Adolescence
Painful, greasy, smelly, hormonal, angry are just a few of the names attributed to adolescents. On one hand, some professionals, including social workers, forget the uphill struggles and peer pressures associated with teenager years. Some think they were model teenagers themselves and have forgotten about the pressures young people face in today’s world. On the other hand, it is often said that the current generation of young people are growing up as self-centred, apathetic, less responsible and are less emotionally aware than their predecessors. Here is a generation far more diverse in their sexuality and gender identity, but who are also paradoxically the least tolerant generation in history.
Adolescence is a massive time for brain development and changes – major changes in the volume of the brain’s grey matter. Did you know that by age six, the brain is ninety-five percent of its adult size? During adolescence, there is so much going on in the head – lots to deal with and learn about coping with life. These days, teenagers spend a significant chunk of their time playing video games, texting, or scrolling social media, and as a result, it takes them longer to fall asleep. Without adequate sleep, children are at increased risk of obesity, impaired cognition, and poor emotion regulation. Are there any answers and if so, what are they?
Increasing numbers of teens with OCD and Eating Disorders
NHS figures show that before the Covid pandemic, the number of children aged six to sixteen with a mental health problem was one in nine – that figure is now one in six. There has been a massive rise in obsessive-compulsive disorder (OCD) and eating disorder cases, which have come at a time when it is more difficult than ever to get treatment on the NHS. This is concerning because most mental illnesses need early intervention. All life-long mental health conditions develop by the age of fourteen.
OCD is described as a repetitious act that compels a sufferer to do something repeatedly, dozens of times daily, to relieve anxiety or some perceived psychological threat. For example, someone may become preoccupied with germs and bacteria and become obsessed with cleaning, whilst others become fixated with keeping things in order and constantly arrange their wardrobe to ensure their clothes hang in a straight line. OCD is a chronic psychological condition. Nobody knows what causes it, but it is often linked to childhood trauma, even sometimes occurring in the womb. This is either chaos around an environment, for example, domestic violence, or mental anguish because of a fear or anxiety. One of the tell-tale signs of OCD is when a child becomes very distressed if they can’t – for whatever reason – carry out their cleaning ritual. There will certainly be tears and a meltdown. It is estimated that every other person has some form of obsession, but only one in a hundred will develop traits which lead to their obsessions becoming compulsive and burdensome, if not debilitating.
Eating disorders mainly affect females but also occur in some young males. A silent voice in the mind tells these young people they need to keep getting thinner and thinner. These disorders generally fall into two groups: anorexia nervosa and bulimia. Both are considered acts of self-harm. Those with anorexia nervosa will constantly consider themselves fat, irrespective of their weight. They will continually be stressed and anxious around food and suffer from low self-esteem, but the compulsion to exercise control over their bodies means that they never eat enough to stay healthy. Bulimia, on the other hand, involves eating copious amounts and inducing vomiting to avoid absorbing the food. Most will binge on junk food before going to the bathroom to regurgitate everything.
Those with critically low weights put themselves at substantial risk of death due to potential organ failure. Some will show all the signs of clinical malnutrition, which includes extreme muscle and fat atrophy on shoulders and arms and extreme loss of subcutaneous fat in faces and abdomens. Others will look emaciated, manifesting as thin limbs, pronounced and protruding bones, sunken eyes, dry skin, thinning hair, a bloated stomach, and a dry or coated tongue. Teenage girls are frequently on diets, with sixty percent at any one time thinking they are overweight, as consequentially, they miss out on vital vitamins and minerals. Many will suffer from vitamin deficiencies, particularly vitamin B, which is important for mood regulation; vitamin B3 (Niacin) helps the body make serotonin, and vitamin B6 is useful for girls during their menstrual cycle to help with mood swings.
Bigorexia is a term coined to describe a term coined to describe a form of body dysmorphia – a disorder that causes sufferers to agonise over self-perceived flaws in their appearance. Teenage boys who admit using muscle-building supplements may have an eating disorder. Those who consume protein or creatine powders to quickly build muscle could be showing early signs of body dysmorphia – especially if this is accompanied with extreme dieting habits.
Shocking Statistics
Child and Adolescent Mental Health Services (CAMHS) have been under pressure for the past two decades, with waiting lists now exceeding several years. There doesn’t seem to be any answers to how this overloaded, understaffed and poorly resourced service can provide a credible service to the current generation of children and young people. In addition to this, the statistics regarding alcohol and substance misuse among young people are massively concerning.
