The Rising Fall in Mental Health (part 1 of 3)
Wherever you go mental health and wellbeing are being discussed, in news reports, in discussions with friends and relatives, adverts on radio and TV and even billboards, podcasts, in magazines on supermarket shelves, as well as in professional books, publications and training – mental health services are buckling under the strain of an ever-increasing burden of need. Particularly services supporting our young people.
At a rock festival in June 2023 the lead singer of Disturbed asked for people to raise their hands if they or someone they knew had experienced depression, (attempted) suicide, addictions, or mental health problems: a sea of hands went up.
This blog (actually, it’s turned out to be a pretty long read, and is now a trilogy) takes a largely random walk around some of the statistics and issues related to mental health today.
Researchers, social workers, mental health workers, teachers, doctors and so many other allied professionals, are struggling to keep up with the level of need. It’s also got a lot worse than when I wrote another blog post in 2017 about politics and the causes of the then already worrying mental health crisis. I have republished that post on this site, at the end of this trilogy.
Of course the very recent Covid19 pandemic has had an enormous impact, but what other factors are there in our modern lives that could be taken into account? Has Covid19 enabled us to be more honest with ourselves as a society, more open to diagnosis? Is a mental health crisis a first world problem? What is the impact of the fragmentation of our society, our individualism, the decline in communities, the rise in our dependence on AI and the Internet? Are we developing a lifestyle and a society that is making us mentally and emotionally sick?
I will touch on some of these subjects, but, without the benefit of hindsight yet, there can be no definitive answers. But the least we can do is try. Because our lives may depend on it. Because ultimately, with our helping professions buckling under the weight of need, we need to consider how we can help them help us. In my experience, information and understanding are the first steps, and this is where I shall begin; some of it will resonate with some readers more than others.
Part 1 – Statistics / Childhood, the Internet & the Online Brain
Part 2 – Loneliness & Happiness
Part 3 – Overcoming & self help / Human Givens
SHOCKING STATISTICS
Statistics can be used lie. Interpretation is just that: interpretation. And sometimes answers give us more questions that we started with. But, here goes:
More than a third of Scottish school pupils now have additional support needs (ASN), reaching a record high of 241,639 children. The figure has more than doubled since 2012 when 118,011 cases of autism, dyslexia and mental health problems were recorded. BASW Professional Social Work Magazine, January/February 2023, p.9
This was the statistic that sowed the seeds for this blog trilogy. How can any society cope with one third of their population being deemed to have additional support needs? How will this affect children’s perception of who they are and their self-esteem? Will they consider themselves to be adults who need additional support? What will this do for their education and job prospects? These might be valid questions anyway, but when it is one third of the population the long-term impact on how that support is provided and by whom could have significant implications for all types of social services, and even the economy.
One in four of all children in Scotland are referred to children’s social care before their fifth birthday. Whilst the number of children being investigated varied from County to County, the levels of investigation ‘had little relationship to levels of deprivation’. BASW Professional Social Work Magazine, March/April 2023, p.7
There are so many statistical questions this article raises; not least how many families have been impacted and why the investigation rates for child protection (safeguarding) varies so widely from County to County? But one theme running through the article is that the research suggests the rise is fuelled by a fear among professionals of being blamed should warning signs deemed to have been missed.
Anxiety, fear, depression. For individuals, professionals, families, the blame culture of our modern society is making people more vulnerable to suffering from mental health problems.
People living in cold homes are more likely to experience severe mental health problems ….
Science Direct, cited in Understanding Society Annual Report 2022 (www.understandingsociety.ac.uk)
As a social work professional, I don’t find this at all surprising. Nor that lone parents, long term sick, unemployed, black people, and those who live in rented accommodation are more likely to be living in cold homes. The links to poverty and deprivation and poorer mental health are strong.
