expressed concern that local authorities are struggling to meet their statutory duties to vulnerable children. Services are squeezed between ever-dwindling central government funding and large increases in the numbers taken into care or suspected of being abused. (The wisdom of these interventions has also come under questioning.)

‘From cyber-bullying to gaming addiction to online grooming, the risks are all too real – and they apply to everyone’, says Khan. The onslaught of multiple and supposedly widening threats to children’s wellbeing appears relentless. And the perception of these risks certainly creates demands that must somehow be met by services under strain. But is this a crisis of our own making, and do these risks really affect ‘everyone’?

It is no wonder young people feel their mental health and emotional wellbeing are under threat when they are constantly told that they are. This also causes them to feel vulnerable to events and experiences that would have seemed unremarkable to previous generations. Should we really be surprised that children’s services are under unprecedented pressure as a result? As a society, we urgently need to grapple with these questions if we are to avoid the self-fulfilling prophecy of making a whole generation of kids unwell.

 First published in spiked

Children need to know stress is normal, not necessarily a mental health problem

First published in Guardian

There is a statistic often quoted by children’s mental health campaigners: 10% of children and young people (aged five to 16 years) have a clinically diagnosable mental health problem. It comes from a 2004 report from the Office for National Statistics (ONS) (pdf), but its methodology is questionable – the diagnoses were made using transcripts of ONS interviews, by clinicians who never met the children in question. But what’s really revealing is the researchers’ broad definition of a mental health problem.

More than half (5.8%) of those diagnosed with a condition (9.6%) had what are described as conduct disorders – antisocial behaviours, such as aggression or deceitfulness. More than a third (3.7%) had emotional disorders including anxiety and depression, but also phobias – for example, a fear of dogs. The remainder were judged either “hyperactive”, “impulsive” and “inattentive” (1.5%) or had less common conditions (1.3%) such as autism.

In other words, a large part of the children’s mental health problem in this country is antisocial behaviour. What would have once been put down to a child being naughty is today turned into a need, and grounds for potential psychological or even psychiatric intervention.

That’s not to deny that there’s a problem. According to a survey conducted by the Association of School and College Leaders (ASCL), more than half (55%) of schools report increased stress and anxiety among their pupils. Over the past five years, 40% have seen a large rise in cyberbullying; four out of five (79%) report more self harm and suicidal thoughts among students; more than half (53%) rate their local Child and Adolescent Mental Health Services (Camhs) as poor or very poor, and 80% want to see those services expanded. This is despite most schools already offering on-site support with for mental health problems.

Young people are typically waiting months and even years for treatment by their local Camhs. But instead of asking how we meet these needs, we need to ask what has given rise to them.

No distinction

As a society, we are encouraged to understand the challenges children face as mental health or emotional problems – no distinction is made between the two. Behavioural problems at nursery and teenage use of social media are spoken of in the same breath as eating disorders. The impression is that a big and growing problem exists and that these very different concerns are somehow related or on a continuum – and that the apparently unprecedentedly challenging world of today is to blame.

The ASCL interim general secretary, Malcolm Trobe, said earlier this year: “Children today face an extraordinary range of pressures.” These include “enormously high expectations, where new technologies present totally new challenges such as cyberbullying”.

Nihara Krause, a clinical psychologist and founder of teenage mental health charity Stem4, says that young people today experience “levels of competition and performance anxiety unknown to any generation”.

“The increase in mental ill-health among our young people is exacerbated by our trophy culture. Outside school, our body-obsessed, share-everything culture subjects them to a new form of scrutiny,” she says.

There is a real problem here, but perhaps it’s not that young people are increasingly mentally or emotionally unwell, or because the difficulties they face are uniquely challenging. Maybe the issue is that we’ve adopted this narrative of vulnerability, and affected the way young people understand themselves and what they are capable of.

Young people are picking up the message that they are defined by their vulnerabilities, and that they are unable to deal with what in the past would have been regarded as unremarkable facts of life. But what does it do to children if they are told that they can’t cope, that they must seek professional help? It means children and families feel less able to draw on their own informal ways of working things out – not least because families themselves (and parents in particular) are often seen by the experts as part of the problem.

If we want to prevent the problems campaigners describe, we need to hold the line – as parents, as teachers, as adults. We need to teach things that bring children out of themselves. We should give them something to aspire to or embrace. We need to prepare them for adulthood, and let them know that a certain amount of stress and feeling down is just part of growing up.

