• Question: Has mental health of pupils got worse, or is more reported?

    Asked by forda to Alice, Cat, Christina, Sveta on 21 May 2018.
    • Photo: Cat Sebastian

      Cat Sebastian answered on 21 May 2018:

      This is a tricky question to answer. As you say, it could be that awareness of and interest in mental health is increasing, leading to increased reports of mental illness by young people. Arguably the stigma associated with mental illness has also declined, leading to a greater willingness to discuss and disclose. Increased awareness of parents, teachers and schools may also mean issues are picked up when they otherwise wouldn’t be. Once professional help is sought, it could also be that willingness to diagnose has increased. As an extreme example, as recently as the 1970s, it was written that ‘the notion of a syndrome of childhood depression rests largely on surmise’ (Lefkowitz & Burton, 1978). So increased awareness, reporting and changes in professional practice go some way towards explaining an increase.

      However, there does seem to be some good evidence of recent increases in poor mental health in children and adolescents, particularly among girls and young women. For example, NHS figures show an increase in the number of admissions for self-harm among under 18s over a 10 year period, with the increase driven mainly by girls (42% increase from 2005-2015). There is also evidence from a couple of studies recently published by Dr Praveetha Patalay and colleagues showing much higher rates of depression in young people (again mainly girls) than had been found in previous years. In 2004, Green et al. estimated the prevalence of adolescent depression at around 8%, while Patalay et al. (2017) found up to 24% 14-year old girls may suffer clinically significant symptoms of depression (9% of boys). Depression is more likely in girls from poorer families, and in bright girls. These studies were conducted using the Millennium Cohort Study data, which provides detailed data on over 10,000 young people, so might be expected to provide a fairly accurate estimate.

      The big question then is why we might be seeing these trends. Obvious culprits are increasing academic pressure, increasing social pressure (e.g. social media), bullying and poverty. Some of these factors likely impact girls to a greater extent. However, to my knowledge it is currently unclear exactly what the increase can be attributed to. Perhaps a combination of several of these factors, which makes addressing this complex problem all the more difficult.

    • Photo: Sveta Mayer

      Sveta Mayer answered on 19 Jun 2018:

      Hi Forda, your question is one that remains very relevant for clinicians who find they are increasingly diagnosing and treating children with mental health conditions (more about this below). However, education professionals, community services (e.g. CAHMS) and policy makers, especially over the last decade, are finding they play an important role in supporting children and young people’s mental health and wellbeing, including those at clinical threshold (again more about this below).

      This widening of mental health and wellbeing provision has arisen from awareness from longitudinal comparative international research by UNICEF and WHO over the last decade. The research revealed English school children’s perception of their mental health lags behind their counterparts in wealthy countries and is within the bottom third of all international countries studied. Such awareness may be responsible for increased clinical referral, diagnosis and treatment, in particular through CAHMS. However, whether these findings reveal mental health and wellbeing is better or worse is difficult to gauge because the diagnostic criteria for mental health disorders has been revised in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM). Why is this of relevance to clinicians? Well, longitudinal comparison with diagnosis of mental health disorders published in the previous edition is not informative and research into the validity of diagnostic criteria to diagnose mental health disorders (see Reference 1 below) suggests a rise in diagnosis but this may not be due to increased prevalence (i.e. not due to more people experiencing mental health problems at clinical threshold).

      Given the ambiguity of longitudinal research based upon diagnostic criteria, research within specific contexts (e.g. geographical regions, settings such as CAHMS) to indicate both prevalence of mental health conditions and effectiveness of mental health provision within these contexts is currently more reliable. When undertaken such studies provide policy makers with evidence-based research about the scope of children and young people’s mental health conditions to inform the need for mental health provision for children and young people (see Reference 2 and 3 as examples of research by Public Health England and Mental Health First Aid England). Such findings are revealing increased reporting by children and young people, clinical diagnosis and treatment.

      So what part might schools and education professionals play in supporting children and young people’s good mental health? Preventative mental health and wellbeing provision for children and young people within the school setting continues to increase. This is facilitated by, for example, the government campaign for national role out of mental health training programmes, including within schools by Mental Health First Aid England, a registered training provider (see Reference 3). I am currently involved in researching one such programme (Youth MHFA training) to identify which school-based characteristics (e.g. school type, curriculum, practitioners’ professional role) are more likely to lead to successful implementation of preventative Youth MHFA provision.

      1. Mental Health Diagnostic Tome Comes Under Fire: https://www.scientificamerican.com/article/mental-health-diagnostics-tome/
      2. Public Health England: https://www.gov.uk/government/publications/improving-the-mental-health-of-children-and-young-people
      3. Youth Mental Health First Aid England: