Part 1: Is there a child and adolescent mental health crisis?
Are we currently in the throws of a child and adolescent mental health crisis? If we are, is our current education system in some way to blame?
These questions might seem simple enough, but when we dig a little deeper we find that any kind consensus is thin on the ground. There is certainly plenty of anecdotal evidence suggesting that young people are finding it increasingly difficult to cope with the pressure or daily life, both within and outside school. Some, like Natasha Devon (mental health campaigner and the former mental health champion for schools), point the finger at changes to education that have led to a high-pressure exam culture. Others, including Tom Bennett, a former teacher and currently advising the UK government on behaviour in schools, are perhaps more sceptical. Some have been more vocal in their absolute rejection of both a mental health crisis and the involvement of the education system in perpetuating it.
A recent addition to the debate has come from Professor Neil Humphrey of the University of Manchester in his open dialogue article in The Psychology of Education Review (Spring 2018). For Humphrey, the situation seems pretty clear: there is a child and adolescent mental health crisis and rapid changes within the education system are (at least in part) to blame.
Humphrey also identifies an interesting paradox, in that even though schools have (seemingly) contributed to the crisis, they are also the institutions favoured to help solve it. Problems abound, including our general understanding of what constitutes mental ill-health and how this relates to wellbeing. Certainly, the evidence base for mental health is much wider than that for wellbeing but the two are intricately linked but not necessarily dependent on each other. For example, a person can be low in feelings of subjective wellbeing, yet display no signs of mental illness.
Possible causes of mental ill-health in children and adolescence.
Humphrey suggests that there a number of factors (other than the education system) that could play a role in the increase of mental health problems in young people. It’s worth briefly identifying these in order to emphasise that there is no single possible explanation.
Digital technology and screen time.
This is perhaps one of the more contentious issues of our time. Some evidence suggests that digital technology and the ubiquitous use of smartphones has had a detrimental impact on young people’s mental health and wellbeing (see, for example, the work of Jean Twenge). Others have pointed to the inconsistency of findings and the use of often poor research methodologies in reaching such conclusions.
Humphrey points to Frith’s 2017 report into digital technology that concludes there is, as yet, very little scientific consensus that screen time impacts mental health in young people. This conclusion has also been drawn elsewhere).
While research has found that extreme internet use is associated with lower levels of well-being and higher levels of mental health difficulties, causal mechanisms remain unclear and could indicate that young people with mental health difficulties seek out the use of the internet as a coping mechanism.
Social and family factors.
These factors include income inequality and changes in family structure (for example, the rise in single-parent households, family conflict and parenting styles).
Normalisation and de-stigmatisation of mental health.
Young people are now much more likely to discuss mental health issues and seek help, in part due to campaigns such as Time to Change who have run highly successful campaigns across social media. Young people, therefore, feel that less stigma in now attached to mental illness, raising levels of willingness to disclose. We can see examples of this willingness to disclose in online videos and vlogs where young people candidly discuss their own struggles with mental health.
What does the data say?
The data is generally mixed, with significant differences by gender. Nevertheless, there does appear to be evidence indicating that mental health difficulties are rising while wellbeing is falling.
From the mid-1970’s to late-1990’s there was an increase in the range of mental health difficulties (Collishaw et al., 2004). Followed by reasonable stability, with no significant changes between 1999 and 2004 (Green et al., 2005).
Bor et al. (2004) looked at international studies in order to identify time trends into the 21st century. No change had taken place in toddlers and children but there has been a significant increase in internalising problems (e.g. depression), particularly in girls.
Fink et al. (2015) Found a significant increase in anxiety amongst girls from 2009 to 2014 but a small (yet significant) decrease in boys mental health difficulties.
It’s worth noting here that, in her commentary of Humphrey’s article, Tamsin Ford (Professor of Child and Adolescent Psychiatry at the University of Exeter Medical School), highlights the methodological issues of relying on such data, while Humphrey himself suggests we exercise caution, particularly in relation to time trends.
Wellbeing data is sparse in comparison to mental health data. UNICEF did find that subjective wellbeing rose from the start of the new millennium to 2010. In 2017 the Children’s Society found that wellbeing was now at its lowest level and lower in girls than in boys. Levels of wellbeing, therefore, rose but are now currently stalled.
Prevalence Versus Provision.
One way to approach this question of a mental health crisis is to look at the balance between need (prevalence of mental health difficulties) and provision (the available access to high-quality comprehensive support).
Humphrey cites the following evidence:
Freedom of Information requests by the charity Young Minds revealed major cuts to CAMHS post-2010.
In 2015 the government pledged an extra £1.25 billion to be spent on child mental health services as part of a five-year investment. However, one year later the Department of Health had only made £143 million available when the expected amount was £250 million. Because the investment was not ring-fenced, much of this had been spent on non-CAMHS NHS activity (Buchanan, 2016).
There has been a significant increase in CAMHS referral thresholds and waiting times (House of Commons Health Committee, 2014). Some children had to wait more than two-hundred days following referral.
Twenty-eight percent of referrals were not allocated a service in 2015 (Children’s Commissioner, 2016).
In 2017, the Children Commissioner stated, ‘the government’s much vaunted prioritisation of mental health has yet to translate to change at a local level’.
Childline saw an 87% increase in young people experiencing difficulties accessing local services (NSPCC, 2016)
A combination of evidence of rising need (for some) and reduced provision (for most) does constitute a crisis. This has resulted in an increasing ‘turn to schools’ as a ‘focal point for resolution.’
Identifying a public health crisis is one thing, but identifying the causes of the crisis is something very different. I have offered some possibilities above but have (as yet) resisted a more in-depth examination of the role played by schools and the wider education establishment.
In part 2 I’ll discuss both the possible role of schools in perpetuating the problem and how schools can also be part of the solution.