Talking therapy won't solve the mental health crisis

[dreamydell]

There's a mental health cross among children and young people. What's the only solution that's ever suggested? Talking therapy.

This is ridiculously expensive to deliver en masse and there is no evidence that it even works.

Instead of endless calls for more therapy, can we start looking at some real solutions. And don't say banning smartphones/social media. If anyone seriously thought that was the cause of poor mental health then the first line of treatment would be remove a person's phone. This costs nothing so would be a cheap and effective intervention.

I'm trying to understand the incongruity of the situation. What I hear is: smartphones cause poor mental health. The cure is therapy. Surely the cure is to remove the smartphone if that is true?

@dreamydell well, what “causes” mental health difficulties is very complicated. There has, and will always be, some level of serious mental illness, regardless of anything else. However, I personally think that the increase of mental health difficulties in young people stems from us living in a society that is highly overstimulating, overwhelming and pressurised. Social media and smart phone use just adds to that, but so does school and, tbh, just modern life in general. One of the positives of talking therapies, like CBT, is that it gives children tools to be able to manage some of the stress resulting from this.

@JennieTheZebra
People's lives now are far more isolated from the wider community and extended family than they once were. That's a lack of stimulation not over stimulation. Young people now spend a huge amount more time alone than previous generations did.

Why would life now be more overwhelming than it was 30 years ago when I was a teen?

Yes, I think it’s also important that kids have reliable routine, good attachments including to adults that aren’t their parents and grow up in a community which they’re full members of. Historically, Scandinavia was better at this than us. I think smart phones provide the illusion of connection while letting individuals cut themselves off from society, the antidote is proper face to face contact with other people.

Children aren't in nursery for decades, just until the age of 6 or 7 which to me, as someone who grew up with a similar setup, seems a more appropriate age to start school than 4. At 4 a child should have no formal structured education. They should learn through play and have more free time. My nursery years were excellent and "being looked after by strangers" did not turn me into a dysfunctional adult. Children are also not treated like underage criminals in school with petty rules and focus on conformity. I am sure this is not the only difference between Scandinavia and the UK, though, but it's not a bad starting point.

Perhaps it's a natural development in evolution?

The more we move away from Hunter/Gatherer the more MH problems emerge?

The more you have, the more you want - or think you ought to have to be a "success".

It certainly seems so to me, that our dissatisfaction multiplies with our material gains?

@dreamydell Constant visual noise, adverts everywhere, jobs require much more complex thinking, a screen in your pocket that beeps all the time, pressure from school, constant requirement to be “doing something”. The amount of stimulation has increased enormously.

I don't actually buy that anything has changed much in the actual world in terms of noise and visual stimulation. Where is the pressure to do things when the vast majority of leisure time is spent looking at a phone?

I think the real solution comes in prevention.
For that we need robust research in order to understand WHY there is such a rise in MH problems amongst children and adolescents.
Only then can we take effective steps to prevent it

Move somewhere where children have better mental health

Kids just need to go outside more. Kick a ball round the park, hang out chatting crap on the playground.

I even see kids walking to school ignoring each other on their respective phones. It’s quick dopamine hits in rapid succession, everything and nothing all at once.

Seriously? Everywhere is much worse for noise and visual over stimulation. I'm relieved when a bus stop doesn't have moving ads.

Yes, but kids are in a constant state of “cognitive overload”, so they struggle to effectively interact and would rather go on their phones as it’s easier-but going on their phones makes it worse and we end up in a vicious cycle. There’s lots of evidence that it’s designed that way, particularly to sell us stuff. https://fortune.com/2023/04/25/social-media-cognitive-overload-advertising-professor-explains/

Many cases of anxiety are in ND young people. CBT is often not a helpful form of therapy for those with autism in particular. An inherent part of being autistic is rigidity of thinking so a therapy based around changing your ways of thinking is not likely to be successful. It is by far the most common form of therapy offered on the NHS. There is a type of therapy called DBT which appears to often have greater success rates with autistic people but there are far fewer therapists that offer it, even privately.

I agree with many of the points raised. One thing I'd add is overcrowding. There are just too many people, full stop. In 1900 the world's population was one billion. By 1960 it had trebled to three billion. It's now eight and heading for ten. Africa's birth rate is so high the African population is going to double. If people like Kurzweil and David Sinclair get their way, there will soon be drugs and nanobots extending the lifespan as well, maybe to 130 and beyond. So people won't be dying and making room.

The consequences of such crowding are awful. My local woods have been hacked down to make way for a new housing estate, and a second massive estate has been built at the other end of the village. Now the fields in the centre are going to have hundreds of disgusting rabbit hutch houses squeezed on top of one another. The traffic is so bad I hardly go out, and at night I'm often woken by the screeching and exploding of boy racer cars. Children are very sensitive to their parents' moods and stress levels. We didn't evolve to live this way, and it's making us all ill. A hundred years ago, if you had a bad day, or were struggling to cope with bereavement, you went for a walk in nature. The silence and beauty calmed and restored you. That's now impossible. If I'm feeling stressed, I have to drive to a beauty spot. On the way I'll probably get caught in traffic, or bibbed by someone, then struggle to get parked. And forget being alone with nature. If I sat somewhere, within minutes there would be people passing by. The world is too noisy, too crowded and too fast-paced. By the end of the week, my nerves are shredded. Even driving across town is now an ordeal. Kids pick up on this. They can sense the stress and tension and anger in the air.