When teachers become glorified therapists rather than educators – by trying to treat young people rather than instruct them, by massaging young minds rather than filling them up with the knowledge – they can unwittingly contribute to the problem. And worse, they are being distracted from the one thing that they are qualified to do and that will help the young flourish and grow into well-adjusted young adults: teach.



Stop telling kids they’re mentally ill

First published in sp!ked

It was World Mental Health Day earlier this week. To mark the occasion, the London Eye was lit up in purple, as part of a global campaign set up in the memory of Amanda Todd, a Canadian teenager who took her own life in 2012.

Todd’s is a tragic story. In 2012, at the age of 15, she killed herself shortly after posting a YouTube video telling of how she was being bullied. However, Todd’s story and others are being used to build a misleading narrative of deepening and widespread mental-health problems among children.

With the endorsement of the younger British royals – ‘Too often we think mental-health problems are things that happen to other people’, says Prince Harry – World Mental Health Day and other ‘awareness-raising’ initiatives create an impression of a growing crisis.

It’s not that there isn’t a problem; there clearly is. The UK Local Government Association (LGA) worries that ‘substantial numbers’ of children are suffering with anxiety, depression and self-harm, and that many more obsess over their body image, exam stress and the perils of social media (a concern heightened by Todd’s tragic case).

A report from the children’s commissioner for England found that 28 per cent of children referred to Child and Adolescent Mental Health Services (CAMHS) do not receive any service at all. Of particular concern are the 3,000 children and young people (around a quarter of all referrals) with a life-threatening condition (such as self-harm, psychosis, severe depression, anorexia and suicidal tendencies). Only 14 per cent of these children are able to access services, and 51 per cent are left to languish on waiting lists, sometimes for months.

However, the root of the problem is being misdiagnosed. The expansion of the definition of what it means to be mentally ill is key here. Indeed, as the frequent references to bullying and exams should make clear, young people’s emotional ‘wellbeing’ and their ability to cope with troubling but very normal parts of childhood are now being collapsed into the alleged mental-health crisis – putting pressure on services as a result.

In response to the children’s commissioner’s report questioning local CAMHS’ ‘failure’ to provide services to all young people who attend, the Yorkshire and the Humber CAMHS had this to say: ‘Our CAMHS do not offer services for normal reactions to adverse life events – eg, parental separation/bereavement or for normal child-development difficulties.’

This is surely the right approach. Not simply as a way of coping with the pressure exerted on mental-health services, but as a challenge to an increasingly therapy-seeking culture. The LGA report, however, shows that this response is atypical. Instead of making the case against the tendency to over-refer – in light of how hard-up local authorities are – the authors of the report argue that there needs to be more ‘identifying and supporting of families experiencing problems’. ‘As young people grow older’, the report continues, ‘the potential hurdles and the challenges to their resilience increase’.

Yes – it is called growing up.

Campaigners are encouraging the young to out themselves as mentally or emotionally unwell. They are claiming mental health is a taboo subject, despite the fact that everyone from royalty down is talking about it endlessly. When they say there is a mental-health crisis, they are absolutely right. There is a crisis. And it is one of their own making.

A royal panic about children’s mental health

First published in sp!ked

Last Sunday was Father’s Day in the UK, and Prince William, the Duke of Cambridge, took a break from celebrating the joys of family life to warn us about the state of our children’s mental health. Father’s Day was also, he wrote in an article for the Sunday Express, ‘a time to reflect on my responsibility to look after not just the physical health of my two children, but to treat their mental needs as just as important a priority’.

His wife Kate, the Duchess of Cambridge, shares a similar sentiment. During her stint guest editing the Huffington Post last year, she wrote that children’s mental health is ‘every bit as important as their physical health’. But Will and Kate’s concern is no revelation. The royals’ demand for what policymakers call a ‘parity of esteem’ for physical and mental health is part of a very contemporary, albeit maddening, obsession.

‘A fifth of children will have a mental-health issue by their 11th birthday. And, left unresolved, those mental-health issues can alter the course of a child’s life forever’, the prince tells us. But all is not as gloomy as he would have us believe. The figures are real enough, but many of the maladies included are not really serious mental-health problems. We are not talking, for the most part, about schizophrenia or clinical depression. It is emotional, behavioural and so-called conduct disorders that are being diagnosed in increasing numbers.

