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Young people’s good mental health is as important as their good physical health if they are to develop into independent and confident adults. Good mental health is an essential part of healthy adolescent development; it helps young people build positive social, emotional, thinking and communication skills and behaviours. It also lays the foundation for better mental health and wellbeing later in life.
There is a strong link between child and adolescent mental health issues and mental health problems in adulthood, which makes the latest findings from studies of the mental health and wellbeing of children and young people in relation to the coronavirus (COVID) pandemic in the UK all the more concerning.
Young people aged between 7 and 24, sometimes called generation Z, have largely avoided the direct physical health impact of COVID, however, the government’s Scientific Advisory Group for Emergencies (SAGE) say that this generation, who have been informally labelled the COVID generation, risk being “catastrophically” hit by the “collateral damage” created by the COVID pandemic crisis in terms of their mental health.
During the first COVID lockdown from March 2020, some ten million schoolchildren across the UK had their schools closed and had to adjust to home and virtual schooling with no physical face-to-face contact with their teachers, peers and school friends.
Exams were cancelled and there has been controversy over GCSE and A level results, with delays or cancellations to college or university starts for the 16- to 19-year-old age group to contend with. Those at college or university missed out on the normal “student experience” and those graduating received no formal graduation ceremony, and many have since had difficulties in finding a job to start their working careers.
Dr Dasha Nicholls, who is part of the You-COPE study into young people’s health and wellbeing during the pandemic, research that is being led by University College London (UCL) and Great Ormond Street Hospital (GOSH), said: “This generation is entering uncharted territory, where their opportunities have been devastated.
People talk of the resilience of the young but this crisis has happened so quickly that young people have had no time to change and adapt. The impact on them could become entrenched, with potentially enduring consequences.”
The Office for National Statistics (ONS) are currently carrying out The National Study of Health and Wellbeing: Children and Young People 2021 to understand how children and young people are being affected by the COVID-19 pandemic, and are now looking for further contributions. Anyone interested in taking part in the study can contact them on +44 (0)800 298 5313.
How common are mental health issues in youths?
NHS Digital stated that in 2020 one in six school-aged young people have a mental health problem. This is an alarming rise from one in ten in 2004 and one in nine in 2017. Emotional disorders such as anxiety and depression are the most common mental disorders experienced by young people.
In younger adolescents aged 11–16, the prevalence of mental disorders is similar among boys and girls. However, among older adolescents aged 17–19, mental disorders are more common in girls, with almost one in four girls (23.9%) experiencing a mental disorder, compared with one in ten boys (10.3%).
The Children’s Society has reported that currently 17- to 22-year-old women are the group most at risk of developing a mental health problem.
Self-harm and attempted suicide is around six times more common among adolescents aged 11–19 with a mental disorder (32.8%) than those without (5.1%). Similar to mental disorders, rates of self-harm and attempted suicide among the adolescent population are increasing.
The ONS reports that suicide is the largest cause of mortality for young people under 35 and that suicide rates have been increasing in recent years.
In the initial 2020 You-COPE study, almost one in two of the young respondents aged 16–24 without previous mental health problems, reported high levels of depressive symptoms and one in three reported moderate to severe anxiety symptoms since COVID.
The British Psychological Society found that in 2021, one-third of UK children could need mental health support due to the pandemic. The Children’s Commissioner reports a 35% increase in referrals to children and young people’s mental health services in 2019/20.
What are the signs of good mental health in youths?
It is not unusual for young people to exhibit some undesirable behaviours, such as lashing out, isolating, or making risky decisions. Growing up is hard, increased responsibilities are stressful, and emotions are often difficult to manage through puberty.
The pressures of responsibilities, emotions and relationships can be particularly intense among teenagers and young adults, as they have not learned how to manage many of the difficult aspects of life at their young age. In addition, their brains are still developing, and it is very common for young people to act unreasonably or engage in risky behaviour. Most of this is quite normal as young people develop and begin to mature.
Young people experience all sorts of emotions as part of growing up:
Young people with good mental health can deal with these fluctuating emotions and normally:
- Feel happy and positive about themselves most of the time.
- Are kind to themselves during tough times or when things don’t go the way they expect.
- Enjoy life.
- Learn well.
- Do physical activities.
- Eat a healthy diet.
- Get involved in leisure pursuits.
- Get along well with family and friends.
- Have a sense of achievement.
- Can relax and get a good night’s sleep.
- Can manage sad, worrying or angry feelings.
- Can bounce back from tough times and disappointments.
- Are prepared to try new or challenging things.
When young people learn to cope with immense emotions or calm themselves down in difficult or emotional situations, they are likely to feel good about themselves. Learning to manage life’s small worries so they don’t become big problems and doing things they are anxious about instead of avoiding uncomfortable situations are all good for their mental wellbeing.
By talking about emotions with the young person, and encouraging them to recognise and label their emotions the young person will appreciate that it is natural to have all sorts of feelings.
What are the signs of bad mental health in youths?
Everyone feels low, angry or anxious at times; it is normal for young people to sometimes have low moods, poor motivation and trouble sleeping. These things are not always the signs of a mental health problem, but when these changes last for a long time or are significantly affecting a young person, it might be time to get professional help.
Warning signs that a young person may have a mental health issue include:
- Persistent sadness for two or more weeks.
- Seeming down, being tearful or lacking motivation.
- Having trouble coping with everyday activities.
- Saying they have constant physical pain, for example headaches, stomach aches or backaches.
- Doing less well at school or college.
- Suddenly refusing to go to school, college or work.
- Withdrawing from or avoiding social interactions.
- Voicing or showing feelings of hopelessness and helplessness.
- Outbursts or extreme irritability.
- Showing sudden changes in behaviour, often for no obvious reason.
- Out-of-control or risk-taking behaviour that can be harmful.
- Signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough.
- Being over anxious about weight or physical appearance.
- Self-harming or talking about self-harming.
- Talking about death or suicide.
- Sleep problems.
- Substance abuse.
- Getting into trouble with the police, fighting or stealing.
What are the common mental health problems in young people?
Over half of all mental ill health issues start before the age of 14, with 75% developing by the age of 24 years. The terms mild, moderate and severe are used to describe different levels of mental health problems.
A mild mental health problem is when a person has a small number of symptoms that have a limited effect on their daily life. A moderate mental health problem is when a person has more symptoms that can make their daily life much more difficult than usual.
A severe mental health problem is when a person has many symptoms that can make their daily life extremely difficult. A person may experience different levels at different times.
Some of the common mental health issues in children and young people include:
Stress – The main symptoms are:
- Worrying a lot.
- Feeling tense.
- Having headaches and stomach pains.
- Not sleeping well.
- Being irritable.
- Losing interest in food or eating more than normal.
- Not enjoying activities previously enjoyed.
- Being negative and having a low mood.
- Feeling hopeless about the future.
Depression – The main symptoms are:
- Feeling ‘low’, sadness, or a low mood that does not go away.
- Being irritable or grumpy all the time.
- Losing interest and pleasure in things that were once enjoyable.
- Feeling tearful.
- Feeling tired and exhausted most of the time.
- Changes in appetite.
- Problems with sleep.
- Concentration and memory issues.
- Negative thoughts.
- Feelings of guilt and/or worthlessness.
- Lacking confidence.
Generalised and Social Anxiety Disorders – The main symptoms are:
- Having a number of different worries that are excessive and out of proportion to a particular situation.
- Having difficulty in controlling worries and concerns.
- Feeling scared or worried about working with other people.
- Feeling scared or worried about social events or situations.
- Avoiding everyday activities, such as seeing friends, going out in public or going to school.
- Feeling irritable or having angry outbursts.
- Feeling easily tired.
- Having tense muscles often in the shoulders and neck.
- Having trouble concentrating.
- Having trouble sleeping or disturbed sleep.
- Start wetting the bed.
Panic Disorder – The main symptoms are:
- Having unexpected and recurring panic attacks.
- Worrying about having another panic attack.
- An increased heart rate.
- A churning stomach.
- Changes in behaviour.
- A fear of being in places or situations.
- Possible development of such as phobias agoraphobia.
A panic attack may happen because of a particular situation, something that the young person fears or wants to avoid, or it may have no obvious cause.
Obsessive-Compulsive Disorder (OCD) – The main symptoms are:
- Having thoughts, images or impulses that keep coming into the mind and are difficult to get rid of (obsessions). Common obsessions include:
– Being afraid of dirt and germs.
– Worrying that something is not safe such as an electrical appliance.
– Wanting to have things in a particular order.
– Thoughts and fears of harming someone else.
- Having strong feelings that you must carry out or repeat certain physical acts or mental processes (compulsions). Common compulsions include:
– Excessive washing and cleaning.
– Checking things repeatedly.
– Keeping objects that other people might throw away.
– Repeating acts, words or numbers in a pattern.
Post-Traumatic Distress Disorder (PTSD) – Following particular threatening or distressing events. The main symptoms can be psychological, physical or both:
- Having repeated and intrusive distressing memories of the event.
- A feeling of reliving the event through flashbacks or nightmares.
- Shaking and sweating.
- Memory loss.
- Feeling distant.
- Spending a lot of time worrying about weight and body shape.
- Avoiding socialising when food will be involved.
- Eating very little food.
- Making themselves sick or taking laxatives after food.
- Exercising too much.
- Having very strict habits or routines around food.
- Changes in mood such as being withdrawn, anxious or depressed.
- Weight being very high or very low for age and height.
- Delayed signs of puberty and/or menstruation.
- Racing heart, fainting or feeling faint.
- Poor circulation.
Body Dysmorphic Disorder – The main symptoms are:
- Worrying a lot about a specific area of the body, particularly the face.
- Spending a lot of time comparing looks with other people’s.
- Looking in mirrors a lot or avoiding mirrors altogether.
- Going to an excessive effort to conceal flaws, for example by spending a long time applying make-up or choosing clothes.
- Picking at skin to make it “smooth”.
- Lightening skin.
How does social media affect teenage mental health?
Social media is a big part of many young people’s lives, but what impact does social media use have on teenagers? 97% of 13- to 17-year-olds use social media platforms, such as YouTube, Twitter, Facebook, Instagram or Snapchat, and 45% of this age group are online almost constantly.
