Guest post: "Are our children more anxious, or are we pathologising adolescence?"

[MumsnetGuestPosts]

Everywhere I turn at the moment, people are talking about adolescents and young people - their entitlement, their anxiety, their isolation, their depression. Running a therapy site that matches people with the therapists best suited to them, I'm always being asked how and where to get help for teenagers and young people by worried parents.

American psychologist Jean Tweng's book iGen claims that for those born after 1995 'the twin rise of the smartphone and social media has caused an earthquake' bringing anxiety, depression, loneliness and a constant fear of not being popular enough, or excluded.

Girlguiding UK's recent poll of more than 1,000 young people showed the biggest worry for 35% of girls aged 11-21 was comparing themselves and their lives with others. Last week the IPPR think tank reported that the number of students who disclosed a mental health problem in their first year rose fivefold to reach 15,395 in a decade.

But hang on now: how real is this epidemic of unhappiness? Could we be pathologising fairly normal adolescent feelings? The teen years are a time of great change. The bodies of girls and boys grow and develop dramatically from childhood into adulthood; we've only recently realised that brain development doesn't really finish until they're in their mid-20s.
Alan Percy, chair of Heads of University Counselling Services, sees a new bunch of 18-year olds every year. He confirms that young adults are reporting they are struggling with symptoms of depression and anxiety 'but the danger is to over medicalise the 'normal' struggles of young adult development.' He feels that rather than jump to treatment, many need to be encouraged to take ownership of their behaviour and feelings, instead of feeling powerless to cope.

One of the problems is unrealistic expectations. 'Young adults feel more overwhelmed by life, but it's important to recognise that for many this sense of anxiety and hopelessness comes from very black and white thinking.'

Cheshire therapist (and mother of teens) Penny Lawson admires how teens deal with the stresses of modern life, but identifies phones as a problem. 'Huge amounts of information coming in throughout the day and into night is having a big effect on this generation.'

She encourages teenage clients to see analyse phone and social media use. 'I ask them to list the good things they get out of it - and recognise the bad. Then they can weigh it up, as if on a set of scales.' Do they take any notice? Yes, she says, but 'I'm not their parent or teacher.'

The World Health Organisation states that across the world 10-20% of adolescents experience mental health disorders; of those affected in adulthood, half had started by age of 14, and three-quarters by mid-20s.

And there's the problem. If adolescence is when things can go wrong, in some cases eventually leading to long-term mental health problems, surely parents need to be serious and alert to problems, rather than simply see it as a common part of growing up?

But, says Percy, parents shouldn't just swoop in to make everything ok. 'As you get older, you have to learn to cope with life's uncertainties. If you fill life with rigid, perfectionist expectations, you’ll feel more anxious and disappointed.' The aim is to let young adults solve as many of their problems as possible. Young adults are grown up when they no longer think it's their parents' job to save them from every thing that might go wrong.

Penny Lawson says many parents struggle with controlling social media, and suffering with social comparisons. 'From the research I've seen, high social media use can be bad for self esteem. If parents don't have skills to navigate it themselves, they can't help their children.'

Where does that leave us? It's not the same world in which I grew up, where I moped in my bedroom but only until boredom got me out to meet a mate, or buy a magazine. But these days the world has permeated that formerly private space. It's brought with it raging FOMO and never-ending, minutely calibrated comparisons between your teen, his or her friends, and enemies. It's no surprise that he or she may be feeling down if they believe they don't measure up.

For some, depression or anxiety may take hold. They may be bullied, start to suffer from eating disorders, feel unable to mix with others, or experience obsessive-compulsive disorder or other phobias and psychological conditions. Therapists and counsellors can help, that's what they're trained to do. But they can also take a walk, go to sleep earlier, take a break from social media, see a good friend, play a team sport. Self-care can help, if they will let it.

As Penny Lawson says, 'These teens are living their lives in the public eye; they're going to behave differently than you or I did, but that doesn't mean they’re going to be a disaster.'

Louise Chunn is the founder of find a therapist platform welldoing.org and will be returning to her post to respond to comments.

[patodp]

George and there'll be pharma cashing in too. (Maybe not your case but plenty others)

rachmac yes it will be interesting research re the long term effects of device use. The blue light frequency emitted is already known to damage the optic part of the brain.

[BeyondThePage]

I think there is a whole spectrum of mental health issues and awareness. People seem to think there is "depressed" and "not depressed" - glass half full types and glass half empty types. Life is not so simple.