The expansion of the diagnosis (and self-diagnosis) of mental-health problems in children and young adults marks a dangerous shift. Claire Fox, director of the Institute of Ideas, has argued that this is part of a wider phenomenon whereby kids are being encouraged to feel anxious and vulnerable about pretty much everything. We have raised ‘Generation Snowflake’, she argues, by promoting a culture of self-esteem in schools that enfeebles young people and encourages them to interpret normal emotions as signs of mental illness.

Indeed, even Natasha Devon, the former government children’s mental-health tsar, admitted that the current definitions of some mental illnesses ‘sound a lot like being a teenager’. But, according to Devon, this blurring of the boundaries between the normal and the abnormal is ‘something to celebrate’, in that it allows children to speak out about their problems. ‘Teaching children to suck it up and soldier on’, she says, is a form of ‘emotional inauthenticity’.

This is worrying. Children’s emotional lives are being colonised, their healthy emotions recast as forms of mental illness, at the very same time that child and adolescent mental-health services are starved of resources. The consequence of all of this is healthy children being stopped from growing into capable adults and mentally ill children being denied the help they so desperately need.

The real crisis here is among adults, not children. We are projecting a contemporary obsession with mental-health on to children, and coddling them as a result. It is as if we can no longer discern the emotional ups and downs that are part and parcel of growing up from serious mental-health problems that require expert help. This confusion is now so widespread, it’s even affected our supposedly stiff-upper-lipped royals.

Are the Kids Really Going Mad?

“That’s mad!” I thought as I read Future in Mind, a report published by the Children and Young People’s Mental Health and Wellbeing Taskforce. Set up by the last government’s Minister of State for Care and Support, Norman Lamb, its aim was to come up with proposals for ‘promoting, protecting and improving our children and young people’s mental health and wellbeing’.

According to the report one in ten children of school age is suffering from a mental disorder, the most common of which are described as conduct disorders, anxiety, depression and hyperkinetic disorders (such as ADHD). This is a big problem. Not because so many kids have a mental health problem or because the report’s figures are reliant on data that is a decade out of date. I suspect the next prevalence survey will find an even larger proportion of children are suffering from these disorders. The real problem is that such a blatatly contestable claim about the mental state of the nation’s children is not met with unbelieving scepticism. There is much assertion about the stigma of mental health but what is most striking is a tendency to over-diagnose and normalise it. For all the protests about a lack of resources, mental health is rising up the political agenda. The new policy orthodoxy says that mental health must have ‘parity of esteem’ with physical health, and care must be prioritised, funded and integrated accordingly.

It is widely agreed that the quality and extent of provision for both adults and children is inadequate. While it is no doubt true that people with serious mental health problems are not receiving the help they need – the extent of mental health problems is inevitably exaggerated by the lumping together of relatively rare psychiatric disorders with the everyday, and apparently growing, problems of bullying and bad behaviour. What makes the report such a depressing read is the authors’ chronic lack of curiosity as to the origins of this remarkable explosion in diseases of the mind amongst the young. They can only recommend the further roll-out of therapeutic interventions in children’s lives; and justify it with a none-too-convincing early intervention dogma, that is as surely as much to blame for the rise in incidences of mental health problems as it is for their prevention.

It doesn’t occur to them to ask whether it is really such a great idea to teach children the lesson that what they need from school is not a good education that might take them out of themselves, but a counsellor to dwell on what’s inside their immature heads every time they get upset. As if that’s not enough, lobbyists are also calling for all teacher training to include mental health awareness. All of which makes the creation of a therapy-seeking generation a self-fulfilling prophecy. We’re already seeing the results of this as undergraduates struggle to cope with the demands of the student bar, never mind their lectures. They demand to be protected from everything from offensive songs (i.e. Blurred Lines) to an alleged ‘rape culture’; and even from the content of their own courses in case they ‘trigger’ a negative emotion. Universities, unsurprisingly, faced with this mass outbreak of students enfeebled by a culture of victimhood and vulnerability, are now complaining that they don’t have the resources to cope with the high numbers of students presenting with mental health problems.

So why are so many of our otherwise healthy offspring apparently afflicted with mental health problems like never before? The maddening thing is that they’re not really all mentally ill. Society is certainly suffering a crippling malady. But it is better understood as a crisis of adulthood, of knowing when to take responsibility, of putting things in perspective, of having the values and the authority, to give children the guidance they need to cope with life’s difficulties and understand that they don’t constitute a mental health issue. It’s just what life is like when you’re growing up; and its only when they understand this that we can be confident that they too won’t be demanding their ‘safe spaces’ on campus.

First published in Huffington Post