For as long as I’ve been teaching there has been significant frustration about the availability of CAMHS – Child and Adolescent Mental Health Services – for those children and young people who urgently need help with mental health problems. In recent years the concerns have been magnified as people worried that the services were being cut even further as the population of young people tended to rise and I have no reason to doubt those claiming the services are inadequate.
However, in the last few months children’s mental health has been cited more and more in other contexts in the education debate. Want children to behave in school? That’s unfair, they probably have mental health problems. Want schools to be held to account for whether their students’ learn? That’s cruel, testing causes mental health problems. Think children are in school to learn? That’s selfish, schools should be dealing with their emotional well-being in order to prevent mental health problems. And that last point leads to calls to teach happiness, mindfulness and emotional literacy that schools buy into from time to time despite the huge questions over the ethics and efficacy of such lessons.
Worse, there have been claims that there is some kind of children’s mental health epidemic in schools. Not just a crisis caused by the lack of services, but actually a massive increase in mental health problems. Here are claims from some recent media reports (I have deliberately tried to avoid including stats that are based on subjective questions about whether problems are worse, or ones that are only about recent increases in specific conditions, so please be aware of the selectivity of my quotations).
Teenage mental-health crisis: Rates of depression have soared in past 25 years
How has society managed to produce a generation of teenagers in which mental-health problems are so prevalent?
…there is growing evidence that teens are in the grip of a mental-health crisis. It is as if, rather than acting out, young people are turning in on themselves.
Rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years. The number of children and young people turning up in A&E with a psychiatric condition has more than doubled since 2009…
From The Independent February 2016.
Child mental health crisis ‘worse than suspected’
Natasha Devon, the government’s mental health champion in England and Wales, warns of ‘medicalising childhood’
…The crisis in children’s mental health is far worse than most people suspect and we are in danger of “medicalising childhood” by focussing on symptoms rather than causes, the government’s mental health champion for schools has warned.
Natasha Devon, who has been working in schools for almost a decade delivering mental health and wellbeing classes, said an average of three children in a class were diagnosed with a mental illness, but many more slipped under the radar.
…rates of depression and anxiety have increased by 70% in a generation,
From The Guardian, April 2016.
As children face a mental health crisis, should schools take the lead in fighting it?
There is a crisis affecting the mental health of England’s young people.
….Three children in every classroom have a diagnosable mental health condition. Half of these are conduct (behavioural) disorders, while one third are emotional disorders such as stress, anxiety and depression, which often becomes outwardly apparent through self-harm.
From The New Statesman, February 2016
Natasha Devon: ‘Britain’s child mental health crisis is spiralling out of control’
…It’s no coincidence that this generation of young people have seen a 70 per cent increase in mental illnesses, such as anxiety and depression
… a 2014 survey by mental health charity Young Minds found that children as young as 12 are concerned that they will be unemployed and cited this as a reason for their anxiety.
From the Telegraph, 29th April
Three children in every classroom have a diagnosable mental health condition. …There has been a staggering 106 per cent increase in the number of children and young people presenting at A & E with a psychiatric condition since 2009. This much is clear: we are in the midst of a crisis regarding the mental health of our children.
From The Independent, February 2016
A closer look at these stories and others like seems to indicate that overwhelmingly the stories reference only a small number of sources. Usually there is a reference to Natasha Devon (and often to her charity the Self-Esteem team) or the charity Young Minds. Occasionally stories like this mention the charity Place2B set up by Camila Batmanghelidjh in the days before Kids Company. The statistics generally seem to be the ones on the Young Minds website. Of these, two seem to be repeated the most:
Among teenagers, rates of depression and anxiety have increased by 70% in the past 25 years, particularly since the mid 1980’s.
The number of children and young people who have presented to A&E with a psychiatric condition have more than doubled since 2009. (8,358 in 10/11; 17,278 in 13/14)
The claim that about 3 children in every classroom having mental health problems (also made on the Young Minds website) is repeatedly mentioned.
None of these statements are false, when used in the correct context, but all three are misleading when used to describe a mental health crisis that is happening right now.
Dealing with each one in turn:
The figure about the 70% increase in depression and anxiety over 25 years has been widely quoted. The source appears to be a 2004 study based on a comparison of data from 1974, 1986 and 1999. Yes, that’s right, 17 years ago. It may or may not have changed since then, but it is clearly not evidence for a crisis now.
The figures about A&E come from a parliamentary answer which is worth quoting in full:
Luciana Berger Shadow Minister (Public Health): To ask the Secretary of State for Health, how many children and young people were diagnosed with a mental health problem in A&E in each year since 2009-10.
Norman Lamb The Minister of State, Department of Health: The information is in the table:
Year 2009-10 2010-11 2011-12 2012-13 2013-14 A&E Attendances 8,358 9,328 11,614 13,655 17,278 FAEs 11,909 12,417 12,361 11,994 12,126
The table shows both the number of attendances in accident and emergency (A&E) in which the A&E diagnosis was ‘psychiatric conditions’ and the number of Finished Admission Episodes (FAEs) in which the primary diagnosis was ‘mental and behavioural disorders’.
This is a remarkable increase in attendances, but the FAEs, which as I understand it are the diagnoses that doctors gave show a completely different story. No significant change. Unless I’ve misunderstood the statistics, to quote only the first row without the second is, in my view, highly misleading. It shows young people attending A&E are more likely to be booked in as having mental and behavioural disorders, but the number being given that as a primary diagnosis is almost the same. Hardly evidence that the conditions are more common.
Finally, the three children in every classroom figure seems to date back to surveys from 2004. So once again the study seems less than up to date. Moreover, while I haven’t compared the methodology, I do recall reports that the rate for adults in surveys of mental health was 23%. Mental health is a very broad category, and half of people will have some kind of mental health problem in their lives, 3 children in every classroom is not that many, and without some indicator that their conditions are severe, that isn’t that many and is not a crisis.
As far as I can tell, there has been a long-term increase in the diagnosis of mental health problems over the last 50 years in young people (although I haven’t compared this with adult rates). Whether this is down to changes in diagnosis or in mental health I could not answer. But I can say that the idea that there is a “mental health crisis” in schools that has happened in the last few years seems to be lacking in good evidence from those who are claiming it is happening. By all means, let’s discuss the issue. Mental health is important. But let’s not be panicked by talk of “crisis” and let’s be very wary of the various vested interests who tell us they have answers to the problem. At the very least, let’s argue for long term investment in CAMHS, not gimmicks like happiness lessons or attempts to dumb down education to make it less stressful. Nor should we forget that, when asked, “Most children report high or very high personal well-being”.