Furthermore, according to Church Army inFocus, January-March 2023, 7.9 million people are going without heating or electricity and 8.5 million are skipping meals, due to the cost-of-living crisis, whilst 20 million people have completely stopped all leisure or social activities. Although skipping meals and going without heating in the winter are serious problems that will affect physical health and make people feel miserable, stopping social activities will make more people more vulnerable to mental health problems arising from loneliness, given the importance of social networks and connections in maintaining good mental health (see Human Givens section in part 3).
An estimated 1 in 6 people in the UK has a mental health condition and evidence shows that individuals with poor mental health have a lower income over their lifespan than those whose mental health is better. Previous research has also shown that workers with poor mental health were much less likely to take part in company pension schemes than other workers, potentially leading to financial hardship in later life.
The intended consequence of automatic enrolment [in workplace pension schemes] was to increase savings rates in general … But the change also had a successful unintended consequence: closing the mental health gap in workplace pension participation.
Science Direct, cited in Understanding Society Annual Report 2022 (www.understandingsociety.ac.uk)
To what extent this unintended consequence helps tackle the issue of the rising numbers of pensioners being pushed into longer-term poverty (also from the Understanding Society Annual Report 2022) is yet to be seen.
Children are getting unhappier. State of the Nation 2022: children & young people’s wellbeing, published in February 2023, is the fourth annual State of the Nation report since being introduced by then Prime Minister Theresa May in 2018. Despite some obvious flaws in the data sets, the conclusions are that largely children’s overall mental health has recovered compared to during the Covid 19 pandemic, but concerns remain due to greater levels of anxiousness among secondary pupils, and an increase in low levels of happiness with family and friends, both of which have mental health implications.
From September 2023, according to the Local Government information Unit (LGiU) (29.5.23), the Met police will stop attending emergency calls related to mental health incidents, unless there is an ‘immediate threat to life’. This is in the face of a ‘significant rise’ across Great Britain in the number of calls to mental health incidents over the last five years. However, the plan is a part of the Right Care, Right Person (RCRP) scheme that should ensure mental health calls are dealt with mental health professionals.
Chhildren & Young People Now, January 2023, p43 reports on the situation for children detained for mental health reasons. Including the case from November 2022 of one teenaged girl spending two days in a police station due to a lack of psychiatric places. Even though detention (or sectioning) under the Mental Health Act is only ever a last resort. Child and Adolescent Mental Health Services (CAMHS) are not keeping up with the decline in mental health of children and young people in the UK. And a small scale qualitative study carried out by Coram International found “voluntary” admissions to mental health units were “coercise” and that the patients stays had left the young people feeling manipulated, powerless, with uncaring staff and punitive punishments. The lack of non-residential mental health care had meant they had had to reach breaking point before receiving help. There is a lot of work to be done to bring children’s mental health services anywhere near up to standard.
Nearly one in five pupils aged 7 to 16 are thought to have a mental health disorder, according to a report from the Local Government information Unit (11.6.23). Mental health support teams (MHSTs) were established by the UK Government to work with students in schools and relieve the burden on the NHS. However, the report states that data obtained by the Liberal Democrats indicate that nearly three quarters of primary schools and nearly 50% of secondary schools will not have access to MHSTs by the end of 2024.
This is another shocking statistic like the one from Scotland above, representing 20% of current school pupils thought to have a mental health ‘disorder’.
Similarly, First magazine, June 2023, p.12, states: In 2022, one in six children aged 7 to 16 had a mental health problem, an increase from one in nine in 2017. Although the statistic is slightly different to the LGiU statistic above, this is particularly useful for its comparison to six years ago, showing a significant increase. As a magazine for local authority councillors and staff, First focuses on political consequences and actions, such as issues around underfunding of services, and national discrepancies in service provision, with particular concern for a lack of early intervention and support. From the same issue (p.29) First highlights that … evidence shows that the mental health needs of the very young – which present differently than in older children and young people – are not well understood and often overlooked. And goes on to promote a new toolkit from Unicef available free online to support local authorities and professionals working with very young children.
