On most counts, young people's lives are improving. Drinking, smoking and drug-taking are down in the UK; teen pregnancies are at their lowest level for nearly half a century. Yet 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 and, in the past three years, hospital admissions for teenagers with eating disorders have also almost doubled. In a 2016 survey for Parent Zone, 93 per cent of teachers reported seeing increased rates of mental illness among children and teenagers and 90 per cent thought the issues were getting more severe, with 62 per cent dealing with a pupil's mental-health problem at least once a month and an additional 20 per cent doing so on a weekly or even daily basis.
For parents and teachers this is a difficult thing to confront: an epidemic of young people at odds with the world around them is hardly a positive reflection of the society we've created for them. When young people's mental health is discussed, there tends to be a lot of hand-wringing about the lack of early help and the long waiting times for clinical support – which is fair enough, because until the Government announced new funding last month, child and adolescent mental health services (CAMHS) received less than 0.6 per cent of the total NHS budget. But perhaps the more interesting question is why is there a crisis in the first place?
Health news in pictures
Health news in pictures
1/25 Most child antidepressants are ineffective and can lead to suicidal thoughts
The majority of antidepressants are ineffective and may be unsafe, for children and teenager with major depression, experts have warned. In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide
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2/25 'Universal cancer vaccine’ breakthrough claimed by experts
Scientists have taken a “very positive step” towards creating a universal vaccine against cancer that makes the body’s immune system attack tumours as if they were a virus, experts have said. Writing in Nature, an international team of researchers described how they had taken pieces of cancer’s genetic RNA code, put them into tiny nanoparticles of fat and then injected the mixture into the bloodstreams of three patients in the advanced stages of the disease. The patients' immune systems responded by producing "killer" T-cells designed to attack cancer. The vaccine was also found to be effective in fighting “aggressively growing” tumours in mice, according to researchers, who were led by Professor Ugur Sahin from Johannes Gutenberg University in Germany
3/25 Green tea could be used to treat brain issues caused by Down’s Syndrome
A compound found in green tea could improve the cognitive abilities of those with Down’s syndrome, a team of scientists has discovered. Researchers found epigallocatechin gallate – which is especially present in green tea but can also be found in white and black teas – combined with cognitive stimulation, improved visual memory and led to more adaptive behaviour. Dr Rafael de la Torre, who led the year-long clinical trial along with Dr Mara Dierrssen, said: “The results suggest that individuals who received treatment with the green tea compound, together with the cognitive stimulation protocol, had better scores in their cognitive capacities”
4/25 New online test predicts skin cancer risk
Health experts have created a new online tool which can predict a person’s risk of developing a common form of skin cancer. The tool uses the results of a 10-question-quiz to estimate the chance of a person aged 40 or over of having non-melanoma skin cancers within three years. Factors including the age, gender, smoking status, skin colour, tanning ability, freckling tendency, and other aspects of medical history are covered by the quiz
5/25 Multiple Sclerosis stem cell treatment 'helps patients walk again'
A new treatment for multiple sclerosis (MS) has enabled some patients to walk again by “rebooting” their immune systems. As part of a clinical trial at Sheffield's Royal Hallamshire Hospital involving around 20 patients, scientists used stem cells to carry out a bone marrow transplant. The method known as an autologous haematopoietic stem cell transplant (HSCT) works by using chemotherapy to destroy the area of the immune system which causes MS
6/25 Dementia patients left without painkillers and handcuffed to bed
Dementia patients experience a ‘shocking’ variation in the quality of hospital care they receive across England, a charity has warned. Staff using excessive force and not giving dementia patients the correct pain medication were among the findings outlined in a new report by The Alzheimer’s Society, to coincide with the launch of Fix Dementia Care campaign
7/25 Cancer risk 'increased' by drinking more than one glass of wine or pint of beer per day