@dreamydell are you saying your job is about as cognitively demanding as screwing lids on jars in a factory? The nature of work has fundamentally changed and this also impacts schools.

Yes, I do. My eldest daughter.
Although we accessed the therapy privately because I was so concerned that she might actually go too far with the self harm. We had to remove all sharp objects and medication and I was terrified the referral would take too long. But the therapy was talk therapy and yes it did work. Her depression and anxiety were severe (and she had selective mutism when younger, probably connected). It gave her the tools to understand what was happening and how to overcome it. It didn’t even take that long. She came out the other side a much stronger person. Ten years on she’s in her mid twenties and I cannot believe she’s the same person as back then.

And don't say banning smartphones/social media. If anyone seriously thought that was the cause of poor mental health then the first line of treatment would be remove a person's phone.

Have you actually tried? or at least introduced parental controls to block SM? and then survived several days of withdrawal tantrums to establish proper human communication?
Don't you see how kids are spend hours and hours on screens, even toddlers, why parents doing own things because it's much easier to shut kids down with screens than parent them? of course there is MH crisis, but don't blame NHS for not providing treatments or state for underfunding.

CBT falls under 'Talking Therapies'. CBT has a lot of evidence base around it. It works for a lot of people, which I see every day in my work. It's not going to solve the MH crisis, no, but it does help many people.

We need to be able to offer therapy to young people in a timely manner, but we know that doesn't happen if you fall under CAMHs or secondary care (CMHT).

We need more staff and funding obviously. We also need a whole change in society.

The reasons for the decline in mental health are no doubt complex. A lot of young people have also experienced trauma. There are no easy answers to this.

And yes, I have known young people who have had support from CAMHs or youth services who have indeed improved. It happens, you just don't hear so much about it. I don't think it's so much the treatment that is neccesarily the problem, but the difficulties accessing it and not always being able to have enough of it.

@lavenderlou DBT is based on CBT. CBT is not so much about “changing what you think” as understanding the link between feeling, thinking and acting, and being aware that changing what you do will impact on what you feel and so what you think-which impacts what you do. If you struggle with knowing what/why you feel a certain way then CBT won’t be effective, and this is where DBT comes in. DBT works well quite well for ND individuals as it explains some the underlying principles of emotion regulation/recognition that CBT presumes are obvious. Fortunately, DBT is a very common therapy on the NHS as it can be effectively delivered in groups. Unfortunately, it can be very difficult to get access to it as an ND individual without a diagnosis of EUPD/BPD due to funding, which is an entirely different topic.

Have you actually tried? or at least introduced parental controls to block SM? and then survived several days of withdrawal tantrums to establish proper human communication?

But it would be worth it right? Because after a few days mental health would start to improve, and that improvement would be long lasting.

@MferMonsterSearchingForRedemption
Do you think it's realistic to offer therapy to every child and young person who feels they could benefit? The numbers are absolutely massive.

I read something interesting recently about increasing anxiety in children. The article proposed it was linked to children being constantly hurried. Get out of bed and hurried to get to school. Get out of school and hurried to do activities. The constant rushing and hurrying creates a constant alertness. The child can never relax and chill as they always have to be somewhere doing something.

https://www.psychologytoday.com/au/blog/decision-principles/202408/the-danger-of-hurried-child-syndrome

I would think a combination of this and children only ever seeing highlights of others lives ie social media posts, creates feelings of inadequacy from comparison.

Also social media and mobile phones never allow people to get a break. I seem to be one of very few people who don't answer my phone just because it rings. If I'm speaking to someone and the phone rings, I silence it and don't let it interrupt the conversation with the person in front of me. Same with text messages and emails. I ignore them until I am free. My phone doesn't summon me, but a lot of others are at the beck and call of their phones - when the phone rings/beeps/flashes they stop what they're doing, even mid conversation, and respond to it.

I remember my childhood in the country. If you went out on weekends, you couldn't be called. No mobile phones. It let you enjoy what you were doing and get some mentally quiet time, where you could disconnect and recharge. There wasn't even answering machines, so you never knew you'd missed a call. These days you get a text telling you that you missed a call as well as a voicemail. So you don't get to be oblivious and reduce the demands for your time and attention.

I completely agree with the last point. The research shows that one of the best things for mental wellbeing is a sense of responsibility (having people who rely on you, being part of a community, having a role/purpose). My interventions for young people would be:

• lots of exercise in the fresh air.
• a job or volunteering
• a drastic reduction in internet use.

These would certainly be things that a MH professional would recommend for many patients, but you can't make people do it.