Professional Social Work Magazine, BASW, January/February 2023, pp18-19, reporting on the Safeguarding Pressures Phase 8 report from the Association of Directors of Children’s Services (ADCS), highlights again some of the statistics above:
- 2.77 million initial contacts were received by children’s social care in 2021/22, an increase of ten percent over the last two years
- 16% increase in early help assessments in the same period
- 21% increase in referrals to children’s social care since 2007/08
- 28.9% of the reasons for early help in 2022 were child mental health
- 26% of social care assessments were due to poor parental mental health and a further 17% for emotional abuse
- ‘probable mental disorder’ has risen from one in nine children and young people in 2017 to one in six in 2021
- 23% increase in children accessing mental health services in 2021/22 compared to two years ago
- SEND is now the main pressure on council budgets
Years of austerity and a 50% real terms reduction in local authority budgets have ‘impeded the ability to work with children and families as early as possible to prevent the escalation of need’. The report calls for … urgent attention from government to draw together disparate policy initiatives and pots of funding, to signal a shift away from private sector profiteering and truly invest in children, young people and the public services that support them.
Whilst these figures and recommendations are looking at the wider picture of children’s services, there is a clear concern for the provision of Special Educational Needs and Disabilities (SEND) services, especially that mental and emotional health services will fall behind physical safeguarding issues given comments above about the rise in referrals being linked to professional agencies’ fears of ‘missing’ something.
The UK Government’s two-child limit on welfare benefits has not pushed more adults in larger families into work, as expected, but rather deepened their poverty and negatively impacted their mental health, as families have faced difficulties over the availability and cost of childcare and choosing to care for their younger child(ren) themselves, according to the Local Government information Unit, 3.6.23. I can’t help but think here, who was surprised other than the government!
Other statistics show a rise in children with mental health problems: c.2015 – approximately 10% of children and young people have mental health problems that are severe enough to require professional help – taken from training handouts for a course “Young People, Mental Health & ADHD” in February 2016, from lifetrainUK
According to NHS Digital, 2020 – 1 in 6 school age children has a mental health problem, compared to 1 in 9 in 2017 and 1 in 10 in 2004
A 2022 BBC News report cites the rise in young people needing specialist treatment for severe mental health crisis as 77% since 2017 while A 2022 Children’s Society report puts the likelihood of young people having a mental health problem as having increased by 50% in three years
A National Education Union survey of more than 18,000 union members found that 66% of teachers and 57% of learning support assistants believe their school college or nursery does not provide enough access to CAMHS (Child & Adolescent Mental Health Services) for students. A quarter of teachers and a third of LSAs said their place of education provided no access to CAMHS. That’s a shocking overall total of some 92% of schools, nurseries and colleges with no or inadequate access to mental health provision for students. Children & Young People Now, May 2023, pp5-6
Even without more detailed analysis the figures can be seen to be comparable. A jump from 10% to 17% of children experiencing severe mental health problems. Although mental health problems in children were already slowly rising, the pandemic has accelerated the problem for today’s young people.
What happened in those years that could have brought on this rise? First suggestion: the introduction in 2007 of the smart phone as we know it today. Before then smartphones were mainly the preserve of businessmen.
When I left the UK to travel abroad in 2010 the touchscreen smartphone with mobile internet connection was still unusual in the hands of many people, and especially children. By the time I returned to the UK in 2014 I was already a dinosaur because I didn’t have one. By then, 73% of US teenagers had a smartphone. By 2022 that figure had risen to 95%. It is unlikely that UK figures will be very different. The statistic of 10% of children with severe mental health problems pre-dates Facebook. For young people today Facebook’s old hat, a place for parents to hang out. YouTube, TikTok, Snapchat, and Instagram, are where young people are more likely to be found now (for now). Choices of social media platform are influenced by gender and race, which may impact on how ‘influencers’ target vulnerable young people. It’s easier to target misogynistic messaging, such as perpetuated by Andrew Tate, when your primary audience is boys.
The second suggestion is the elephant in the room – the Covid19 effect. It’s almost as if we have a collective desire for amnesia, a need to forget a time too awful to remember. A collective mental health issue. But it happened, it’s a part of our history even if we want to deny it, and it’s unchangeable.