According to statistics by the charity ‘Young Minds’(Impact Report, 2022), a third of all young people will have tried cannabis by the age of fifteen. The UK is the third highest country in the world for alcohol misuse among young people, however, there is data evidence from the annual Health Survey for England (2024) that states that lots of young people are now choosing not to drink and have a much different ‘relationship’ with alcohol than their parents’ generation who grew up in an era of binge drinking. However, those who start drinking at 15 are five times more likely to become heavy drinkers as adults. Forty percent of 13- to 14-year-olds have their first sexual experience when drinking or taking drugs although these days most are mindful to practice safe sex. Between the ages of 15 and 24, half of accidental deaths involve drink or drugs – so do many suicides. Suicide in the UK is the second most common cause of death in those aged between 15-24 after road accidents.
Over the past five years, there has been an increase in the number of children with autism also receiving an ADHD diagnosis. Online, the idea that autism and ADHD can coexist is so widely accepted that it has spawned its own label – “AuDHD.” It remains unclear why this dual diagnosis has suddenly become so popular in psychiatric quarters. This increase tends to be mostly in males but can also apply to females. Some psychiatrists claim that female brains have a greater proportion of grey matter, which comes with several advantages – they are better protected against autism, dyslexia, ADHD, and Tourette’s syndrome; hence, fewer are diagnosed.
Depression and anxiety are also on the increase, and currently, it is estimated that around twenty percent of teenagers suffer from depression. One of the reasons for this is said to be the pressure that sometimes comes with online activity. For example, there is enormous psychological pressure on girls to share indecent pictures of themselves with boys online and vice versa. There is an increase in sexist and misogynistic behaviour among boys who rate girls using derogatory terms such as peng (attractive), leng (sexy) and meedy (ugly). Early access to pornography is blamed for this increase in toxic teenage culture. Additionally, researchers at Tehran University (2024) found in a study that persistent eating of junk food significantly raises the risk of depression by fifteen percent. This study concluded that the link between poor mental health and diet increases when someone routinely eats ready-made meals, sugary cereals and soft drinks, often high in fat, salt, and sugar and low in vitamins and fibre.
Young people under the age of eighteen are often given diagnoses of personality disorders or placed under the premise of being at the point of an ‘emerging personality disorder’. Leading medics are calling for a ban on under eighteens being diagnosed with borderline personality disorder (BPD) as this is often spuriously given to adolescents considered angry and manipulative without looking at other probable causes. Once given this diagnosis, they are stigmatised by professionals who often view them as timewasters and troublesome. Many are denied and refused counselling and medication, although evidence indicates that one in every ten adults who have this diagnosis ends up dying by suicide.
No Easy Solutions
Mental health issues have always existed, and young people have always endured different types of pressures throughout history. A generation ago, however, there was less awareness of and more refusal to talk about mental health issues. These days, parents of children with mental health problems sometimes differ in their approach. Some will be caring and attentive, while others will be harsh or indifferent to feelings. I remember a young person once telling me that ‘not every house is a home’, meaning that emotional safety and security aren’t always guaranteed to be available in the space where it is expected and most desired. A minority of parents will push for their children to get a diagnosis with the purpose of pursuing financial gain through benefits.
Given the current long waiting list for CAMHS, a growing number of middle-class parents are paying for private treatment for their children. Some are paying up to £3,000 a time for private assessments for ASD and ADHD. The increasing number of children being diagnosed also has an impact on schools. They are under pressure to cope with the rising numbers of children who need to see school counsellors; hence, the creation of waiting lists. Children who do not have a safety net at home need this safe space to discuss their emotions, but often, when there are issues, it becomes necessary for referrals to be made to Children’s Services and/or the police when neglect and abuse are divulged. This may seem to be a ‘breach of trust’ between the child and the counsellor, but it must be done to safeguard the child and prevent further abuse.
Some young people are less sympathetic towards peers with ADHD because they feel they aren’t treated the same as other students, that allowances are made, and corrections are not forthcoming. They can also feel like they get lumbered with the ‘problem child’ who is put next to them and they are often expected to ‘parent’ them. When this happens, these young people resent their teachers for placing them in such a position. They question why schools don’t place greater emphasis on nutrition and sports for those who are considered neurodivergent.
The Changing Face of Youth Services
Alora works at a youth centre that offers universal young club services, a specialist group for those with additional and learning needs and a special emotional wellbeing programme for those with self-harming behaviours and who exhibit signs of emerging personality disorders. Here are her views of the current problems that young people and professionals face daily.
