The state of young people’s mental health

To coincide with World Mental Health Day, guest blogger, young person and professional Kat Cormack looks at the state of young people’s mental health in 2013 and examines access to treatment, perception of people with mental health issues and stigma.

So here we are on the week of World Mental Health Day 2013 and I can’t believe a year has passed already since the last one.

It’s also ten years since I started receiving mental health treatment and so now seems to me like a good time to take stock and see what is currently happening in children and young people’s mental health. I guess that makes this my “State of the mental health nation” speech.

Mental health, illness and everything in between is a massive area and I could talk to you about everything from ADHD to Z-drugs but then this would be less blog and more book: or five! So I’m going to focus on a few areas that I feel make for good indicators to assess the health of our mental health and services.

The last 10 years have been huge for me, seeing me going from a severely ill 14-year-old to a moderately ill but high functioning adult. In this time I have gone from being a student at school using CAMHS to someone who now works for the NHS and with YoungMinds (and occasionally uses Adult Mental Health Services).

I have also spent five years working with YoungMinds, the Royal College of Psychiatrists as well as completing an undergraduate degree in Psychology where my dissertation was based on young people’s experiences of transitions from CAMHS to adult services. This puts me in a somewhat unique situation (not unlike a tightrope at times) of being a professional, a “young person” and a service user all at once.

So where do we begin? I think two of the most salient indicators are access to treatment and perception of people with mental health issues. These are the two areas I will be covering in this blog.

Access to treatment

Asking for help with a mental health problem is daunting. I’m not going to lie. It takes courage to admit that things aren’t right and that you’re struggling and I commend everyone who takes this first step.

For most young people the first port of call is their GP, it was for me too. Ten years ago when I first asked for help my GP (newly qualified) had no idea about mental health having received no real training in the area. At the time I didn’t think much of it but looking back that’s pretty shocking given that such a high percentage of GP visits are related to mental health.

Fast forward 10 years and some progress has been made and I have met a lot of GPs who are very much up to speed with mental health and act accordingly. However many still have limited training and understanding and I have had my fair share of run-ins with GPs who are ignorant to the point of negligence. This needs to change. We cannot keep telling young people just to “talk to a teacher or your doctor” if they’re worried if we don’t then train these professionals to respond appropriately.

After seeing the GP for many young people they are referred to CAMHS. However we know that waiting lists are still unacceptably long with many young people waiting months (or even up to 18 months) for the support they so desperately need. This is not acceptable.

There is much talk of bringing about “parity of esteem”, to put it simply this means we need to start treating mental health as seriously as we treat physical health and that includes holding services to account to the same waiting times. You wouldn’t have to wait 18 months to get a broken leg fixed!

Another big problem we face in 2013 is the increasingly savage cuts to health and social care. Through an FOI request YoungMinds found that two thirds of local authorities have cut their budgets for children and young people’s mental health services since the coalition government came to power in 2010. One service suffered cuts of 41%. (Source: http://www.bbc.co.uk/newsbeat/21737173)

At a time when even more children and young people are experiencing mental health problems the last thing we can afford to do is cut services. Children and young people are not immune to the effects of the recession which have lead to a surge in family breakdown, youth unemployment and stress for young people. And as Tier 3 services like children’s centers are closed the burden increasingly falls even more heavily on CAMHS which was struggling as it was 10 years ago when I first came into contact with them.

With three in every classroom affected by a mental health problem we are letting down too many children and young people.

This is why I am happy to hear that many schools are beginning to ask more organisations like the wonderful BodyGossip to come in and talk to their students. I’m also glad that there is a lot more talk of teaching children resilience and even screening for mental health issues from the age of 7.

Perception of mental illness

Another area that I have watched with interest over the last decade is the way mental illness is viewed and the stigma associated with it.

Thankfully I can say that we’re making some progress with this. When I was at school we never ever heard about mental illness. Now we have amazing campaigns like Time to Change’s Stand Up Kid, YoungMinds in Schools, Student Minds, The Acseed initiative and Mental Wealth.

But we still have a long way to go. I may now be very open about my mental health, something I definitely didn’t feel able to do 10 years ago, but I am part of a minority. I am lucky enough to have the support of my family, friends and importantly my employer. This has not always been the case and I have suffered discrimination in the workplace because of my health as have many thousands of others. We need to create an environment in our country where it is okay to talk about how we feel.