Drinking more than one glass of wine or pint of beer a day increases the risk of developing cancer, according to medical experts. New guidelines for alcohol consumption by the UK published by chief medical officers warn that drinking any level of alcohol has been linked to a range of different cancers. The evidence from the Committee on Carcinogenicity (COC) overturns the oft-held view that a glass of red wine can have significant medical benefits for both men and women
8/25 Vaping 'no better' than smoking regular cigarettes
Vaping could be “no better” than smoking regular cigarettes and may be linked to cancer, scientists have found. The study which showed that vapour from e-cigarettes can damage or kill human cells was publsihed as the devices are to be rolled out by UK public health officials as an aid to quit smoking from 2016. An estimated 2.6 million people in the UK currently use e-cigarettes
9/25 Rat-bite fever
A teenager was hospitalised and left unable to move after she developed the rare rat-bite fever disease from her pet rodents which lived in her bedroom. The teenager, who has not been named, was taken to hospital after she complained of a pain in her right hip and lower back which later made her immobile, according to the online medical journal BMJ Case Reports. She suffered for two weeks with an intermittent fever, nausea and vomiting and had a pink rash on her hands and feet. The teenager, who had numerous pets including a dog, cat, horse and three pet rats, has since made a full recovery after undergoing a course of antibiotics. Blood tests showed that she was infected with for streptobacillus moniliformis – the most common cause of rat-bite fever. One of her three pet rats lay dead in her room for three weeks before her symptoms showed
10/25 Taking antidepressants in pregnancy ‘could double the risk of autism in toddlers’
Taking antidepressants during pregnancy could almost double the risk of a child being diagnosed with autism in the first years of life, a major study of nearly 150,000 pregnancies has suggested. Researchers have found a link between women in the later stages of pregnancy who were prescribed one of the most common types of antidepressant drugs, and autism diagnosed in children under seven years of age
11/25 Warning over Calpol
Parents have been warned that giving children paracetamol-based medicines such as Calpol and Disprol too often could lead to serious health issues later in life. Leading paediatrician and professor of general paediatrics at University College London, Alastair Sutcliffe, said parents were overusing paracetamol to treat mild fevers. As a result, the risk of developing asthma, as well as kidney, heart and liver damage is heightened
12/25 Fat loss from pancreas 'can reverse' effects of type-2 diabetes
Less than half a teaspoon of fat is all that it takes to turn someone into a type-2 diabetic according to a study that could overturn conventional wisdom on a disease affecting nearly 3 million people in Britain. Researchers have found it is not so much the overall body fat that is important in determining the onset of type-2 diabetes but the small amount of fat deposited in the pancreas, the endocrine organ responsible for insulin production
13/25 Potatoes reduce risk of stomach cancer
Scientists have found people who eat large amounts of white vegetables were a third less likely to contract stomach cancer. The study, undertaken by Chinese scientists at Zhejiang University, found eating cauliflower, potatoes and onions reduces the chance of contracting stomach cancer but that beer, spirits, salt and preserved foods increased a person’s risk of the cancer
14/25 Connections between brain cells destroyed in early stages of Alzheimer’s disease
Scientists have pinpointed how connections in the brain are destroyed in the early stages of Alzheimer’s disease, in a study which it is hoped will help in the development of treatments for the debilitating condition. At the early stages of the development of Alzheimer’s disease the synapses – which connect the neurons in the brain – are destroyed, according to researchers at the University of New South Wales, Australia. The synapses are vital for brain function, particularly learning and forming memories
15/25 Sugar tax
The Government should introduce a sugar tax to prevent an “obesity crisis” from crippling the NHS, a senior Conservative MP and former health minister has said. Dr Dan Poulter believes that the case for increased taxes on unhealthy sugary products was “increasingly compelling”
16/25 Cancer breakthrough offers new hope for survivors rendered infertile by chemotherapy
A potentially “phenomenal” scientific breakthrough has offered fresh hope to cancer patients rendered infertile by chemotherapy. For the first time, researchers managed to restore ovaries in mice affected by chemotherapy so that they were able to have offspring. The scientists now plan to begin clinical trials to see if the technique, which involves the use of stem cells, will also work in humans by using umbilical cord material and possibly stem cells taken from human embryos, if regulators agree