One in four teenagers are struggling because of trauma, chaos, neglect, and the absence of stability in their lives. Youth workers are seeing more self-harming behaviours, suicidal ideation, sexual abuse, and the exhibiting of sexualised behaviour among young people. A growing number of young people have profound additional needs, including neurodivergent children with ASD, ADHD, and body dysmorphia. These young people are often depressed and feel powerless to change anything. Some find it incredibly difficult to socialise with peers. Many struggle to control their emotions and behaviour, which hurts both them and others. We try our best to encourage them to get in touch with their emotions and learn to control negative impulses. There is also the matter of unhealed ‘historical’ trauma that gets handed down from one generation to the next. We often see children whose parents and grandparents were open to Children’s Services and young people with alcoholism issues that run in the family, as well as sexual and domestic abuse. We see young people entering similar relationships and showing characteristics that resemble the experiences of their parents. It is not unusual to meet a young female who has been abused by her grandfather, who will also have sexually abused her mother when she too was a teenager.
Anxiety levels are extremely high and so are peer pressure and bullying. Young people are more than capable of being nasty towards each other, and while they are battling their own issues, this does not prevent them from targeting someone else with a different vulnerability. Young people do get challenged on homophobia, transphobia, racism, colourism, sexism, and ableism, as well as hate speech and hate crime. Boys body-shame each other and make comments about weight and muscles and being fit and toned. Anybody who does art gets teased as it is seen as being effeminate. Boys self-harm in less visible ways than girls and are more prone to risk-taking behaviours to alleviate anger and sadness. There never seems to be a reprieve from negative news, with young people constantly accessing this via various social media platforms. It’s not an enjoyable time to be young and neither is it necessarily an enjoyable time to be LGBTQ+ because difference is often rejected. More people are saying they accept gay and transgender people, but society is still often not friendly towards them. Many non-binary people feel they do not belong in a world that still belongs with a set ‘binary’ mindset. This includes their parents. They feel they are unable to confide their innermost fears and worries, hence the high rates of self-harming in this group.
Things have worsened in recent years because of the huge decrease in the standard of living and people’s ability to afford the basics. Many parents are seeking free school meals and going to food banks. Services must justify every penny they spend. Are we being reduced to just having empathy but unable to do anything practical? Workers must jump through loops to get beds, furniture, and other equipment for struggling families. It also seems that to get a service these days, you must be beyond crisis. There is also an increase in the number of teenagers taken into care because there are more relationship breakdowns between young people and their parents because of social and cultural gaps between them. Many people fail to realise that the world is completely different now for young people, having changed so radically in the past twenty years. Parents are under so much stress themselves that they are unable to give time to really understand the culture of their children. Day-to-day activities and responsibilities become extremely hard to fulfil when they don’t have the emotional energy necessary to listen to their children because they are so worried about not being able to afford to pay the gas bill or not having enough money for food and clothes.
Counselling services that offer compassion, empathy and time to young people are underfunded, with long waiting lists and the threat of being unable to continue because of cutbacks in non-statutory services. Social workers are tired and burnt out with bulging caseloads. Schools are often about structure, exams, and success, whereas some young people find it impossible to settle and adjust. The options for those over sixteen get smaller and smaller. There appears to be an abundance of information and advice but little choice. In fairness to teachers, they too are under enormous stress. The general picture is that all professionals working with young people are massively over-stretched and running out of empathy, which results in them finding it harder and harder to offer any level of service.
Conclusion
To bring about positive change to the landscape of mental health, investment in early intervention must become a priority. It is obvious that a complete overhaul of CAMHS must be done to reduce the senselessly long waiting lists and ineffective responses to young people in crisis. Psychiatry has a long-standing reputation for ineffectiveness and is criticised for sometimes doing little except prescribe medication. Parents of children and young people who receive a diagnosis, including neurodivergent labels like ADHD, need to be fully informed of the serious side effects and possible addiction to psychotropic medication before it is prescribed. Only when these changes come into place and are rigorously reinforced can lasting and enduring change take place that improves the recovery rates of children and young people experiencing mental health difficulties.
It is worth remembering that while there are currently around thirty percent of teenagers enduring emotional and mental health difficulties, the remaining seventy percent will successfully navigate their way to adulthood without ever having been referred to a mental health service. We must ensure that the pendulum doesn’t swing in the opposite direction. We all have a responsibility to play our part in ensuring that every child is given the best possible opportunity to enjoy positive mental health and that those most in need are given the correct help swiftly and efficiently.