For two years our entire society faced being prevented from seeing family and friends, isolated from work colleagues and even from a cheery hello and chat with the chemist or post office clerk. The urge for that sense of normality, that compulsion to be a part of a community, to interact with others whether families, friends or colleagues, at the root of so many breaches of lockdown rules, and, ultimately, what has been a surprisingly rapid return to ‘normal life’.
Covid19 affected all generations: babies and young children lost early socialisation skills; middle school children suffered with adapting to online learning; teenagers and younger adults should have been out and about doing the whole meet, greet, date and mate routine at the same time as experimenting with their peers to find their adult identities; young parents were challenged by meeting their children’s developmental needs without the support of extended families; older adults were thrown into a new isolation and working from home, and our oldest generations were left in fear of social interactions in the face of catching a disease that could quickly kill them. It’s no wonder we are taking time to recover mentally and emotionally.
CHILDHOOD, THE INTERNET & THE ONLINE BRAIN
Depression, isolation, poverty, pressure to conform, always being under the spotlight. Reminiscent of George Orwell’s 1984. A child growing up in the 20th Century would likely have periods of time away from adult supervision, out playing or going on mini adventures. Sometimes they might get into difficulties, but, usually with friends, they survived only slightly scathed.
Today’s children have lost those freedoms: parental fears of paedophiles and murderers lurking to attack or abduct their children, declining sense of belonging to a community, greater travel and movement away from family and support networks, leading to ever increasing parental supervision. This is touched on further in The Kids Aren’t Alright, below.
Technological advances such as phone tracking have facilitated this further. Yet the human condition hasn’t changed, children’s developmental needs as they enter adolescence haven’t changed: the need to explore, experiment, learn how to take risks, and ultimately find what will become their own adult identity – things that have always been done with peers and not under close adult supervision.
At the same time the Internet has brought new dangers as children and young people are exposed to online grooming, and false information they don’t yet have the skills to discern. Living their lives in the public domain they are under pressure to appear perfect, and not just physically: there is no room for taking risks and learning from mistakes. Malign influencers such as Andrew Tate, with his online misogynistic messaging to boys and young men affect their ability to form healthy relationships. Children are having to practice critical analysis long before they would normally be at that developmental stage in their lives. (Help children challenge unhealthy messages on social media in RSE, Children & Young People Now, February 2023, p.13)
Books have been written, seminars attended, research conducted, and even proposed new legislation in the form of the Online Safety Bill, to help parents and professionals protect children from the dangerous side of the Internet. Yet it seems that no sooner are these written than they are out of date. The Online Safety Bill originated with a white paper published in April 2019; it was introduced into the House of Commons in March 2022; in June 2023 it is still at the Committee stage in the House of Lords. In that time it has already faced amendments as new dangers have emerged. Children & Young People Now February 2023, p22.
There have been various research conclusions about the relationship between ‘screen time’ (including TV) and children’s mental health and vulnerability to ADHD and ASD. Websites advising parents of children with ADHD tend to lean towards dismissing or minimising the impact in favour of the perceived benefits. But among professionals and researchers concerns remain, whilst recognising that we still know very little about the impact of screen time.
As early as 2004 Pediatrics Vol 113, No4. April 2004, published a research paper entitled Early Television Exposure and Subsequent Attentional Problems in Children. It concluded: Early [age 1-3] television exposure is associated with attentional problems at age 7. The paper was clear to state that the findings did not indicate that early television exposure would lead to clinically diagnosed ADHD, but could not rule out a link and that more research was needed.
More recently, Dr Aric Sigman, discussed the links between recreational screen time and neurodivergent disorders in the 2022 Human Givens podcast. Sigman describes ‘gaming’ as now being a recognised addiction with evidence that someone with a gaming addiction shows the same changes in the brain as someone with a drug addiction. Even without convincing evidence of a neurodivergent link, excessive recreational screen time has clear negative impacts: including on physical health due to lack of exercise and eating more leading to obesity; myopia due to changes in the development of the shape of the eyes; increased risk of heart disease and diabetes; poorer impulse control; impaired of attention or concentration skills; lower educational grades; sleep deprivation (blue light syndrome); impaired social development due to lack of real time and environmental engagement with the natural world around them.