17/25 Take this NHS test to find out if you have a cancerous mole
An interactive test could help flag up whether you should seek advice from a health professional for one of the most common types of cancer. The test is available on the NHS Choices website and reveals whether you are at risk from the disease and recommends if you should seek help. The mole self-assessment factors in elements such as complexion, the number of times you have been severely sunburnt and whether skin cancer runs in your family. It also quizzes you on the number of moles you have and whether there have been any changes in appearance regarding size, shape and colour
18/25 Health apps approved by NHS 'may put users at risk of identity theft'
Experts have warned that some apps do not adequately protect personal information
19/25 A watchdog has said that care visits must last longer
The National Institute for Health and Care Excellence (Nice) said home help visits of less than 30 minutes were not acceptable unless part of a wider package of support
20/25 Pendle in Lancashire tops list of five most anxious places to live in the UK
Pendle in Lancashire has been named the most anxious place to live in the UK, while people living in Fermanagh and Omagh in Northern Ireland have been found to be the happiest
21/25 Ketamine could be used as anti-depressant
Researchers at the University of Auckland said monitoring the effects of the drug on the brain has revealed neural pathways that could aid the development of fast-acting medications. Ketamine is a synthetic compound used as an off anaesthetic and analgesic drug, but is commonly used illegally as a hallucinogenic party drug. Dr Suresh Muthukumaraswamy, a senior researcher at the university and a member of the institution’s Centre for Brain Research, used the latest technology in brain imaging to investigate what mechanisms ketamine uses to be active in the human brain
22/25 A prosthetic hand that lets people actually feel through
The technology lets paralysed people feel actual sensations when touching objects — including light taps on the mechanical finger — and could be a huge breakthrough for prosthetics, according to its makers. The tool was used to let a 28-year-old man who has been paralysed for more than a decade. While prosthetics have previously been able to be controlled directly from the brain, it is the first time that signals have been successfully sent the other way
23/25 The biggest cause of early death in the world is what you eat
Unhealthy eating has been named as the most common cause of premature death around the globe, new data has revealed. A poor diet – which involves eating too few vegetables, fruits, nuts and grains and too much red meat, salt and sugar - was shown to be a bigger killer than smoking and alcohol
24/25 Scientists develop blood test that estimates how quickly people age
Scientists believe it could be used to predict a person’s risk of developing Alzheimer’s disease as well as the “youthfulness” of donated organs for transplant operations. The test measures the vitality of certain genes which the researchers believe is an accurate indication of a person’s “biological age”, which may be younger or older than their actual chronological age
25/25 Aspirin could help boost therapies that fight cancer
The latest therapies that fight cancer could work better when combined with aspirin, research has suggested. Scientists from the Francis Crick Institute in London say the anti-inflammatory pain killer suppresses a cancer molecule that allows tumours to evade the body’s immune defences. Laboratory tests have shown that skin, breast and bowel cancer cells often generate large amounts of this molecule, called prostaglandin E2 (PGE2). But Aspirin is one of a family of drugs that sends messages to the brain to block production of PGE2 and this means cancer cells can be attacked by the body’s natural defences
With celebrities (Stephen Fry, Ruby Wax, Alastair Campbell) increasingly talking openly about their own mental illnesses, there is much greater awareness than there used to be and correspondingly less stigma, making it easier for teenagers to acknowledge their problems. This undoubtedly skews the figures (insofar as there are figures: we were very bad at measuring young people's mental health in the past). But even if you accept that there's more reporting than there was a decade or two ago, pretty much everyone agrees that something very disturbing is happening.
Those who are worried include David Cameron, the first Prime Minister ever to have talked about teenage mental health. Last month he personally announced new money and the introduction of waiting times for teenagers with eating disorders. The Duchess of Cambridge has also made young people's mental health one of her major interests. A Girl Guides' attitudes survey found that mental health was one of the most pressing concerns, with 62 per cent of those surveyed knowing a girl their age who has struggled with mental-health problems.
