No Mental Health Crisis?

There was a long and protracted discussion on twitter yesterday about whether or not it was right to call current problems with children’s mental health a ‘crisis’ or not. Those working at the frontline of mental health services might well shake their heads at teachers  picking over semantic details or attempting to score patronising points over one another on the finer points of research methodologies. They probably would like to bang our heads together. But it threw up some interesting questions. Is there enough data to warrant the claim and is it any worse than before? And crucially, if so, is the education system to blame? For it is this latter point that seems to make those questioning the evidence most hot under the collar. Especially those who strongly support the changes that we’ve seen under this Conservative government.

One of the key points being made by those who wanted to see evidence for this so called crisis was the lack of reliable data – indeed this was a point made by the House of Commons Health Committee in 2014 who pointed to the fact that the last large scale ONS study into children’s mental health was in 2004 and a new study was needed to examine the current situation. The fact that this is still not forthcoming speaks, in my opinion, volumes about the government’s unwillingness to engage in this discussion at any meaningful level – perhaps because they worry it will reflect badly on their policies. There are currently surveys being done and we will have more reliable data emerging, but for now we can make some reasonable claims based on what we already know.

In 2004 1 in 10 children presented with mental health problems and 70% of those did not receive the intervention they needed. At the time, those figures were reported as a crisis – I think fairly. If 1 in 10 of our children were presenting with diabetes, we would certainly use that term. To put that into context, there are currently 500 children in the country diagnosed with Type 2 diabetes. There are 11 million children in the country. So let’s call 1 in 10 a crisis. The question we need to ask now is has it improved and therefore we no longer have a crisis, or has it got worse? This is the bone of contention. What do we know?

Well, we know that between 2012 and 2013, Childline reported a 116% increase on the year before on children being counselled about suicidal thoughts. That represented 35,000 children, 5800 of whom had previously attempted and survived suicide.

Last year 201 children between the ages of 10 and 19 committed suicide, an increase of almost 11% on the year before. And there have been increases, year on year since 2007 – coinciding with the onset of the recession. Overall, however, numbers are slightly down on 2004. This might support the idea that things have not got worse since 2004. But that ignores the large increase in reports of suicidal thoughts and attempts. It may well be that fewer children are dying than in 2004, but more are trying. To describe these increases, as one did, as ‘marginal’ is quite shockingly cavalier.

Still, we might argue that there is still little evidence that things are worse. Unless we turn our attention to self harming rates. Between 2012 and 2014 the NHS reported a 70% increase in 10-15 year olds attending A&E for injuries relating to self harm. It is, of course impossible to know the total figure for self harm as most children do not seek medical help and try to hide their injuries from others, but a WHO report in 2015 found that 1 in five children self harmed –  a threefold increase since 2005.

An ATL survey of headteachers reported that 79% of them were seeing increases in children reporting suicidal thoughts. The headteachers are not diagnosing here – they are simply reporting what they and their staff are being told by children. A 2012 Princes Trust survey reported that 30% of children felt depressed “all” or “most” of the time – this would suggest a threefold increase on the data we have from 2004, a figure also supported by Mick Cooper, on the Mental Health task force group. All these figures point to an increase in the numbers of young people suffering with mental health issues since 2004. And I’ve not even started on the reports from those working at the frontline of treating these young people.

Like, for example, the 54% increase in the prescription of anti-depressants to young people in the years between 2005-2013 – at the very same time as it was becoming more widely accepted that counselling treatments were more appropriate for children. The House of Commons Health Committee report (2014) makes it clear that the increased pressure on CAHMS services is not only down to funding cuts, but increased demand. Not only are demands for prescriptive treatments increasing, but also therapeutic ones. It is hard to argue the case then, that the rise of one is compensating for a fall in the other.

While there may not be a comprehensive set of ONS data since 2004, the picture created by combining all these smaller scale pieces of evidence creates a compelling case that there is a significant issue to be tackled. Arguing over whether or not to call this a crisis is immaterial. Making the case, piece by piece against each individual section of data is sophistry. The picture shows that even in 2004 10% of our young people were in crisis. Recent data suggests this may now be as high as 30%. 20% of our young people fail to reach the expected standards in reading – and look at the time, energy and money spent on addressing that figure. Only a fool would not consider this information important and significant. But what of the causes?

It seems to me that those most keen to deny that there is a crisis in mental health are those most keen to defend the current education system. But is it the case that these problems are caused by education? It’s impossible to say with any certainty. For example, my husband who counsels young people in distress, says that many of them come to him concerned about exam pressure. But in most of those cases they also report fears of letting their parents down. To what extent is the exam the problem or the parent? It’s impossible to say. What we do know is that there is a growing trend of children referring to school as a significant cause of their stress. We need to be careful here to recognise that while a child may highlight a predominant concern, the likelihood is that there are multiple and complex reasons creating the circumstances under which they may feel depressed. Nevertheless…

• 29% of teenage suicides can be attributed to examination stress according to a report by The University of Manchester – the second biggest dominant cause. Again this must be reported with the caveat that there will have been other contributory causes.
• In 2014 Childline reported that for the first time ever, school and exam stress came into the top ten causes of significant stress for children. Way below bullying and family issues, but still a cause. In the 16-18 age group, there was a 30% increase in the number of depressed teenagers citing school/exam stress as the main cause of their distress.

It would be foolish and self serving to claim that education is creating a mental health crisis. But it would be more than fair to say that it is increasingly a contributing factor. And certainly that it’s not helping to reduce the difficulties that young people are having.

So let’s stop arguing about who can make the cleverest argument. Who can win. It’s childish and demeaning. Even one child thinking about killing themselves is a child too many. Let’s instead push harder to demand comprehensive data. Let’s do what we can to help those young people who are presenting with problems and difficulties – pushing for better services, considering whether or not we can employ full time counsellors in our schools, remembering that stressed people don’t learn very well. We all have a role to play in this. And bickering is not part of it.