Whilst the podcast recommends limiting children’s recreational screen-time to 2 hours per day (over the age of 5), this isn’t something that can be just implemented suddenly at a later date.
The “online brain”
More specifically, World Psychiatry published a paper entitled The “online brain”: how the Internet may be changing our cognition (18:2 June 2019).
The article mentions that even before the Internet was invented, scientists and researchers knew of the brain’s malleability due to its “neuroplasticity”: repetitive actions can bring about physical changes in the brain, or withdrawing from social interactions can accelerate changes in natural aging in the brain. And the article cites research (Zhou, Montag, Scarlyska, 2019) which showed that ‘six weeks of online gaming caused significant reductions in grey matter within the orbitofrontal cortex, a brain region implicated in impulse control and decision making’.
Researchers are still investigating the extent to which the impact on the developing brains of children and adolescents are affected by environmental factors, and how the multiple pathways through which the Internet could also affect our brains’ structure, function and cognitive development. Particularly relevant as we now have a whole generation of “digital natives”: young people growing up only knowing what it is like to live in a digitally connected world.
As well as reinforcing the view that the Internet has a tendency to reinforce compulsive behaviours (collecting followers and ‘likes’ and through gaming) it also notes a reduced the need for the memorisation of facts, replaced with a skill of searching for facts. Whilst the Internet can provide for an enormous storage of facts and data, that doesn’t transfer to our human ability to analyse and understand how to use that information. Education providers have observed a detrimental impact on the Internet on children’s attention, saying “today’s digital technologies are creating an easily distracted generation”, and although the research shows different results for different types of cognition there does appear to be a negative impact on tasks that require sustained attention, due to a susceptibility to irrelevant external / environmental stimuli. “Media multi-tasking” doesn’t necessarily translate into improved multi-tasking in other areas. Longitudinal studies are indicating the development of attentional deficits in early adolescents. Indirect consequences of media multi-tasking could include reduced engagement in academic and school activities, poor sleep and creative thinking activities.
On the positive side, for older adults the internet can provide ‘cognitive stimulation’.
This is an evolving area of study in what is effectively a global real-time experiment. In the meantime I think I might just try and curb my media multi-tasking activities.
As adults, as carers, as professionals, we need to understand how a young person is engaging online. In the case of Tallulah drastic action to protect her online proved fatal, when Tallulah committed suicide after her mother deleted her Tumblr account. The account was one in which Tallulah had apparently created an alternative persona for herself, with a large following for her posts about self-harm and suicide. The question is raised as to whether, in finding her online persona deleted, did Tallulah feel her very self, her whole identity, to have been deleted, and therefore her physical life no longer valid or worth living. Safeguarding Children & Young People Online: a guide for practitioners, Claudia Megele, 2018, Policy Press, Bristol, pp.1-2
I can hardly begin to contemplate how Tallulah’s mother must have felt.
The book goes on to describe another case of a teenage girl obsessed with maintaining her ‘Snapstreak’ on Snapchat alive when her parents confiscated her phone for two weeks. (pp.11-12) Old parenting concepts of the value of sanctions and what comprises acceptable sanctions have had to change in the face of the trauma caused by the removal of what is plainly an addictive habit shared between friends (many of whom may only be on-screen friends and not friends in real life and real time).
Children today have an online experience older adults can barely comprehend, living their lives in neither one world nor another but straddling the two. Personal validation is achieved through posting photos and receiving ‘likes’ from strangers. This sounds, like the reference to gaming above, to be another form of addiction. Which has serious implications for the long-term mental health of an entire generation now and in years to come. Without even considering the risks of cyber-bullying, grooming, radicalisation, or sexting.
