Some things to consider before declaring a crisisPosted: June 17, 2016
“There’s a club if you’d like to go
you could meet somebody who really loves you
so you go, and you stand on your own
and you leave on your own
and you go home, and you cry
and you want to die”
How Soon is Now – The Smiths
There have been a number of recent blog posts about the existence or not of a mental health ‘crisis’ among schoolchildren in England. Some of this seems to be related to the recent dismissal by the UK government of their mental health champion for schools but I am pretty sure that similar arguments about mental health could be rehearsed in the US or Australia. Before commenting on this issue, I wish to make it absolutely clear that children’s mental health is a serious matter and I support increased investment to ensure that all children have access to the support services that they need.
Much of the debate has been about data. What data supports a crisis? Is this data recent enough? Are there other indicators that we can look at? I don’t wish to go over this ground. Instead, I would like to ask a few questions that I hope might provoke some reflection on the conduct of this discussion.
Imagine that we had a robust data set showing an increase in the rate of depressive disorders and anxiety disorders in schoolchildren over time. Would this be proof of a mental health crisis?
It is interesting to take an historical view of depressive disorders. If you were able to plot a graph of the prevalence of depression over the last few hundred years then it would start at zero near the beginning of the 19th century and gradually increase until the present day. People were depressed prior to 1800 but they called it something else: ‘melancholia’ (there was also an ongoing debate as to whether this was a physical or spiritual affliction). It might seem odd to make a point about the name of the condition but the history of mental health is marked by an increasing recognition of a variety of different disorders. If a new disorder is recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM) then it logically must follow that the rate of incidence of that disorder will increase as more people are diagnosed with it.
It is also likely that many people suffering from mental health disorders go undiagnosed and that our ability to recognise these disorders varies with time. Some writers have linked exam stress to mental health problems but these are not the only stressful events that can occur in school. When I was at school in the 1980s, I would become anxious at the thought of trying to pass through the alleyway where the smokers used to hang out because they would flick lit matches or worse. The PE changing rooms made me similarly nervous. It sounds a little silly from this distance but these were issues that could keep me awake at night. At times, I was also pretty low – when my bandmates made a backdrop to use on stage they drew a picture of me wearing a severe frown. I never associated this low mood with anything other than being a teenager. After all, teenage angst was well recognised and was reflected in popular culture such as the music of The Smiths. Talking about my feelings would have seemed odd and perhaps a sign of weakness. If I had wanted to go to the school counsellor then I wouldn’t have been able to because I’m pretty sure that we didn’t have one.
It is therefore possible – just possible – that any increase in the rate of mental health disorders that we might record could be due to actual improvements that are taking place in society; a loss of stigma around mental health and a greater access to mental health professionals that leads to more reporting.
Can a mental health crisis be causally linked to particular government or school policies?
Given this context, it seems like a stretch to start to linking government policies on testing to a mental health crisis. I have to admit that I find this idea a little confusing because the government in England does not appear to have actually increased the amount of testing, at least from my faraway perspective. As far as I’m aware, they removed a layer of testing at the age of 17 and reframed policy to discourage the endless resitting of high school examinations that I remember from the late 2000s. On the other hand, they have introduced a phonics check in Year 1. Taken as a whole, it is hard to see this as a net increase so perhaps I’m missing something.
It is entirely possible that schools and parents are mismanaging students and allowing them to become more anxious about tests than the tests actually warrant. There are disturbing anecdotes about headteachers sending out emotional letters and reorganising curricula around exam preparation, only to relax and do something entirely different once the exams are over. All of these measures construct exams as a big life event and are therefore likely to add to the tension. As professionals, I think we all have a responsibility to not transmit our own concerns over accountability to our students.
Finally, according to teachers on social media, school mental health services have been hit as part of the government austerity drive. This cannot have been an initial cause of any crisis but it would clearly harm the response and perhaps make it worse. So this is an area of serious concern.
What effect does framing the issue as a ‘crisis’ have on children’s mental health?
Tom Bennett makes an important point in his blog post that mental health issues relate to the mind and are therefore susceptible to influence from the the way that we discuss and frame them. He mentions the well-known Werther effect where suicide can form clusters and which has led to media rules on the reporting of self harm. It does not seem to be helpful for children who might be vulnerable to mental health problems to grow up in the midst of a proclaimed mental health ‘crisis’. It implies a desperate situation and a lack of agency on the part of sufferers – it is all being done to them as a result of the actions of others – whereas one potential way to treat a mental health disorder is to attempt to build the agency that sufferers have over the condition.
Clearly, it is legitimate to be concerned about government policies on testing or the provision of mental health services and these arguments should be made and heard. However, I would urge such advocates to avoid the notion of a mental health ‘crisis’ to support these arguments, however well-meaning. It’s not clear that it is accurate and, even if it is, it might cause harm to those whom it seeks to help.