Minding Your Mind
Is the mental health of our children getting worse?
Every time a new statistical survey is conducted assessing the prevalence of diagnosed mental health disorders in children, it is inevitably followed by a media wave of debate, discussion and distress. “Mental health in children at an all time low”, we are shouted at by various headlines. What is happening? Why on earth are our children gradually being sucked into a vacuum of ill health? And, perhaps most importantly – is there anything we should be doing differently?
First of all – let’s examine the facts. Major surveys of the mental health of children in England were carried out in 1999, 2004, and 2017. The data does indeed reveal an upward trend, with prevalence of diagnosed mental health disorders in young people aged 5-15 increasing steadily to reach 11.2% in 2017. This means that approximately 1 in 8 children are currently falling under the diagnostic criteria for a mental health disorder. So, is the mental health of our children gradually getting worse?
Well, not necessarily. There are several possible explanations for this trend, only one of which is that the prevalence of mental ill health is actually increasing. A possible alternative explanation is that the diagnostic criteria for every single mental health disorder is widening each year – a phenomenon known as ‘diagnostic creep’. This means, by definition, that more and more children will fulfil these diagnostic criteria each year.
Another explanation is that, as the taboo surrounding mental ill health is gradually being lifted, a higher proportion of young people are seeking a doctor’s opinion on symptoms which they may previously have dismissed, or been too scared or ashamed to take with them to their GP. Further to this, as mental health awareness is growing, and will doubtless continue to do so, parents are becoming increasingly alarmed by possible signs of mental ill health in their offspring.
“Every time we have a mental health awareness week my spirits sink”, famously commented Simon Wessely, the first psychiatric president of the Royal Society of Medicine. His worry was that a new generation of hyper-aware patients would spring out of nowhere – that people who had hitherto lived quite comfortable lives would suddenly recognise in themselves symptoms which made them eligible for a diagnosis of mental ill health.
We can conclude, therefore, that whilst we are not necessarily experiencing an increased prevalence of mental ill health, we are certainly experiencing higher numbers of positive diagnoses. The problem of maintaining the delicate balance between awareness (diagnosis) and hyper-awareness (over-diagnosis and over-treatment) is a particularly poignant one in the realm of mental health.
We are not so far historically removed from the days when a mental disorder meant either a lifetime of dismissal by doctors or a life sentence in an institution – surely it is better to over-diagnose and over-treat than to go back to a situation like that? Mental health also poses a very singular medical challenge as, unlike physical illness, it skates uncomfortably close to personality, and to the very fabric of what makes us human.
Should we reduce unhappy children to the label ‘depressed’? What if they have good reasons for their distress? Should we try and ‘fix’ their minds, or should we try and fix their worlds? Or both? If your daughter seems to develop phobias easily, how long do you wait before rushing her off to a psychiatrist? If your son washes his hands particularly regular, do you praise him on his exemplar attention to personal hygiene, or start googling ‘does my son have OCD’?
The question we should be trying to answer, therefore, is not ‘why is the mental health of our children getting so much worse?’ but rather ‘is the increased diagnostic prevalence of mental ill health in children at all beneficial?’. It’s a question which is almost impossible to answer. On the one hand, we want to be able to recognise illness, of whatever kind it may be, in our children, and get them suitable treatment. On the other hand, we don’t want to take personality traits, especially those which may not be distressing to our children, and stick medical labels on them. Perhaps the best thing we can do is simply re-adjust our way of thinking slightly. Rather than reading headlines and dissolving into helpless tears at the state of our kids’ minds – we can try and think of the situation as an illustration of how far medicine has come. We have become far more adept at recognising mental ill health, far more comfortable discussing it, and far more proficient at treating it. Instead of reading “mental health in children at an all time low”, perhaps we ought to train ourselves to see the much more inspiring message “medical progress opening up new frontiers”.