Social media enables teenagers to create online identities, communicate with others and build social networks.
These networks can provide teenagers with valuable support, especially helping those who experience exclusion or have disabilities or chronic illnesses. This has never been as important as it has during the COVID lockdowns where teenagers’ usual social outlets have not been available to them.
Teenagers also use social media for entertainment and self-expression, and the platforms can expose teenagers to current events, enable them to interact across geographic barriers and teach them about a variety of subjects, including healthy behaviours. Social media that is humorous or distracting or provides meaningful connections to peers and a wide social network might even help teenagers avoid depression.
However, social media use can also negatively affect teenagers, distracting them, disrupting their sleep, and exposing them to bullying, rumour spreading, unrealistic views of other people’s lives and peer pressure. Almost 25% of teenagers believe that social media has a mostly negative effect.
Many studies have found an association between time spent on social media as well as the number of social media platforms used, and symptoms of depression and anxiety, but that doesn’t necessarily mean that social media causes these problems. Researchers believe that one problem is that social media use can disrupt sleep, and poor sleep can lead to anxiety and depression.
Social media use at night disrupts sleep in a number of ways; teenagers stay up late online and many of them wake up in the night in order to check or respond to messages, and the light from the screen can disrupt their circadian rhythm. Circadian rhythms are 24-hour cycles that are part of the body’s internal clock, running in the background to carry out essential functions and processes. One of the most important and well-known circadian rhythms is the sleep-wake cycle.
When properly aligned, a circadian rhythm can promote consistent and restorative sleep. But when this circadian rhythm is thrown off, it can create significant sleeping problems, including insomnia, and can play an integral role in diverse aspects of physical and mental health.
Teenagers and young adults often worry about what they call FOMO, which stands for “fear of missing out”, which is anxiety about missing out on experiences. Social media can worsen feelings of FOMO.
Browsing social media and seeing events they have not been invited to or posts about the exciting lives others experience or expensive purchases that others have made, promotes the belief of being excluded and can lead to negative feelings.
Anxiety and depression are not the only mental health problems associated with social media use; body image, in both girls and boys, can be harmed by social media use and can lead to “body surveillance”. This is when someone constantly monitors their body and becomes judgemental of it.
Young people who do too much body surveillance report feeling more shame about their bodies. Looking at profiles of “attractive” people leads to more negative body self-image; teenagers often compare themselves to these ideals or these edited images and feel like they do not measure up. There are also many “fitspiration” accounts on Instagram, that is postings about diet and exercise in order to be thin.
It is common for people to filter or photoshop their posts on Instagram in order to remove any so-called “flaws”, setting up unreal models for teenagers to aspire to. All this can cause poor body image and lead to eating disorders, self-harm and other mental health issues.
Cyberbullying is another harmful aspect of social media. This is bullying that occurs online. As many as 72% of teenagers say that they have been cyberbullied at some point, and cyberbullying has been more strongly linked with suicide attempts than face-to-face bullying has.
Unlike bullying that takes place in-person, cyberbullying happens out of sight of others such as teachers and parents and the victims cannot get away from it. It stays online and can be circulated, thereby gaining traction. Anyone being cyberbullied via social media should be assured that this behaviour is unacceptable.
The first thing to do is to block the person who is bullying and report them to the social media site. Also try to document the bullying with a screenshot of the message or photo as proof and send this to the social media site with the report. The police and social media sites are taking these reports seriously in an attempt to eliminate this crime.
What support is available for young people with mental health issues?
Mental illness can be preventable and is certainly treatable. Mental health problems are unlikely to get better on their own and poor mental health or unmanaged mental health issues can affect a young person’s wellbeing and development, physical health, school and college work, career opportunities and progression, personal and family relationships and life chances.
This means that if a young person is experiencing mental health issues, it is important to get professional help as soon as possible. Mental health problems do respond well to interventions and treatment. Parents, carers and young people can receive direct support through the NHS children and young people’s mental health services (CYPMHS).
They are multidisciplinary teams that often consist of:
- Social workers.
- Support workers.
- Occupational therapists.
- Psychological therapists – this may include child psychotherapists, family psychotherapists, play therapists and creative art therapists.
- Primary mental health workers.
- Education mental health practitioners, who work in mental health support teams in schools and colleges.
- Children’s wellbeing practitioners.
- Specialist substance misuse workers.
You may also find it helpful to speak to your GP or young people’s mental health advice services such as:
- Childline 0800 1111.
- Papyrus 0800 068 4141 email: firstname.lastname@example.org.
- The Mix 0808 808 4994.
- Mind 0300 123 3393 or text 86463 (9am to 6pm on weekdays).
- Harmless email email@example.com.
- Self-injury Support (for women and girls) 0808 800 8088.
- CALM (for men) 0800 58 58 58.
- The Prince’s Trust 0800 842 842.
- Anxiety UK 03444 775 774 (helpline).
- Beat 0808 801 0711 (youth line).
- OCD Youthyouthhelpline@ocdaction.org.uk (e-Helpline).
- National Bullying Helpline 0300 323 0169.