Mental illness can feel like a personal indictment to parents. It is known that children who are looked after by their local authority are particularly susceptible and, conversely, that there are protective factors linked to a stable home life. Nonetheless, children are often reluctant to talk to their parents, and parents slow to respond, despite the fact that swift intervention is important to recovery. But there's no point in parents blaming themselves: mental illness is caused by a combination of factors and it can strike anywhere. Being middle class, affluent, in a two-parent household, loved, cherished, and successful at school is no guarantee of anything.
Fixers, the charity offering young people the opportunity to create media campaigns, says that 69 per cent of the 18,000 young people they have worked with have wanted to raise awareness of mental health. "We're a barometer of young public opinion," says CEO Margo Horsley, "and the resounding majority want to show people the tough realities of living with anxiety, depression, self-harm, anorexia, bulimia, diabulimia, body dysmorphia, binge-eating disorder … the list goes on." The stories of many of the young people they have worked with suggest that when mental illness strikes, it feels elemental, chemical and incomprehensible; they commonly liken it to possession.
That doesn't mean that we shouldn't query whether there are things going on to do with the way we live our lives. Unhappiness and depression are concentrated in highly unequal societies. In his book The Happiness Industry, William Davies assembles evidence (including from Wilkinson and Pickett in The Spirit Level and Carles Muntaner of the World Health Organisation) to demonstrate that strongly materialist and competitive values lead to higher levels of mental distress. When people feel buffeted by forces over which they have no control, he argues, we conclude it is they who need correcting, rather than the forces: "In the long history of scientifically analysing the relationship between subjective feelings and external circumstances, there is always a tendency to see the former as more changeable than the latter."
Research by the mental-health charity Young Minds has found that exams are a significant trigger for mental illness in young people. Under pressure to get the best possible results, schools are inclined to give teenagers the impression that they have only one shot at tests that will determine the rest of their lives (even though this is not true). The anxiety transmits itself to parents – and this, according to Julie Lythcott-Haims, former dean of freshmen at Stanford and the author of How to Raise an Adult, is having a direct impact on young people's mental health, as parents strive to maximise their children's accomplishments, seeing them as an indication of their own value.
Responsibility for your parents' sense of self-worth is a heavy burden to bear. Natasha Devon, the Government's first ever mental-health champion for schools, who runs workshops through her organisation Self-Esteem Team, says she often encounters young people at independent schools who are "hyper-aware of how much parents have spent on their education and of the expectation that they will go on to university".
The American College Health Association surveyed 100,000 college students at 53 US campuses and found that 84 per cent of US students feel unable to cope, 79 per cent are exhausted, 60 per cent feel very sad and more than half are experiencing overwhelming anxiety. Lythcott-Haims directly links these staggering conclusions to the way that children have become a project, not just in themselves, but also for their parents' egos.
American (or indeed British) students may well be wondering what all their effort is for exactly. Yale professor Bill Deresiewicz has characterised the current generation of high-achieving students as "excellent sheep", haunted by a fear of failure yet clueless about where they're going. They're probably worried that it's nowhere: the OECD's projections for the world economy between now and 2060 are for slowing world growth and near-stagnation in advanced economies. The Oxford Martin School has predicted that 47 per cent of US jobs are susceptible to automation. Sarah Brennan, chief executive of Young Minds, says her organisation is seeing children as young as 11 worrying about unemployment.
We are educating young people for a world that is unlikely to exist in 20 years' time and, arguably, not equipping them with the skills they need for the one that will. And then there's the internet, which has grown up at the same time as the explosion in teen mental illness, and is often seen as part of the problem, with cyberbullying and worries about body image (created partly by selfie culture) often cited as triggers.
Social media doesn't create bullying or anxieties about body image (it's worth noting that rates of bullying haven't risen in the last 10 years). But technology can amplify problems or give them new forms of expression. Cyberbullying can be particularly painful. But the trouble with seeing social media as the problem is that it's the technology that then gets addressed rather than the underlying issues. And after the digital detox, the problems remain.
