A few years ago, on a work visit to Montreal, I tried to explain our CAO college offers system to a colleague whose son was starting college. They were baffled – why leave the offers so late? Is the uncertainty not stressful, posing problems for students’ wellbeing?
The answer, of course, is yes – it’s clearly not a student-centred system.
No doubt college students everywhere could talk about the unique stresses they face, whether high fees, living away from home or academic pressures. As a result, one might expect that levels of wellbeing and prevalence of mental health difficulties would vary widely from country to country.
Astonishingly, though, any such inter-country differences appear to be largely eclipsed by global trends in the mental health of young people aged 12-25 years. As reported by an international Lancet commission recently, a steady and sustained decline in youth mental health is apparent worldwide and has been for some time.
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The numbers are sobering. In data from the UK, mainland Europe, Australia and the US, up to 60 per cent of young people (depending on which measure is used) report clinically significant symptoms of mental ill-health, most often related to anxiety or low mood. This compares with a prevalence of 10-20 per cent 20 years ago. These figures (which are mirrored in the Irish MyWorld survey) reflect a steady decline in wellbeing in the intervening time, accelerated during and since the Covid pandemic, but apparent long before this. Mental health disorders are now by far the number one health condition faced by young people.
While the precise causes of these changes are still to be fully understood, the report highlights several “mega-trends” that are believed to play a role. These include unregulated social media, precarity of employment, intergenerational inequality (such as in housing), and the climate crisis. Prof Patrick McGorry, lead author of the commission, said: “This crisis is not only costing lives and futures but it also weakening society and the economy. Young people are the canaries in the coalmine of modern society.”
That a big scientific report focuses on these broader economic and societal trends should really give pause for thought. Traditionally, mental health difficulties have been understood at the level of the individual and their immediate family. The commission’s expert group, however, are pointing to broader difficulties – the fragmentation of society and growing uncertainty about finding a long-term community to belong to, whether through your work, or where you live. Social media, an escape for many young people, not only fails to meet their need for connection, but often compounds the resulting sense of alienation.
These difficulties are coupled with enormous challenges for young people seeking help. The Lancet Commission’s report highlights the fact that young people have the poorest access to healthcare of all age groups. The lack of investment in mental health (~2 per cent of health budgets globally) is taken to reflect the ambivalence that society often seems to show to young people’s needs. Even in developed countries such as Ireland, evidence abounds that the demand for services such as Camhs, Jigsaw and third-level counselling services vastly outstrips supply.
Some have suggested that there is now an “epidemic” of youth mental health difficulties. I’m not sure this term is helpful. The deterioration in youth mental health in the past two decades is not sudden, nor is it like some new virus that we don’t know how to treat. The Lancet commission underlines the fact that we already know much about what works for whom and in what settings, describing several of the important characteristics of effective prevention and intervention strategies.
In terms of prevention, the commission suggests that approaches to building mental wellbeing need to include both the universal (such as school and university-based programmes that focus on building resilience and reducing substance abuse and self-harm) and the selective (programmes targeting specific risks such as eating disorders). In terms of treatment provision, the commission highlights the need for developmentally appropriate, integrated services that are co-produced with young people at the level of both service development and service delivery. Such services show robust evidence that they are effective, valued by young people and capable of being deliverable at scale.
The Lancet commission concludes that the crisis in youth mental health requires an urgent response by governments in both the developed and developing world to address these difficulties. In terms of Ireland specifically, commission lead Prof McGorry said “Blueprints for achievable reform are in the hands of the major government and opposition parties with whom I have met and advised personally. Ireland has made some positive early steps but there is a major task ahead ... It is time to act”.
- Prof Gary Donohoe is University of Galway established professor of psychology, and HRB Research Leader in youth mental health