I tell my kids that the important thing to remember with that metaphor is that a glass is refillable, it doesn't have to, and will not, stay empty/low for ever, at different points in life there will be different levels, that sometimes you can just fill the damn thing up and start again.

[TeenTimesTwo]

Rach Previously we were "mindful" as we were walking/waiting for a bus etc today young people don't take that mental space they fill that time on a device.

I completely agree with you there. My (adopted) teen has been having counselling for a year. I do think that if she spent more time doing stuff and less online it would be good. When she is busy she is always happier. However at 18 now I can't force her, and being 18 she thinks she knows best.

It makes me sad when you see a bunch of kids, and even if together they are all on their own devices. I think they are missing so much.

[leonardthelemming]

Just going back to lljkk's point:

When kids could truly leave at 16 they used to be able to get any job.
Now that job has to have an education element to it

I'm really not convinced this is the case. This link

www.thesource.me.uk/learning/faqs-raising-the-participation-age/

from Suffolk, suggests that someone could work full time and then meet the RPA requirements by doing an online/distance learning course, part time. There seems to be nothing to imply a training requirement for the work.

So in this way, someone for whom school was not a good fit could work at any job, just as before. If it was school that caused the stress, that source, at least, would be removed.
The difficulty occurs with the education requirement, as any course is supposed to lead to an approved qualification and this could still cause stress for some people. But at least there seems to be scope for a young person to work without having a linked training requirement, and this offers some flexibility.

[randomactsofkindness]

It's good that today's teens have the words to describe how they're feeling - depression, anxiety, etc. Those terms weren't part of our vocabulary when I was that age.

But just because teens can, and do, label their feelings more these days, doesn't mean to say that they're suffering more than previous generations. It's just that previous generations suffered in silence and often in confusion.

I'm concerned that our society is wringing its hands over not being able to "cure" everyone of these extremely common conditions. They are things that people can self-manage or get help with, but there is no cure. The mental health policy at my DCs' school is all about identifying children with these conditions and referring them to people who can "help" (despite the terrible reputation of the local CAMHS service) but there's nothing in there about respecting a teenager's right to deal with their feelings privately if they wish, or empowering them to understand and self-manage their condition by stocking the library with suitable self-help books.

[forcryinoutloud]

One thing we are overlooking here is that I don't think all these problem suddenly begin at the teenage years. Look around your streets, where are the children playing as they used to 20 plus years ago, I certainly don't see any any more. Either parents are too scared to let them out or the children aren't encouraged or want to go outside, they can be inside looking at a screen instead.
In other words, today's teenagers have no foundation that would have (in my generation) been formed in the earlier years when they were outside, engaging with other children, using their imaginations etc etc.

'A poor foundation leads to an unstable house' OK I am generalising but you get my drift.

And for sure, being addicted to a smartphone and social media does not help.

[midsummabreak]

There are a minority - usually, within the upper middle class- who overworry abour every child or adolescent upset. But majority of parents work too hard and just dont have the emotional or physical energy to spend pathologising their adolscent children! Many adolscents just have the usual ups and downs, occassional periods of moodiness or sadness- yes- and majority of their worn out, dying to get a break parents, roll with it and know from chatting to other parents to let it be, and things often sort themselves out , with or without guidance. Agree with others that we should never use the usual adolescent ups and downs as an excuse to ignore the signs from individual children that they are indeed suffering and need their parents to take it seriously enough to get support

[midsummabreak]

Randomactofkindness, Maybe i am wring, but i feel most teens just wouldnt seek out or accept the help easily from a mental health service, anyway? That is why they need support, to identify as having an issue that is impacting their ability to get through usual daily life? So if they are quietly cutting up their arms, as my neice did, they can benefit from someone gently supporting them to reach out and accept support?

[midsummabreak]

Forcryingoutloud, I too have found that the more my 3 teens are busy outside or out with friends ( and off their devices) the happier they really do appear. But trying to cut down on internet & device time is one of the crappiest roles of todays parents of teens!!!! 🙃...... sometimes we manage to support our teens to get a good balance between activities and device/ internet time, but many times it is lop sided towards teens 'pigging out' on their playstations, consoles, phones laptops, tablets...... I do confess to delighting in mumsnet stories of playstations left in buckets of water on doorsteps and the like 😜

[MissBabbs]

One thing is that so many people are 'suffering from depression' when they used to be sad or depressed. Once something is labelled a disease which has 'randomly' afflicted you it becomes something medication or a qualified person must cure. Not something you could fix with lifestyle changes.
I see adults in my voluntary work who are suffering from anxiety and depression but they are often unemployed and with long empty days to fill (mostly with tv and iphones).