I think that the recent ASDA/Tesco “mental patient” costume scandal is a very good example of some of the stigma we still face in society. Although having said that, the fact that this story hit the news as hard as it did is actually quite heartening. It wouldn’t have made mainstream news 10 years ago.

I also recently ran into the anti-psychiatry movement founded by Scientology, the ironically named Citizens Commission on Human Rights. As I stated in my blog here this was really shocking for me. I know people struggle with the idea that children can experience distress and mental illness but to run head first into people that don’t believe that mental illness exists at all?

There is definitely a lot of work still to be done to help educate people but I also know that there are lots of fantastic organisations, too many to name, fighting daily to reduce stigma and increase awareness.

So overall how is the state of children and young people’s mental health in 2013? I don’t think we can say clearly that it is “better” or “worse” than it was 10 years ago. There have been improvements, there have been set backs but perhaps, if I am dangerously optimistic, I would say things are gradually improving in some ways.

What we need now is for proper investment in children and young people’s mental health, and in mental health in general. For too long it has been a Cinderella service and we cannot continue this way. Research shows both that over half of adults with a mental health issue developed it by the age of 14 and that prevention and early intervention work and save both money, and more importantly lives, in the long run.

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Confession time: the first time i asked for help

The World in Mentalists this week featured a blog about first experiences (or first contact!) seeking help for a mental health problem.

Reading that blog which you can find here i suddenly found myself transported back almost ten years ago now to my own first time. The first time i admitted that i needed help and couldn’t do it on my own any more.

This first experience is, for many, a huge deal. It is the first time they have ever admitted it and let their carefully crafted mask fall and from personal experience it feels like a confessional.

Forgive me doctor but something is really not right in my head.

The first time i ever admitted out loud that something was not all right was  definitely a shatter point in my existence. My memories of it are vivid even now and i look back and have so many things i wish i could say to that scared girl.

I was fourteen when i first went to my GP and asked for help. I had been ill for a fairly long time by this point, having already fallen quite deep down the rabbit hole of Depression, Anorexia, Anxiety and OCD.

These were not conditions that had come about suddenly, they had grown up with me, slowly and silently. I had always been an anxious child and i can remember very ritualised behaviour and obsessive compulsive symptoms dating back to the age of 6 but it had always seemed very normal and very manageable to me.

In fact i remember thinking that everyone did the strange rituals i did and thought the way i did, we never talk about it because everyone does it i reasoned to myself.

When i was thirteen it began to manifest more strongly and i started retreating into myself. I had always been quiet and i had just started the “terrible teens” so it was not really noticed, not even by me, that i had started withdrawing from the world.

I had a lot of friends online and they were the ones that eventually managed to convince me to tell people “IRL” (in real life) and that what i was feeling was not normal.

Up to this point i had told almost no one that actually knew me, it was something i kept incredibly close to my chest and that not even family or close friends knew about.

I finally managed to work up the courage to tell my parents. Almost. I left them a note that said i needed to go to the doctor because something wasn’t right. This may seem cowardly but at this point i was literally unable to get the words out of my mouth.

They were shocked and scared, it was completely out of the blue, so good i had got at hiding that anything was wrong.

I wrote a four page letter to my doctor on my computer and printed it out because i was terrified of saying anything and i knew i would sabotage it and end up saying that nothing was really wrong, i had made a mistake.

I honestly did not know what to expect or what would happen after i handed over those pieces of paper. Mental health was not talked about ten years ago. We now have wonderful campaigns like Time to Change and politicians talking about their experiences of mental illness but when i was 14 this just did not happen.

There certainly wasn’t anything about mental health or illness at school. People made jokes about “nutters” and “men in white coats” sure but there was deafening silence from the curriculum.

I was scared that i was going to be sent straight to a psychiatric hospital right there and then on the spot. I was scared i would be medicated up to my eye balls.

Luckily this was not the case!

The doctor i saw was young and very newly qualified. She admitted from the very beginning that she knew very little about mental illness or the conditions i was suffering from and had never had a patient like me but that she would do everything in her power to find out more and help.

She was incredibly kind and compassionate and refused to give me medication, saying instead that i would have a referral to the local CAMHS team for an assessment. I remember how wonderful she was, so non judgemental and what’s more she believed me and what i was going through.

