The Mental Health Crisis in England: A Manifestation of Societal Dysfunction and Unmet Need
The Children’s Commissioner for England’s report on ‘Children’s mental health services 2022-23’ was published on 14 March 2024. Dame Rachel de Souza’s assertion that she did “not think it is an overstatement to speak of a crisis in children’s mental health and the services needed to support them,” was supported by NHS England data contained within the report. During the 2022-23 financial year, 949,200 children (8 per cent of the 11.9 million children and young people in England) were referred to the Children and Young People’s Mental Health Services (CYPMHS). Out of this number, almost 305,000 entered treatment, having waited an average of 108 days, while 270, 300 were still waiting at the end of the year. A further 372, 800 children and young people had their referrals closed before accessing CYPMHS. Of those still waiting for treatment, 32,200 had been waiting for over two years. This latest report only adds to a growing number of reports and surveys attesting to a rising prevalence of mental health problems affecting children, young people, and young adults across the world over the past twenty years.
Mental illness among the young was already on the rise before the COVID-19 pandemic, during which lockdowns, social isolation, and academic disruption only worsened matters. Even before the pandemic, multiple challenges to the mental health of children and young people had started to emerge. Rising mental illness is a genuine phenomenon, and not merely a reporting artefact secondary to better awareness and efficient reporting
In the 21st century, mental health of young people is being compromised by problems at home (poverty, poor parenting, domestic violence, sexual abuse, family breakdown) and at school (learning difficulties, racism, bullying, anti-LGTBQ sentiments). Then there are the harmful effects of social media platforms, which set unrealistic standards of physical appearance to the detriment of one’s body self-image, provide access to unsuitable and destabilising content, and enable cyberbullying and online stalking- all of which can lead to self-harm and even suicide. On a wider scale, information overload and a polarised political climate foster anxiety over such weighty matters as climate change, natural disasters, and global conflict, further adding to mental distress.
Societal disruption has blunted or removed the many protective factors that once counterbalanced the many risk factors for mental illness in younger people. A stable and loving family, a suitable home environment, a supportive school, a positive self-image, and a network of friends are frequently lacking in our troubled times, either individually or in combination.
The common forms of mental illness in younger people include disorders of mood (depression), anxiety (generalised anxiety disorder, panic attacks), attention (ADHD), behaviour (conduct disorder), and eating (anorexia, bulimia), as well as intentional self-harm. Recognition can be difficult as other explanations may be considered in the presence of mood swings, out-of-control behaviour, social withdrawal, sleep disturbance, changes in eating habits, truanting, poor school performance, and alcohol or substance abuse, to list but a few of the many manifestations of mental ill health. Potential sources of help include confiding in parents or trusted adults or friends, approaching one’s GP, contacting designated mental health services and organisations, or attending the emergency department.
The problems of mental ill health may be carried on into young adult life, particularly among Generation Z people. Long-term sickness absenteeism and economic inactivity in young adults may be related to uncertain employment prospects in a gig economy with zero-hour contracts, low-paid and unfulfilling jobs, workplace stress, financial insecurity, and other side-effects of neoliberal economic policies.
Mental ill health continues to be stigmatised and frequently invokes guilt and shame, rather than being treated on an equal footing with physical illness. Mental illness is under-recognised, under-reported, and under-treated, even though it impairs normal functioning and can even shorten life in severe instances. For those with documented mental health problems, services have unfortunately not kept pace with the continually rising demand for the same. This mismatch of supply and demand is likely to have long-term effects on the wellbeing of society as a whole and stifle the economic productivity of coming generations.
We live in a cruel world, which no longer provides a protective and supportive environment which earlier generations benefited from. Family breakdown, social isolation, disrupted communities, a shortage of affordable housing, a paucity of suitable educational opportunities, unhappy working conditions, financial pressures, and a cost-of-living crisis have created a toxic environment which engenders mental ill health.
It isn’t just the NHS mental health services that need a boost. Mental ill health is a manifestation of wider social and economic malaise. Schools, communities, and dedicated charities all have an important role to play in the prevention and early detection of mental illness, which in turn warrants early intervention and specialist support where required. Unless this mental health crisis is treated as an emergency, and responded to rapidly and appropriately, the consequences are likely to be devastating for the nation as a whole.
Ashis Banerjee