[randomactsofkindness]

they can benefit from someone gently supporting them to reach out and accept support?

But, midsumma, can teenagers who are feeling sad and anxious benefit from well meaning somebodies cack-handedly "noticing", telling them what they think they should do about it, and then writing to their parents and the "appropriate agencies" to get them "in the system" for an appointment in 3 months time, that then gets postponed for a further 3 months because they're short staffed, only to eventually meet with someone who is a recent "graduate" of some local college psychology course, and only got into that line of work because there's a big recruitment drive on, and they know what it's like to feel anxious and depressed themselves so thought they'd be good at it?

It's nonsense to assume that we have a huge army of people out there who are vocationally suited to support these extremely common conditions which are also extremely personal and unique to each individual. We need to give teenagers a trusted library of self-help tools, not just refer them to mental health services as a first resort. Mental health services should be reserved for the more complex cases, not swamped with teenagers feeling anxious about feeling anxious or depressed about feeling depressed.

[midsummabreak]

Just because the system is understaffed and underfunded does not mean teens with mental health issues impacting their ability to attend to daily tasks should suck it up without formal support. Many teens with mental health issues may not feel like seeking out a self help book if their mental health is messing with their thinking. But i do agree it would be fantastic for those who are able to benefit from skilling teens up with knowledge on how to look after oneself in regards to mental health issues. Wonderful to include this self help for mental health as part of the curriculum

[moutonfou]

I think we need to focus on the stage before mental illness, i.e. the circumstances which create the potential for mental illness, namely low self-esteem, low resilience, and low mental wellbeing.

Certainly when I was at school, I never even heard of these terms. Now as an adult, having had to go through a lot of pain to develop them for myself, I see that resilience and self-esteem are the two most important aspects of mental wellbeing. So much so that we've had multiple workshops and guest speakers on resilience and wellbeing at work, because our employer recognises that these are at the heart of happy, productive employees.

So I think it would be good if something similar happened in schools from an early age.

[NolongerAnxiousCarer]

Also all these celebrities, there are so many I've lost count, who claim to have Bi-Polar like it's some tag of specialness "oh look at me and my great struggle" when everyone gets mood swings you know!

The ignorance of a lot of posts on here makes me really sad, I hadn't realised that the minimalisation of mental health problems was still so widespread. I do know that stigma is still alive and kicking, but it is improving and a huge factor in this improvement has been people in the public eye coming forward and talking about their own mental health problems. I don't think that they are saying "look at my struggle and how special I am" I think they are saying to other people with these conditions "you are not alone with your condition and it's still possible for you to achieve success" And bipolar is not a case of mood swings, it's a lot more serious than that!

The fact is that suicide is the leading cause of death in young adults in the UK and the second highest cause of death in 15-25 year olds world wide according to the world health organisation, (so not just a western problem). Its about time that mental health and mental wellness were taken seriously in all age groups.

[leonardthelemming]

This is interesting reading:

www.mentalhealth.org.uk/publications/truth-about-self-harm

[blueberrypie0112]

Most people I know who committed suicide were not from the igen or generation x. They were the ones who grew up in the 50’s and 60’s and especially 70’s

[oldcrownie]

In my family there have been mental health problems in each generation. I do therefore wonder if there is some kind of genetic pre disposition going on, or are we more accepting and aware of it. I will freely admit that I am acutely aware of my teens mental wellbeing and having had a sibling take their own life I will do anything to never let them get to that point. My parents didn't know anything was wrong other than he had been 'a bit down'. So I maybe struggle to be rational about it.

The way I see it is we all have physical and mental health. We all get minor coughs and colds and we all get periods of feeling low or anxious. Mostly we can self treat but, like a cough that won't clear, you would seek advice if you don't feel better just incase it is a sign of something more serious.

[JustDanceAddict]

I don’t know tbh. Both my teens suffer with anxiety in different forms and they’ve had some therapy, but never taken any medication as haven’t needed to. I also struggled as a younger teen / bullied (but never told parents) and just wanted to be accepted as part of a crowd. I did find it in the end at age 15 (out of school), and things got better, but not perfect. Was always desperate for a boyfriend as well and felt a lot of pressure to conform and have one. I probably could’ve done with some counselling at least but it wasn’t the ‘done thing’ then. I would like to think most parents can differentiate between ‘normal’ teen angst and something that needs medical intervention. Self-harm or thoughts of it are not normal, but occasionally feeling down for no reason, is.