It may be that those young people who are now perceived as ‘disadvantaged’ by poverty and digital exclusion may end up being better off in the long run when it comes to their mental health. Just as the world’s leaders in the development of internet services and social media are reported to restrict their own children’s access from a very young age. Do they know something the rest of us seem to want to ignore?
The Kids Aren’t Alright: why young people are detaching from democratic and social norms (1 Sept 2022) Published by UKOnward, a think tank that describes itself as mainstream conservatism.
I have been unable to identify quite what mainstream conservatism means. In the US it sounds similar to what in the UK I would call ‘small state politics’: low taxation, minimal state services and intervention, individualism. In the UK, Byline Times, a Left-wing publication, aligns mainstream conservatism with far right extremism. Given the reference to democracy in the sub-title this could be important. Nonetheless the data comes from several sources I recognise as reliable, such as the Understanding Society longitudinal study and writers such as Jonathan Haidt. If there is any leaning towards the extreme right wing it is in the recommendations rather than the observations and conclusions.
Nonetheless, the information in the report highlights how young people’s lives have changed from the carefree and socially connected lives of the 20th Century, to socially detached and isolated with fewer friends. They are less likely to volunteer or contribute to their neighbourhoods. They are more likely to suffer emotional problems at school and stress at work. And their narrowing social networks are undermining economic mobility. All of these are self-reinforcing, with narrower networks driving greater loneliness and lower social trust. (Full report, first page of Summary, pages unnumbered)
The summary goes on to provide ‘four convincing explanations’: narrow social networks; overprotective parenting; treadmill of modern work; and “always online” culture.
A matter of concern to the report writers is the narrowing of social networks is leading to greater tolerance of authoritarian (army, dictatorship) styles of government amongst the 18-45 generations, particularly those who have not had a university education.
Of particular interest to this blog trilogy is the clear impact of the Internet (online culture) on children and young adults’ mental health, including increased loneliness through declining offline social interactions, poorer access to the jobs market (particularly for more disadvantaged groups), increase in depression and anxiety, rising referrals to mental health services, the negative impact of loneliness on physical health (through increase in stress hormones, increased smoking among those identifying as lonely, and other lifestyle choices).
Young people are becoming less tolerant and less willing to engage with others who hold different views. In looking at the causes of this change, one of the suggestions is the ‘self sort’ theory (Bill Bishop, United States), where people increasingly only interact with others like themselves. Whilst several possible causes of this are put forward, little (if any) attention is given to the algorithms of social media that push adverts and connections that are similar to already held interests and beliefs.
The report refers to what I have said elsewhere, children are subjected to much more supervision than, say, 50 years ago (referred to here as overprotective parenting), which in turn is impacting on their ability to socialise, learn to assess risk, develop independence skills, whilst absorbing parental fears and anxieties, increasing the likelihood of mental health problems in children and young people.
For younger adults work is more stressful and less social than for earlier generations, increasing depression and anxiety among 18-34 year olds.
Interestingly, the report reasonably concludes, from a confusing array of inconclusive statistics, ‘there is a lack of evidence that socialising online impacts on the quality of friendships’, however, ‘reliance on technology for making friends and securing social validation appears to be strongly correlated with social and democratic detachment’.
Whilst the report’s concern is primarily about young people’s lack of democratic engagement, preferencing authoritarian styles of government over democracy, some of the proposed ‘solutions’ should also help young people develop better social skills and improved mental health. These are: Establishing new and ambitious civic service schemes to encourage young people to mix with a wider group of others from different socio-economic backgrounds. Encourage a national network of ‘independent play’ clubs, supervised by parents or volunteers (although I am not sure how much this will really help counter the issue of overprotective parenting). Encouraging volunteering to support public services or civic activities through employment flexibility to allow time off from work. And mandatory age and identity checks for social media usage.
Full pdf of report available from here
LONELINESS
If there is one subject that seems to encapsulate the impact of changes in our society over the last couple of centuries it is probably the hidden rise in loneliness. We have never been more connected, yet never more lonely.
To be continued in part 2