For most people, the effects of technology are noticeable in the changes, mostly small but cumulative, in our moods, manners, feelings and ways of going about our lives. Facebook's famous experiment, published in July 2014, in which it doctored the feeds of some of its users to spread unhappiness, proved that social media can affect our moods (as if we needed proof that Facebook makes us feel as though everyone else is eating better food and hanging out with cooler people than we are). The curated lives displayed online can make anyone feeling even slightly vulnerable feel really wretched.
That said, social media can also provide support for young people, especially for those struggling with their sexuality (44 per cent of 16-24 year-old LGBT people have considered suicide) or feeling isolated. Technology is an easy target for adults: it's new, it moves faster than we do and it's very visible in young people's lives. But it may be that some of the energy adults spend worrying about technology would be better spent worrying about the world that creates and shapes both social media and the psyches of our children.
There is much about mental illness that may well be very difficult to prevent: biological susceptibility, unavoidable triggers like bereavement. It makes sense to focus on the dearth of early-stage therapies that are known to make a difference because, at the moment, as Brennan says, "we are investing in having a sick adult population: 75 per cent of adult mental illness emerges before the age of 25 and only 50 per cent of young people are getting any kind of care."
Still, when you are tackling an epidemic, you need to think about more than treatment. We also need to ask hard questions about why children feel so at odds with a world that ought, after all, to be all about them and their future.
CASE STUDY 1:
Jordan Caldwell, 18
Carnmoney, Co Antrim
I was diagnosed with anorexia at the age of 12. My grandad and two uncles had died in a short space of time. I was representing Northern Ireland in football matches; I got a call saying they didn't want me back. I decided it was because I was too fat. I'd always been a big strong lad for my age but I thought if I lost a bit of weight I'd be able to play at the top level again.
For a while my mum and dad thought I was just being faddy. I wish I had been able to talk to someone before the thoughts became so strong but I didn't want to. Then one day my mum saw me coming out of the shower and she was horrified. My parents took me to the GP, who referred me to the eating disorders clinic. On my first visit they did some tests, bloods and blood pressure and so on, and said I was too ill to go home. I had two months in hospital. They didn't know what to do. I still wasn't eating.
After I was discharged, I was very abusive. I was constantly shaking and screaming. I would try and hit my head on things. I'll never forgive myself for what I put the family through. My little sister was afraid to say hello to me. The anorexia was like demons inside my head, telling me what to do. My mum says I vanished. She said she saw me fighting every day and if it had been a person I was fighting, she would have killed them.
I hadn't eaten or drunk anything or brushed my teeth for a week – I thought the toothpaste had calories in it – when I had a seizure. It was my 14th birthday. The doctors said afterwards it was a miracle I survived. I went into a psychiatric hospital for 11 and a half months. My little sister had to go and live with my granny because my parents were with me 10 hours a day and the hospital didn't want her to see me in the state I was in.
Eventually I started to make signs of improvement – I could talk the talk – but when I was discharged the nurses predicted I'd be back in a couple of weeks. I was up and down after that but I was determined to stay out of the hospital. I wanted my sister to be able to stay at home. The illness tried to tear the family apart. It came very close.
I went three or four times a week as an outpatient to the CAMHS eating disorders clinic. I got a personal trainer, who helped me to exercise and talked about the need to put food into your body to do that. When he first came to see me there was a mark in the carpet where I'd been doing sit-ups so frantically. I needed someone to be harsh with me. Up until then, if I argued with Mum and Dad, I wouldn't eat. Now I am working at the gym as a receptionist and I've just passed my level 2 to be a gym instructor. I still ask "why me?" and I don't know the answer. I feel it's important to talk about it, though. If I can help one other person, that would be something.
CASE STUDY 2:
Cerys Pumphrey, 18
The crisis came when a pen that had been in someone's mouth a week or two earlier touched my cheek. I burst into tears. I was in absolute panic; I felt I was going to be sick. My heart was in my throat: it was like when you hear that a close family member has died. I was about 16 and the stress of GCSEs was really kicking off.