[NolongerAnxiousCarer]

The way I see it is we all have physical and mental health. We all get minor coughs and colds and we all get periods of feeling low or anxious. Mostly we can self treat but, like a cough that won't clear, you would seek advice if you don't feel better just incase it is a sign of something more serious.

Exactly!

[patodp]

nolongeranxious I knew someone would twist that the wrong way. I fail to believe all these self obsessed naval gazing celebrities have bi polar disorder. They are the ones reducing the very serious disorder to a matter of mood swings...

[OhTheRoses]

I don't know about pathological but there seem two problems. Inadequate involvement of qualified psychiatrists/doctor's at assessment and misapplication of funding. If under 21s make-up about 20-25% of the population and only receive 5-6% of the overall MH budget what are CEOs of MH trust's doing to put that right when they control the budgets. Is it because parents of over 16s can't complain on their behalf and parents of under 16s have the I might threat of social services over them if they don't follow advice.

CAMHS practice in the UK is dismal and it is about far more than funding.

Take my dd for example cutting and taking od's in yr 11, felt desperate but masked it well. I had no idea. Went to the Dr of her own volition the day after her last GCSE. That Dr said she'd be seen within two weeks. But we were moving house five days later. New GP wouldn't see her for three weeks. Referred to CAMHS saying they were useless and told me to find a therapist off the internet.

Saw CAMHS six weeks later. They did not listen to the fact that dd's issues were related to academic performance. They offered group therapy at 11am and refused to offer anything else even when it was explained this would make dd worse because it would takes out six continuous weeks of a two hour lesson for a new subject at A'Level. They unilaterally closed her case.

We referred her to a consultant psychiatrist privately. Immediately the psychiatrist identified her problems weren't social. She sent off bloods for Vit D and thyroid. VitD was on the floor, thyroid was odd. Further tests identified early Addisons. This was possible because the psych was fully medically trained in a way that nurses are not.

D'S improved dramatically but was assessed a month before exams for ASD and ADHD. Before we got the results dd escalated and took a small od. She regretted it and took herself 26 hours later to A&E to check herself out physically. That resulted in a referral to SS and they told her she needed to be admitted to an acute bed with a 1:1 nurse overnight (MH). The nurses were unaware of the statutory instruments and howbtheybapplied to 16-18 year olds. The Dr was not aware she could be assessed in A&E by their own MH liaison person. In any event the nurses had booked it all before he signed it off and before I arrives because they didn't bother calling me for four three hours. This was epic wastage of resources by nurses who knew no better.

D'S had an emergency CAMHS assessment that promised counselling over the hols. Such an emergency in A&E deemed her low to moderate risk and the counselling didn't materialise until September. Admittedly they rolled out some holding sessions in August because I went ballistic. What was impossible on 5th Aug became possible on 8th Aug when our MP got back from his holidays! CAMHS closed her case midway through counselling so couldn't have known the outcome.

Oh and the day after the CAMHS assessment her psychiatrist confirmed she had ADHD ADD variant. I called the nurse at CAMHS "well mum I think she's a bit old for that at 17".

DD required further counselling and an adjustment to fluoxetine after her case was closed. But with diagnosis and treatment she is very much better. She got 4 A* A'Level. She is applying for Oxford.

The state did nothing except to report me for obstructing her care because there was no point staying in hospital overnight taking an acute bed and 1:1 nurse; CAMHS then reported me for being overprotective because I complained about their failure to put counselling in place to the promised time frame. This was detrimental because when I found out three weeks later the therapist she could have seen privately was fully booked.

The service standards and levels of competence and wasted resources beggar belief. Many of the problems could be staunched by preliminary psychiatric assessment and this would be more cost effective because it would lead to less inter trust time wasting and young people would have a fair stab at recovery; issues seeping into adulthood would diminish and the young people themselves would lead more productive lives and be less reliant on benefits and other services.

It is sad the people in charge seem incapable of making these points.

[Allthelightsgoout]

Was your DD actually diagnosed with Addisons disease? It is very rare so not something that even most NHS Psychiatrists would necessarily consider when given the seemingly straightforward presentation of your DD.

And although I echo your views about the inadequacies of NHS CAMHS services - I remember your posts about your DDs A and E contact after the overdose (could be found on MN) and I think she agreed to impatient admission until you arrived and changed her mind after you spoke to her.

Which could absolutely be because she felt unable to express her wishes without you there but services unfortunately encounter abusive parents all the time - whether physical or emotional and if they see a sudden change in children or adolescents when parents arrive, they have to flag that up if it is a cause of concern.