Through the weeks she helped me understand that medically i was not well and i needed help, she helped me talk to my parents and together we learnt more about my illness.

Later on she left her position at my surgery and went elsewhere, however because of the way she had responded to me i felt optimistic about my treatment from this point onwards.

I hear about some people’s first experiences and think back to some of my own later run ins with professionals i feel terrible thinking about it. It is so important that your first time “coming out” as it were about a mental health problem is not a negative one. I know so many people that tried once and it took them years afterwards to try again because their first experience had been so traumatic.

There is still a real gap that needs to be dealt with in terms of good and actual patient experience is and the education of GPs when it comes to mental health, especially in young people.

But i hope that through continuing work by organisations like YoungMinds we can get there. Everyone deserves to be taken seriously and treated with respect.

And if you want to help support mental health education in schools check out my friend Charlotte’s amazing AcSEED project.

Talking Taboos: Self Harm

There is a phenomena that lurks, mostly hidden away, and that affects more young people than i think anyone really dared, or wanted, to imagine. The number has been growing for years. In fact it affects one in twelve young people and yet is one of the most misunderstood and mistreated issues they face today.

The issue i’m talking about here if you hadn’t guessed is Self Harm.

At YoungMinds and the VIK project we have known for a very long time that self harm is a huge problem for many young people. We campaign to raise awareness about self harm and reduce some of the stigma that surrounds it and do this by giving training to professionals, speaking and writing publicly about our experiences and feeding into research. So when  YoungMinds were given the chance to do a major piece of research on self harm they jumped and together with CELLO they produced a year long piece of research entitled: “Talking Taboos”.

I was lucky enough to attend the launch of Talking Taboos at Portcullis House on the 23rd of October. The launch was a fantastic success with a wonderful audience that were full of questions for our panel of experts:

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The panel

 

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Lucie Russell, YoungMinds

The report, aimed at exploring society’s perceptions of self harm as well as young people’s experiences also goes on to give key recommendations to try and bring self harm out of the shadows and break down the barriers so many face in seeking help. In a world where there is so much fear around self injury it is great to see such clear, straightforward steps we can begin to take to improve this area.

The report showed a widespread lack of understanding and training around self harm for near enough all frontline staff in young people’s lives; from parents, to teachers to GP’s. However it also showed that so much of the time it is not a wilful ignorance.

 

97% of young people say that they believe self harm should be addressed in schools and 80% of teachers want clear, practical advice and materials that they can share with pupils.

 

Those are overwhelming numbers that cannot be ignored. There is a strong desire for knowledge and to open up a dialogue with young people and i would love to see more schools actively engaging with young people about mental health and emotional wellbeing at the very least.

We need to help GPs to understand too. Four out of five do not feel that they have the right language to speak to young people about self harm. That worries me.

We need a new era of openness and tolerance and not only that but empathy for our fellow men, women and children who are suffering silently because of ignorance and stigma.

Self harm is a widespread problem and just like mental illness it does not discriminate between genders, or races or even age ranges. We have all at some point or another i imagine done something that could be seen as self destructive and everyone has less than perfect coping mechanisms. It might take the form of smoking, or drinking too much, or self harming. Either way we need to stop obsessing about the fact it is happening and start asking “why?”.

 

 

 

The report can be read in full here: Talking Taboos

And for more information and advice on self harm i would strongly recommend checking out LifeSIGNS which is run by people with direct experience of self injury.

Continuing on the schools theme (tw)

Beat’s “PSHE: Managing challenging conditions” conference.
City University, London.

On the 31st of March after a ridiculously busy month of training, conferences and consultations i attended the last conference for the near future with Roger Catchpole, our training and development manager at YoungMinds.

The conference was organised by Beat, the UK’s leading eating disorder charity, and titled “PSHE: Managing challenging conditions”. It set out to look at mental health issues faced by young people in education and how to manage these conditions and help pupils and was open to educators and clinicians.

Unfortunately neither me or Roger could attend the morning or early afternoon part of the session but looking over the print outs for some of the other speaker’s presentations it looks like some amazing ground was covered on a diverse range of mental health problems in relation to young people.

Roger spoke about what role schools play and what their boundaries are as it’s often difficult for schools to know what to do when they have an unwell pupil..a lot of the time they tend to panic and this is not helped by very little mental health training and education in schools both for the teachers and the other pupils.

