‘We’re encouraging young people to talk about mental health but, when they do, the support is not always there,” was the key message from last night’s Dispatches: Young, British and Depressed on Channel 4.
Last year, there were 700,000 referrals of children and young people into mental health services – a 45% increase in two years. What questions should we be asking about such a sharp rise? Can it really be that this generation’s teenagers are inherently more sad, anxious or vulnerable than those of the past?
Bringing together critical voices in psychiatry and psychology – clinicians who look towards social change as a means of preventing mental distress, rather than always seeing people as fundamentally disordered or damaged – Young, British and Depressed asked if we are too quick to medicalise young people’s emotions. As a headteacher in a highly deprived area of London said on camera: “It is a difficult time to be a young person, particularly in areas of deprivation and poverty.”
No doubt. Poverty and social inequality are known to be the greatest causes of suffering on Earth – particularly for children. The proportion of children living in relative poverty in the UK risks hitting a record high by the end of this parliament. Government pledges to funnel millions of pounds into improving mental health provisions are farcical in light of such endemic suffering caused by continued austerity measures – including further cuts to already buckling services.
The reporter Sanah Ahsan spoke to those who have been waiting six months (or more) for talking therapy, including a teenage girl who harmed herself with intent to end her life. Such waiting times are an unequivocal injustice for anyone feeling mentally unwell. Pressurised GPs often prescribe antidepressants to young people in the interim. Many may find the medication helpful. However, as one GP interviewed said, it is “far from ideal” – and this echoes the majority view.
Of 1,000 UK GPs surveyed in the show, 86% agreed that the prescribing of antidepressants has increased due to problems accessing specialist services. Only 1% feel this is the best treatment for depression. In fact, only one type of antidepressant has been shown to be effective and recommended as a treatment for depression in children and adolescents. Dr James Davies, a psychotherapist and mental health researcher, explained how withdrawing from antidepressants can often take longer than the seven days stated in clinical guidelines. A young man spoke of his months-long experience of “brain zaps”. The guidelines are currently being updated.
Another key question raised by the programme was whether the abundance of anti-stigma campaigns geared towards young people is having an inverse effect. It is often suggested that increased referrals to mental health services shows how young people are feeling empowered to express their distress, gaining new language with which to do so. This may be true. But the “talk to someone” message means very little if there’s no one to talk to. Jenny, a young person featured, says: “These campaigns are asking people to reach out for help, it’s OK to feel this way, it’s OK like there’ll be help there if you reach out. There isn’t. There isn’t help. And so I actually think it’s dangerous that we’re telling people that and it’s not the case.”
Awareness is not the problem; providing care to people who need it is. Speaking critically of such well-meaning campaigns can be seen as controversial. Yet many senior clinicians now feel what we are saying to young people needs to change.
The NHS psychiatrist Sami Timimi, who works with children and teenagers, said young people are too readily diagnosed with mental illness, when many will be responding reasonably to the difficult business of growing up. “We’re promoting the idea that we should talk about things more often and it’s OK to have a mental health problem, but it’s made us afraid of emotions,” he said. “It’s as if, when you experience intense emotions, that’s a sign that you’ve got a mental health problem, that’s a sign that there’s something wrong with you.”
Timimi, plus others interviewed like the clinical psychologist Lucy Johnston, argue that readily putting young people’s intense emotions into the bracket of mental illness does little to encourage emotional resilience. Johnston was a key interview because she has, along with other senior psychologists, spent five years developing a new framework as an alternative to traditional psychiatric diagnoses.
As was caveated several times, diagnostic terms can be helpful for some. A diagnosis is also, currently, required to access NHS therapy. Davies argued that we need to move away from medicalising young people’s distress, in which labels – that can significantly change how a person views their normal ups and downs – are not necessarily needed. For example, a common NHS approach for borderline personality disorder is dialectical behaviour therapy, which often requires patients to attend “pre-commitment sessions” to establish that they are “owning their diagnosis.” How can this be right when the label itself is so woolly and controversial?
The implication is that we are, potentially, creating a huge group of people who believe they have perennial mental illness; creating long-term patients of the future. We need more programmes like this and, at 30 minutes, it wasn’t enough. Dissenting voices like Johnston are often condemned, but with record numbers of young people entering mental health services that cannot cope, it is time we started asking difficult, deeper questions about what’s going on.
