Few people know more about the current state of adolescent mental health in the UK than Paul Stallard. He’s professor of child and family mental health at the University of Bath, where he leads the child and adolescent mental health research group. He’s also a consultant clinical psychologist with almost 40 years’ experience of working in child and adolescent mental health services (Camhs). And he has contributed to the UK’s Improving Access to Psychological Therapies programme for children and young people and helped to develop training for childcare professionals all around the globe, as well as working with the NHS in Scotland and the Department of Health.
But even with a CV – as well as experiences and contacts – as impressive as that, he still can’t tell you whether more young people are experiencing a deterioration of their mental health. He says it’s hard to ascertain with “academic certainty” whether or not there are more young people presenting with serious mental health problems today than there were in the past because we don’t have a “good, up-to-date” survey of child mental health problems.
“The last one was conducted in 2004, so it’s already 13 years out of date. During that time, we know there has been a big rise in the use of the internet, new issues have arisen around cyberbullying and body image, and there has been more awareness of the threat and danger of terrorist attacks and natural disasters in the country,” says Stallard. “So it’s difficult to know with any certainty whether there are more mental health problems today than there were a decade ago. But we do know that more children are seeking help from online counselling and telephone helplines and we know the rate of self-harm in young people is increasing, so I suspect that although we don’t have the definitive evidence, there does seem to be a lot of child mental health problems out there at the moment.”
Just a snapshot of recent reports and anecdotal musings back up that claim: in October, children’s helpline Childline announced that it had conducted more than 60 counselling sessions on suicide every day last year – a 15 per cent increase in the number of calls recorded the previous year. And, according to clinical experts, there are a growing number of children and young people being referred to Camhs because of complex and very significant mental health problems, including issues around self-harming, suicidal thoughts and eating disorders.
‘General shift upwards’
Worryingly, experts report that these problems are now more chronic and serious than they have been in the past – a trend Stallard has witnessed, too.
“The sense is there has just been a general shift upwards in terms of the severity and complexity of mental health problems,” he explains. “A lot of our work is linking in with schools who seem to be coming across young people who they are very concerned about – whether they are self-harming, suicidal or extremely unhappy – on a much more regular basis. I’m not able to say if that is down to an increased awareness of mental health problems or if there is an increase in young people who are feeling like this.”
What he is willing to say is that there are a number of factors that are contributing to mental health problems in this age group.
Smartphone technology and social media are two key elements – especially in relation to cyberbullying – but there are a host of other factors that need to be taken into consideration.
“You’ve got the academic pressures and the rigours and demands the government has set for the regular testing of young people,” says Stallard. “Then you have all of the social expectations that are out there and that are propagated by the media, particularly around body image, socialisation and the need to engage in all sorts of activities.
“There is also growing awareness of upsetting and concerning events going on, whether that’s in the country or around the world, that people are having more exposure to. Cumulatively, this means our young people are experiencing lots of different pressures and concerns from lots of different parts of their everyday lives.”
At the same time as these contributing factors are accumulating, many teachers would argue that they have experienced greater difficulty in getting students the help they need from Camhs.
A report in Tes earlier this year documented cases of students putting their lives at risk in order to access services, as they knew that only the most severe cases would be seen (bit.ly/PupilsRisk).
Stallard admits there is a problem.
“The thresholds now might seem quite severe to some schools and referrers because the children who we do see are coming through with some fairly significant and often what we call ‘co-morbid’ problems, where they have a significant anxiety or depression, often with some associated self-harming episodes going on,” he says.
“Then what you end up with is a group of young people at school who are suffering from some form of low mood, anxiety or eating disorder, but because perhaps the problem has not yet become significant enough, they won’t meet the criteria for Camhs and often school staff feel they are left to pick up the pieces with that group.”
So what can schools do to help these individuals who are suffering from mental health problems, but not to such an extent that they are able to access support from Camhs?
Stallard says that, in the first instance, it’s vitally important that teachers try to boost a child’s self-esteem levels by getting them to recognise their own strengths and value themselves. For many children suffering from mental health issues, a member of school staff will often be their first point of contact, so it’s crucial that these people understand mental health issues and know how to discuss them in a positive manner – because if that initial conversation is negative, it can be incredibly damaging.
“Some of the feedback from our young people here in Camhs is perhaps they have tried to talk to a teacher about self-harming or something like that and some of them have said that because of the reaction from the teacher it made them never want to talk to anybody else about it again,” says Stallard.
On the flipside, he adds that when members of staff have handled these interactions in an appropriate manner, it has provided a real sense of relief to the affected individual. The good news for teachers is that creating a positive outcome from these conversations is relatively straightforward.
“Staff need to engage in conversations with children in a caring, empathic, open way rather than being judgemental, critical or wanting to jump in too quickly with a ‘let’s sort this out’ attitude,” says Stallard. “Just giving young people an opportunity to express how they are feeling can in itself be a very positive experience, without having to go into any wonderful whizzy intervention.”
Stallard adds that, generally speaking, he thinks that schools are doing a decent job of tackling the issue of mental health in young people, but he says the starting point is always that we could do better.
“I think there is some very good practice going on in some schools, and some schools are very tuned into the mental health needs of young people and are very actively looking after their children,” he says. “They are identifying those at risk, identifying those who might be in stressful situations and putting in support care and low-level interventions to help them cope.
“But I’m also aware that schools are very busy. That they have lots of pressures in terms of academic targets. That schools are under staffing and financial pressures, which means that school staff themselves are going to be struggling to cope. Knowing that mental health problems in adults are quite common, a number of school staff will have their own psychological problems, too, which might get in the way of them being able to provide anything else to their students.”
Teachers, of course, should have more help here when supporting students, but the lack of Camhs funding remains an issue. Although Stallard says that some investment is being made by the government into these services, question marks remain about whether the level of investment is enough.
As for prime minister Theresa May’s ambitious aim of each school having a mental health-trained member of staff, Stallard doubts this will ever happen, although he welcomes any initiative that promotes a greater understanding of mental health problems among young people and he says that some Camhs teams are making good inroads in this area.
“I am aware of a number of Camhs teams who are reaching out into schools so they have much more of a presence,” says Stallard. “They might work one day per week in a secondary school so that they can be there to provide specialist advice to staff; they can talk to staff about young people who they are worried about; they can provide drop-in sessions for young folk and they can provide some assessment to help identify those young people who are most in need of support.
“So I think the in-reach of mental health services into schools is to be welcomed, and developing expertise within the schools by providing a school mental health expert would also be a good idea.”
The main thing that is needed in all areas of a young person’s life, though, is an openness to the issue of mental health, says Stallard. If there is one thing every teacher needs to remember, it is that this is not something to speak about in hushed tones or to be embarrassed about. If we are to really help young people, we need to force mental health into the open.
“Mental health is everybody’s business,” he explains. “We all have opportunities to promote mental health and to try and care for those people who perhaps might be having some difficulties. The key message is don’t be afraid of mental health and don’t be afraid to talk to young people about it because, firstly, I think some of those conversations can be very reassuring for young people, but also they can pave the way for that young person being prepared and motivated to seek some help to try and change things.”
Simon Creasey is a freelance journalist based in Kent