I also spoke about my experiences of school and i thought i would post up what i said as i think it’s very relevant to a lot of recent posts about school experiences.

So here it goes!

PLEASE NOTE: Some of this may be potentially triggering so please take care of yourself while reading.

My schooldays are quite a way behind me now (i turn 22 soon and left at 18), but what do i remember about being a mentally ill pupil?

Well i remember what it was like before and the stark contrast between that time and after i got “sick”. I was a good student, rarely late, always conscientious. I cared so much about what my teachers and parents thought about me and felt absolutely crushed when i did something wrong. I was definitely verging on a perfectionist and was always prone to anxiety but i had a good group of friends, i managed and life was good.

And then the depression and anorexia got their grip on me around the age of 13-14 and exacerbated issues i had always had; OCD, Anxiety and insomnia; it became overwhelming and things began to spiral downwards at a rate of knots.

I remember sleeping through lessons and turning up to others looking and feeling like a zombie. I remember not eating, self harming in the school toilets and pulling my hair out in class and wearing long sleeves all year around.. Going home at lunch to avoid people and becoming more withdrawn by the day.

And feeling alone.

I remember that the most. The isolation of it all, feeling like everyone else was going about their normal lives whilst i fell apart in the corner.

My school, when they found out, did what they could but what they did was not always helpful. I don’t blame them though. They had no support to support me and i imagine having such a good and supposedly “normal” student going so far off the rails was bewildering for them.

I’ll start with what didn’t work so we can end on a more positive note.

What didn’t help was their panicking. At points they felt they couldn’t cope with me so i wasn’t allowed to come to school. This felt like a punishment and was damaging at a time when i needed to retain some semblance of normality; some kind of structure to my day and a chance to interact with other people and see my friends.

When i was allowed in school having an SEN assistant follow me around from class to class (not subtly either) to make sure i didn’t abscond or do something to myself-and forcing me to spend all of my break and lunchtimes in the tiny SEN office made me feel like a freak. I couldn’t pretend i was normal anymore, everyone, pupils and teachers alike, knew that something wasn’t right. All this did was make me even more painfully aware that i was “different”.

We also never learnt anything about mental health or illness in school, it just wasn’t a subject that was ever broached. It, of course, came up when i did A level Psychology but that was to be expected and it felt like too little too late and in the wrong context. We focused on specific mental illnesses and it would have been so helpful to have something much earlier in my school career about mental health and emotional wellbeing and something, anything, to reduce the stigma of mental ill health.

The only time mental health was raised was by classmates making jokes about “nutters” and “the men in white coats coming”-not exactly things that are going to produce an environment where it is seen as OK to talk or to turn around and say “actually i have mental health problems”. As a result i only told a couple of people what i was going through and the rest was hidden away and bottled up. I told people i missed a lot of school because of physical health problems because it seemed more socially acceptable and said i had physio for some mysterious issues 1-3 a week for two years instead of admitting i went to a CAMHS clinic for therapy.

In fact, with my local trust i recently went into a school to talk about my experiences and to dispel some myths about mental illness. I came out of it wishing there had been something similar at my school to make it feel a bit less wrong and bad to be ill and to make me feel a bit less alone in it all.

But it wasn’t all bad. I was lucky in that my form tutor was an amazing man. He was seen as quite intimidating by a lot of people, ex-army turned PE and Maths teacher and i wouldn’t have liked to get on the wrong side of him. But we clicked and when he found out about what i was going through he told me he had a long history of depression. And although he didn’t have any kind of mental health training he understood and he took me under his wing and looked out for me. I am eternally grateful for the care and compassion he showed me. He didn’t treat me differently or draw attention to what was going on but he was there and a friendly face in the crowd.

I think the most important thing for schools is not to panic-it doesn’t help you and it certainly doesn’t help us as young people, especially as we are often confused, scared and overwhelmed enough. Mental illness at school is common. I wasn’t alone in what i was going through (hell the statistics say that 3 pupils in every classroom have a diagnosable mental health problem) but i was made to feel like i was. Since leaving school and becoming more open about what i’ve been through i’ve found that a lot of ex-schoolmates had similar issues and i just wish we had known and been able to talk about it and support each other at the time, i think it could have helped.

First published 4th April 2011:

http://www.vik.org.uk/2011/04/06/continuing-on-the-schools-theme-tw/