The adolescent mental health mess
The backlash against mental health awareness has started. Media interest is swelling, but more research is badly needed
Something major is going wrong with how we talk about adolescent mental health — in schools and universities, at home, online. There are multiple layers to this problem, which started with a well-intended desire to destigmatise mental disorders and ends somewhere considerably more complex, problematic and surprising.
The first layer is the concern that talking so much about mental health has meant milder problems are now confounded with mental disorders, and young people are diagnosing themselves with problems they don’t really have. Low mood is too readily being described as depression, mild anxiety as an anxiety disorder, and so on. I think this really can be a problem, and I stand by the arguments I’ve made about this before. I’m conducting research on this right now.
But the changing public conversation had led to a second, less acknowledged problem: that in some camps all young people who say they have mental health problems are now being treated with scepticism. In my research group, we are currently running a study analysing attitudes towards self-diagnosis of mental disorders, and some people believe that any young person who self-diagnoses has inevitably misunderstood and is mistaking their mild problems for more serious disorders.
When I am interviewed about this topic, the subtext is sometimes obvious: Why are young people lying, and how can we get them to stop? If I could sum up how some adults feel today about adolescent mental health problems, it would be one big eye roll: one collective, disdainful urge to tell snowflakes to pull up their socks.
I think overpathologising is happening in some cases, as I say above, and that this needs careful examination. But the problem is that, obviously, some young people really do have significant levels of distress and dysfunction that absolutely cross the threshold for a psychiatric disorder, whether or not they have been officially diagnosed. Even the ones who don’t meet all the criteria are simply fighting to have their distress heard, using the language that surrounds them. But now, ironically, none of them are being believed. They can’t all be unwell, the attitude seems to be, so none of them are. The backlash against mental health awareness has begun before we are even close to understanding how to support anyone who needs help.
This is where things get really messy. It’s all happening in parallel. We are in a situation where some adolescents are very legitimately experiencing mental health crises, without decent treatment, while others are inaccurately describing typical developmental stress with the language of disorder. Adults who support young people know there is a difference, but understandably struggle to make the distinction, partly through a lack of knowledge and partly because there is no clean distinction between the two groups anyway — everything exists on continua; lines are blurred. The upshot is that in some cases everyone is treated like a serious risk, which is unhelpful in itself, but in others everyone is dismissed. The whole thing is a mess, and a thousand miles away from the original goal of mental health awareness.
Whenever I am interviewed about all this, I try to convey that, whatever the impact of the changing conversation, there are still young people who are seriously unwell and need help. But I cannot guarantee this point will make the final cut and often it doesn’t. I firmly believe we need to critique the recent transformation in the public mental health discourse, but I worry about the consequences of asking the questions. I’m deeply conflicted about how the things I’ve said and written might end up being misused.
A call to action
What makes this harder is that there is almost no empirical research on any of this. The potential downsides of mental health awareness — overpathologising, scepticism — are widely discussed among anyone working with young people. Yet with a handful of exceptions, my research group is the only one in the world looking at this, and even we are still right at the beginning. Academic research into adolescent mental health is focusing on many other (important!) issues, but not this.
This is utterly at odds with the public interest in this topic. In the last few months alone, my theoretical article on this topic had been discussed on BBC2’s Newsnight and BBC Radio 4’s Analysis, and in articles for The Economist, The Times, The Times again, New Scientist, The New York Times and The Atlantic. I have turned down many other requests to be interviewed. When I don’t have the capacity, and journalists ask me who else they can talk to, I don’t know who to suggest.
I am writing this as a call to action. This is potentially a major, major public health problem, a damning tale of unintended consequences, and we need sensitive academic research to understand it better. We need to empirically test, somehow, whether the burgeoning mental health conversation has affected how adolescents understand, label and experience mental health problems. Somehow, we need to do this without dismissing or ignoring any of the young people who are clearly struggling so badly, whatever you call it.
We then need to understand what we might be able to do about this. I am asked repeatedly what might be a better way of talking about adolescent mental health, if the current approach is wrong. My honest answer is I don’t know. I have no idea. We are miles off even understanding whether and how the current approach is wrong. It’s hard to say ‘I don’t know’ to a journalist, in a public display of my apparent expertise, but right now it’s all I have.
I am also asked, sometimes, whether attempts at a corrective might be too late. An interviewer asked me whether, if TikTok videos are indeed shown to warp young people’s understanding of mental health, then what I am proposing to do about it. My answer, again, is that I don’t know. Of course, I hope it’s not too late. Societal approaches to mental health have changed in the past, so there’s every chance they can change again. But an awful lot of work needs to be done to get there, and there are adolescents growing up, right now, while we try to figure it out.
If you or your group are working on the negative consequences of mental health awareness or are planning work in this area, and we haven’t yet met, please get in touch — I’d love to hear about your research.
