It’s children’s mental health week, and children’s mental health has probably never had a higher profile in news media. It’s a subject that people love to worry about, as well as deny and neglect. It’s been a ‘crisis’ since at least the 1970s. And yet we are no closer to agreeing on its root causes, and a debate continues about whether the data really supports the existence of anything even approaching a crisis.
What is clear is that children’s – let’s say ‘youth’, as we’re talking about 0-24 years – mental health is vitally important: 75% of lifetime mental illness emerges by the early twenties, so the earlier we intervene, the less likely we are to see more complex, acute (and expensive) illness emerging later.
The data
Inequality experts Kate Pickett and Richard Wilkinson recently noted that the global clinical data on youth mental health is so poor, proxies such as suicide rate or life satisfaction tend to be utilised. In England, the prevalence of common mental health conditions among youth has been measured substantively three times in the last four decades, in 1999, 2004 and 2017. These involved diagnostic, DAWBA-structured interviews, with parents for 10 year olds or younger, alongside a diagnostic questionnaire (the SDQ). They used highly medicalised language, which changed between surveys due to shifts in methodology. The 2004 survey was followed-up in 2007, and the 2017 survey was followed-up in 2020, 2021, 2022 during the Covid-19 pandemic, and 2023. The follow-ups used only the SDQ.
Between 1999 and 2004, not much changed; around 10% of 5-15 year olds had a ‘mental disorder’. By post-pandemic 2023, 20% of 8-25 year olds had a ‘probable mental disorder’, higher still for 17-19 year olds (23%), than other age groups. The headline is that we’ve seen a steady uptick in ‘diagnosable disorders’ since 2004, with young women fairing worse, though it’s not clear when the increase began.
Commentators have picked holes in the data and survey methodology, and argued that prevalence is inflated by the expansion of diagnostic categories, and pathologisation of normal distress following awareness-raising initiatives. What is indisputable is that demand for youth mental health services has increased dramatically over the past few years, despite increases in NHS clinical activity, to a level that overwhelms services’ capacity to respond.
It is of course possible that mental health fluctuates and that these patterns have never been noticed before, because the data hasn’t been collected so regularly. It may also be possible to argue that these aren’t all authentic problems, but only if you are looking for reasons to refuse help to those asking for it.
It would be easy to take aim at health services and point to the fact that only about 11% of the NHS mental health budget (around £1 billion) goes towards young people’s mental health despite their comprising a quarter of the population. This is probably a hang up from an era when children were expected to simply pull themselves together, and weren’t considered capable even of real emotional distress (only ‘attention seeking’).
However, it’s also the case that randomised controlled trials of interventions for mental health conditions (the gold standard of clinical research) show positive outcomes for only around half of subjects. The best thing for mental health is to prevent problems from emerging altogether by addressing their root causes.
Depressing prospects
For today’s young people, all the adjuncts to peace of mind available to previous generations – secure employment, a stable family life, a home of their own, the option of obliviousness to the horrors of the world surrounding them, and avenues for avoiding tokenistic, transactional relationships without risking ostracism – are less and less available.
This has meant that living the life they expected to live is harder, if not impossible, not only on a material plane, but on a psychological one too. Materially, for example, younger millennials in the UK are earning 8% less at age 30 than the generational cohort before them, and, in terms of wealth, a typical late 30-year-old in 2018-20 had £30,000 less than similarly aged people in 2006-8.
If you cannot realistically envisage a positive future, the prospects of depression are magnified
In addition, policy decisions in the recent past that cut working-age benefits, while protecting the basic state pension, have meant income forecasts for pensioners’ incomes outperform working-age incomes across much of the income distribution. Home ownership has become a chimera for young people without affluent parents. Nor do things look like they’re going to improve. This isn’t even a left-coded view of the circumstances, see Matthew Goodwin in UnNerd, for instance. The plight of young people is beyond debate.
All of this creates depressing prospects which occlude the imagining of a positive future for Gen Z. Their living standards (particularly in the UK) show no sign of improving, even in the minor way millennials enjoyed. A psychiatrist making a phenomenological exploration of depression has observed that what is lacking in those that are depressed is often a sense that there could be any meaningful change in the future, often accompanied by an erosion of possibility. It’s worth noting that it was emotional disorders of depression and anxiety for which the prevalence has been increasing. If you cannot realistically envisage a positive future, the prospects of depression are magnified.
As well as the lack of, or precarity of, several foundational elements of Malsow’s hierarchy of needs identified above, there are a number of other factors that evidentially contribute to poorer mental health, economically and otherwise: the direct and indirect consequences of air pollution; the unpredictable consequences of climate change; the exploitative design of digital technologies (especially social media); the commodification of (our) attention; the increasingly instrumental and transactional nature of social relationships; inequality, and (yes, Marx) the general unfairness of the constitution of the relations between labour and capital.
Late capitalism demands individuals dedicated to self-actualisation while denying them the tools necessary to achieve it. These conditions appear designed for emotional instability.
Blaming the internet
Why is it then in recent high-profile books about youth mental health – Jean Twenge, Jonathan Haidt – that social determinants are almost entirely excluded? Does it simply come down to a stubborn refusal to look at the material environments? Is it simply the easiest way of making a compelling case? Haidt (a social scientist) most recently has built on Twenge’s analysis of survey data of US youth and determined that it is smartphones and the internet, rather than the global financial crash, inequality, climate change or any other material condition that correlate best with the uptick in mental illness prevalence.
Smartphones may play a role, but they seem to have done nothing more than magnify and make more accessible the worsening problems inherent in the structures in which we live. Haidt rails against the way social media forces young users to become their own brand managers, without finding fault with the super-structure that inscribes those dynamics. What commentators like Haidt and Twenge have done successfully is locate the most actionable thing that may be contributing to mental unease, but it’s hard not to wonder what this enthusiastic rejection of other causes is hiding.
The dominant narratives about mental health are emerging from the USA, a more prosperous country than England, where prospects for the young are brighter, and which lacks the prevalence data carefully collected here. In addition, despite this country’s attempts at co-production, it’s unusual for anyone to simply ask young people why they’re unwell. While the NHS 10 Year Plan’s mission to shift investment in intervention to prevention is laudable, and should involve far greater investment in support for children and young people, if we don’t correct the glaring issues within our society, the prolonged emotional stress they foment will only continue.
The adults in the room seem rather confused about this – as parents, we’ve been feeding our kids narratives about being good, and doing good throughout their childhood, and then, as they approach adulthood, they discover, in stark contrast to the stories we tell them, that the world is dominated by humans selfishly exploiting other humans.
Somehow, humans are becoming increasingly sensitive to everything, from allergens, to unkind words, and we shouldn’t be surprised that the cohort of young people (millennials) variously referred to as ‘the lost generation’, ‘the empathetic generation’, or simply ‘snowflakes’, has led to a further cohort of young people who are struggling with their emotional wellbeing to the degree that they need specialist help. Perhaps what smartphones have done is to expose children from a younger age to the unvarnished truth about the world in which we all live. As Mark Fisher might have noted, following Lacan, the big Other is no longer able to conceal the truth.