I can't pinpoint the first symptoms of my OCD: it's a voice in my head, like the voice of conscience, and when I was younger I had the power to shut it out. By the time I was 16 I couldn't control it. I think there is a biological aspect to it: I have OCD, my cousin has depression, and they are both linked to low levels of serotonin. But there has to be a trigger and for me it was the stress of exams.
After the pen incident I talked to my mum but it was very difficult for her to understand: I was playing rugby, I'd done my Duke of Edinburgh; in her mind there was no way I could have a mental-health issue. I booked an appointment with the GP and I'd been there about two minutes before they said I needed to be referred to Child and Mental Health Services (CAMHS). I think it was because of my hands: it was December and every winter they get cracked and dry to the point that I can't move them, because I am washing them so many times a day – about 30 times, usually.
I was really lucky: I only had to wait about two months for my CAMHS appointment. The whole thing was a massive shock to my family: they didn't know how to take it. The first year with CAMHS I was a mess. I kept having panic attacks. They'd come on if someone brushed past me who I thought was dirty, or if I thought I was sitting down on a bodily fluid. Most people call their voice something like "devil", but I called mine Helen.
When I turned 18, I was discharged from CAMHS. They really helped me sort out some of my weaker compulsions but we weren't able to get to the handwashing. I'm with the adult service now. At my last therapy session my psychologist said that CBT (cognitive behavioural therapy) could well work for me.
I told people once I started going to CAMHS. I wasn't going to keep it secret. A lot of people thought I was attention-seeking and some people didn't believe me. It annoys me when people say, "I'm a little bit OCD," because it's not a joke. I struggle to explain why I do certain things. I have to wash my hands up to my forearms in school. It looks very weird, washing half my arm. I use a lot of soap and I have to wash three or four times before I can leave the toilet. Sometimes I have to wash my bag if it touches something I think is dirty. It's very lonely.
I am doing A-levels now and I've applied to do history at university. The universities I've applied to have very good mental-health services; that was one of my main criteria. It will be hard to adjust, but I think I will be safe.
CASE STUDY 3:
Naomi Lea, 17
St Asaph, Denbighshire
I realised there was something wrong when I was 14. I was increasingly stressed about exams and I was having panic attacks in school and couldn't stay in lessons. I was predicted all As and A*s at GCSE but my self-esteem was so low, I didn't think it was possible. I became terrified that teachers would ask me a question in class.
I started self-harming. I hid it very well; no one was aware of what I was doing. I went very quiet and I wouldn't socialise or speak in class. My teachers thought it was because I was shy.
In Year 11, just before my GCSEs, I decided I'd had enough and I spoke to a teacher about how I was feeling. Once I had opened up, the school got me a referral to CAMHS. I had to wait about six months for an appointment – there was a horrendous waiting list – and I had four sessions with a counsellor in school in the mean time.
I really struggled with the first few exams. I would lose concentration and go blank. As they went on I would get really really anxious beforehand but, once I was there, I could manage. Eventually, about a year ago, when I started with CAMHS, we did tell my mum. She was really understanding. She's a single parent – or she was then, she's in a relationship now. It's very difficult for parents to deal with.
Once I got through the waiting list, I had quite a good relationship with my psychologist and I had a course of CBT which was really helpful: I learnt skills that helped me manage my anxiety. When they discharged me, I felt I wasn't ready but they wanted me to see if I could deal with it alone. For the first few months I felt I was managing, but things have gone downhill again recently, possibly because I'm coming up to A-levels. I'm on the horrible waiting list again.
I've applied for university and I'm hoping that independence will help me to learn to control it better. The whole time I was in school, I never had a lesson about mental health. I saw a post online about a project with [mental-health support group] Fixers and I wanted to make a film that could be shown to students in the early years of secondary school, about recognising the signs. I have run a workshop with it at school and shared it on Facebook and it was shown on ITV news.
The online world was my support network. Most of the time, it was really helpful. I made friends I could talk to regularly and it gave me someone to rant about my day to at a time when I couldn't tell my school friends. I thought they would judge me.