Under pressure

Childhood and the teenage years are a time of emotional as well as physical changes. What services are in place to support the mental health of the nation’s youngsters?

When most people think of health for the six to 18 year age group, minor ailments and immunisations often spring to mind. Yet children’s mental health is a significant issue in the UK. The proportion of 15 to 16-year-olds who frequently feel anxious or depressed has doubled in the past 30 years, according to the charity YoungMinds, and one in 10 young people now experience a mental health problem.

In mid-February 2016, the Duchess of Cambridge guest-edited the Huffington Post website and used it as a vehicle to launch ‘Young Minds Matter’, which brings together a number of charities to discuss new ways of tackling mental health awareness in children. The children’s mental health charity Place2Be highlighted that one in five children will experience a mental health difficulty at least once during their first 11 years and many adults with lifetime mental health issues can trace their symptoms back to childhood.

“We shouldn’t underestimate the huge amount of pressure young people are facing today, including family breakdown, stress at school, body image issues, early sexualisation, 24/7 online networking, bullying on and offline and uncertain futures when they leave school,” says Lucie Russell, director of campaigns at YoungMinds.

“We need to ensure young people are equipped with the skills to deal with these pressures and to navigate positive paths into adulthood, and to make sure that if young people are struggling they get help as early as possible before their problems reach crisis point. If we neglect young people’s mental health, it will lead to thousands with enduring mental illness, cause years of suffering and cost huge amounts to this country’s health and social care budgets.”

Common pressures

According to the NSPCC-run ChildLine, the pressure for the “perfect online life” is being blamed for a nation of “deeply unhappy” young teenagers. Many are dealing with fears and worries that didn’t exist 30 years ago. In January 2016, ChildLine found many children reported that the ever-growing influence of the internet in their lives was leaving them feeling isolated, with many saying that social media led to them comparing themselves to others and feeling inferior, ugly and unpopular as a result.

“Children and young people inhabit an online world that means they live their lives in the public domain, constantly needing reassurance from others in the form of likes and status updates,” says Lucie. “A recent report by YoungMinds and Ecorys called Resilience in the Digital World stresses that the digital world can offer huge social and emotional benefits, and that many young people with mental health conditions go online to research their conditions and reach out for support. But messages, images and peer discussion can also reinforce negative beliefs, while excessive use of social media is associated with depression and lower self-esteem. Some dedicated sites on the so-called dark net also promote negative and destructive behaviour.”

Schools are becoming more like exam factories, and university entry has become more competitive and expensive. Geraldine Walford, consultant in paediatric and adolescent psychiatry for medical helpline Dr Morton’s, says high stake tests at the end of primary school mean children are experiencing exam stress at a younger age. “This continues all the way through schooling,” she says.

“Teachers and parents put pressure on children by testing them all the time, which means a lot of the creativity and spontaneity of childhood is now gone. Bullying is another big issue and can lead to exclusion and isolation. But it is no longer confined to schools. Cyberbullying can now happen in children’s own bedrooms, which means they have lost their only secure place in their world.”

Body image is another source of distress for many young people. In 2013, Girl Guiding UK reported that one in five primary school age girls say they have been on a diet, while 87 per cent of girls aged 11 to 21 think that women are judged more on their appearance than on their ability. “Children seem to be preoccupied and worried about their appearance, and this applies just as much to boys and girls,” says Geraldine. “Eating disorders are still on the rise in children and teenagers, poorly managed acne can lead to scarring and obesity is on the increase.”

Seeking help

In November 2015, a campaign launched by Time to Change in partnership with YoungMinds – ‘Mind and Rethink Mental Illness’ – revealed that 55 per cent of parents have never spoken to their children about mental health. Some 45 per cent of parents said they didn’t feel the need to discuss the subject and 20 per cent said they chose not to because they didn’t know how to tackle it.

“Bullying, body shaming, sexting, et cetera, all put pressure on children at a very important stage of development – particularly the development of self-identity,” says developmental psychologist Karen Sullivan, author of Kids Under Pressure.

“Parents need to be alert and ensure that their children have time away from screens, time spent talking, relaxing and communicating within the family unit and time out of the house for sport or music – anything that helps to reduce the impact of stress and builds self-esteem. Emotional and physical health are inextricably linked, and everything from poor diet to inadequate sleep can affect moods and emotional wellbeing.”

According to Place2Be, which focuses on providing in-school support, only just over a third of primary schools report that their pupils currently have access to a school-based counsellor. Of those that do have access to a school-based counsellor, 59 per cent are on-site for one day a week or less. “Primary school leaders are well aware of the challenges that their pupils face, whether it’s coping with parental separation, the illness or death of a loved one, or even witnessing domestic violence or substance misuse at home,” says Catherine Roche, chief executive officer of Place2Be.

“The vast majority are already working hard to support them so that they’re ready to learn and can get the most out of their education. But teachers are not counsellors, and sometimes schools need professional support to make sure that problems in childhood don’t spiral into bigger mental health issues later in life.”

The Mental Health Foundation recently launched a pilot study – ‘Teenage Mental Health: Peer Support in Schools’ – to ensure that every secondary school identifies and implements better practice to safeguard children’s mental health and tackle issues such as teenage eating disorders and self-harm. The charity aims to work with children to improve their understanding and use of self-help techniques, including offering and receiving peer support, to help and encourage them to seek early intervention to avoid mental health problems.

Emotional and physical health are inextricably linked

Graham Doke, mindfulness practitioner and co-founder and director of Anamaya Health in London, believes that mindfulness needs to be used more often in schools. “A significant amount of a mindfulness programme will be devoted to awareness of emotions,” he says. “How they arise and in what forms, and, importantly, their interaction with thoughts to produce behaviours. The lesson is that emotions are neither good nor bad, they simply exist, but when they take over, they can cause unwanted results. So it’s important to be aware of emotions, and how they may grow and compel behaviour.”

When problems do arise, families often struggle to access NHS children’s mental health services. According to a survey by the NSPCC in late 2015, in many cases, children have to wait for more than five months to get specialist support. “Although the Government has announced an extra £1.4 billion over five years towards child and teenage mental health services, this comes in the context of decades of underfunding,” says Lucie.

“It is crucial that the extra investment the Government has recently announced is used to transform mental health services for children, and not to plug existing gaps. Otherwise, too many young people and parents will continue to struggle to get the support they so urgently need.”

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We need to ensure young people are equipped with the skills to deal with these pressures and to navigate positive paths into adulthood

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