Our culture demands certainty, and our political discourse is intensely polarised. We all face pressure to take sides. To say something is right or wrong. Or to provide definitive answers to difficult questions. Sometimes this is easy: racism is bad; children should be well cared for. But often it isn’t so simple. Two things can be true at the same time. It is consistent, for example, to believe the murderous rampage of Hamas militants in Israel on 7 October was an abhorrent act of terrorism and that the killing of thousands of innocent children and their families in the Gaza war is equally awful. It’s also OK to say we don’t have the answers to the most difficult of questions. We don’t know how to solve the crisis in the Middle East in a way that both protects innocents and doesn’t reward criminality.
One such area of contention in Britain is mental health in adolescence, which the Oxford psychologist Lucy Foulkes and her colleagues have been examining. There is no doubt young people are experiencing poor mental health in ever-greater numbers, but Foulkes is asking a fascinating question: for some, might well-meaning attempts to reduce these difficulties be inadvertently making the problem worse?
Foulkes suggests that endless talk about mental health – in schools, universities, online and at home – has “meant milder problems are now confounded with mental disorders, and young people are diagnosing themselves with problems they don’t really have”. Feeling sad becomes depression. Low-level nervousness becomes an anxiety disorder. Rather than being understood as the normal fluctuations of being human, emotions are something to be frightened of. Schools have extended programmes intended for select pupils to each and every child. Intuitively, that might sound like a good idea. But why should one intervention work for everyone?
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While the evidence for what works is limited, Foulkes says, there are indications that this part of their hypothesis may well be correct. Studies have found that pupils who were taught cognitive behavioural therapy in school reported an increase in internalising problems compared with those who hadn’t. Mindfulness lessons were found by one large-scale trial to lead to more depressive symptoms in children who had mental health problems at the outset. These findings have profound implications. Even if only a minority are harmed in each school, when scaled up across the country it could affect thousands of young people. That, Foulkes argues, “amounts to a potentially vast public health problem”.
But, having raised the question, Foulkes has found she’s also been expected instantly to provide the answer. She recently wrote that she finds it hard to say “I don’t know” to a journalist. It shouldn’t be difficult. It also shouldn’t be hard to say “I don’t know” as a journalist. Not only is it OK, it’s honest.
Foulkes and her researchers do not suggest that no young people suffer from genuine poor mental health, nor that interventions can’t be beneficial for some. But some commentators have seized the “controversial” part of her hypothesis and ignored the rest. “When I am interviewed… the subtext is sometimes obvious: why are young people lying, and how can we get them to stop?” she says. When a newspaper featured her work, the letters that followed had a distinct tone of “just get on with it”. “The backlash against mental health awareness has begun,” Foulkes says, “before we are even close to understanding how to support anyone who needs help.”
The debate about child mental health is a classic case of identifying a real problem, attempting to rectify it with a sweeping intervention, and in doing so causing harm or over-correcting. For decades, parents were told to put babies to bed on their stomachs for fear they might vomit and choke. In fact, this was far more dangerous than placing them on their backs, and resulted in thousands of deaths. Accounts of sexual abuse were wrongly ignored for decades in Britain. Then, as part of a much-needed cultural shift in the 1980s and 1990s, the police and public came to believe outlandish accounts of ritualistic child abuse in the “satanic panic”.
Children’s mental health referrals more than doubled between 2017 and 2022, to over 1.2 million. There are long waits to be seen by Child and Adolescent Mental Health Services. It would be of enormous benefit to prevent those who do not need support from slowing access for those who do. There’s an economic incentive as well. Depression and anxiety are the problems cited most often in preventing adults from working, and the Department for Work and Pensions predicts spending on disability benefits will rise by over half by 2029 – from £31bn now to £48bn – if nothing changes.
There is always a danger in uncovering uncomfortable truths that others will misuse them for other purposes or to affirm political positions and prejudices. Nuanced argument, in which two things can be true, is lost as we stick to polarised positions, triggering unintended responses. In this case: a potential backlash against young people with real mental-health difficulties. Lucy Foulkes says she now worries about “the consequences of asking the questions”. But we must ask questions, especially difficult ones. We may not always like the answers, but without acknowledging that there is a problem, there can be no way even to start to think about how to tackle it.
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This article appears in the 10 Jan 2024 issue of the New Statesman, The Year of Voting Dangerously