ADHD is a pervasive developmental disorder (ADD variant is a term that isn't widely used, primarily inattentive type is more usual) which is on an spectrum from mild to severe in the DSM which doesn't necessarily relate to symptoms but level of impairment . You can be a high achiever with ADHD but unfortunately it often needs a very specialised assessment.

CAMHS prioritise children with obvious educational and behavioural impairment for ADHD assessment. Which is as it should be. I'd love for all children to be assessed but it's unworkable and not financially appropriate when you consider the small number of high-functioning children that may be identified given the cost of doing so.

[OhTheRoses]

It could also absolutely be because she wasn't given the option of an assessment in A&E and nursing staff didn't have the courtesy to inform her it would be difficult to change her mind once arrangements were made.

After the interesting thyroid tests we had her referred to an endocrinologist and her cortisol was low which led to more tests.

The only things I saw CAMHS prioritise were to ensure they were as opaque as possible and did as little as possible. If my dd was not their priority they should have said so and helpfully referred to a private psychiatrist. They can't do that though.

Whilst hospital staff may experience abusive parents they should as a bare minimum know what assessment avenues are available at their own hospitals, they should provide a young person and their family with clarity and they should not delay contacting a parent if they are going to treat the young person as a child. My daughter was told they thought it would be a good idea if she stayed. They did not provide options, they did not know the bad I facts. It was a complete and utter shambles.

[OhTheRoses]

And I should have said that the ADHD diagnosis was what started the recovery because her issues were around her perceived underperformance.

The public services could have been more helpful and made the last two years easier by being more honest and doing less. That however would involve admitting the inadequacies of MH services and they won't do that. Nor will MH trùsts own up to how little budget they allocate to CAMHS services when compared to the number of users and how much is allocated to adult services.

It is always conveyed as the parent's fault. It isn't always. I saw not one competent CAMHS nurse and the knowledge about statutory instruments and violation of liberty witnessed in A&E was breathtaking.

[OhTheRoses]

I've been reflecting about your post allthlightsgoout. Especially the sentence obvious educational and behavioural impairment. So cutting with a razor blade and self poisoning by taking small overdoses isn't an obvious behavioural impairment for which a young person needs help then?

It would be nice if the state will not provide help, if it's representatives were a little more understanding and could appreciate that some families love and nurture their children. My dd did not start behaving differently when she spoke to me, for two hours she said she just wanted to check herself out physically and go home. They wore her down and persuaded her to agree to an admission without telling her she was not free to leave or giving her any choices. There was no discussion about the admission being required under the MH or Children's Acts and there was clear breach of the Capacity Act, the MH Code of Conduct and DOLs pertinent to 16-18 year olds. My dd was there for 8.5 hours. I arrived after 5. When I arrived the doctor agreed she could be assessed in A&E and she was and a discussion took place with the CAMHS psych and we were informed we could leave once A&E had signed off the paperwork. An hour later we were still waiting and a nurse then shouted at me that I was obstructing my daughter's care and she'd call the police if we left. That was wrong on so many levels. If nursing/hospital staff wish to dictate in breach of statutory instruments may I respectfully suggest that they are made aware of the options available on their own premises and are afforded some MH training and taught how to respect young patients and their parents.

There needs to be an open debate about CAMHS services and resources. Where I live resources have increased but the underlying framework of incompetence in the CAMHS offices continues to exist with the same number of staff making excuses, assertions and compiling inaccurate reports to cloud clarity further.

Let's have clarity about what can be funded by the state, what the thresholds are, and identify pathways according to means. If a low rate of taxation only funds a quarter of CAMHS referrals receiving help Let's be honest, Let's means test (financially and clinically). If there had been a pathway for referral that we could have been directed down and paid for what our daughter needed then we'd have paid. Being told to source help off the internet is not helpful, not least because the good therapists don't want to take an actively self harming teen - they feel they need more specialist help.

Thinking through that further I suppose the other side of the argument is that once a person is paying for a service the service has to become client/patient centric and look for solutions and ways to help rather than relying on an excuse culture which seeks to find causation in parenting rather than in complex clinical issues.

Anyway I don't think we are pathologising adolescence but I think with a higher focus on education and league tables young people have more to worry about. In the mid 70s it was possible for Nice but dims to go into insurance or broking and be quite successful and for dizzy girls to learn to cook and hostess. It isn't now but how people could sparkle when being well educated meant as much as being well qualified.

Anyway up one thing I do know for sure is that I shall never ever trust a nurse ever again or discuss anything whatsoever with one least of all something that relates to someone for whom I am responsible.