Five ways Britain wrecks young people’s mental health – and how to stop it | Emily Reynolds

A study from the Varkey Foundation has revealed that young people in the UK suffer from some of the “lowest levels of mental wellbeing in the world” – second only to Japan.

This won’t be a shock to anyone familiar with statistics on child and adolescent mental health in Britain. Some 75% of mental illnesses begin before the age of 18, and the charity MQ estimates that on average, there are three children in every classroom with a diagnosable mental illness. This, combined with a continuing crisis in mental healthcare in Britain, means young people are not getting the help they need or deserve. But how exactly are young people being failed?

Slashing NHS budgets

Cuts to the NHS aren’t new – the Conservative government has been slowly dismantling the health service since 2010. And it shows no sign of slowing – a 2016 investigation by the Guardian and 38 Degrees revealed that trusts around England were “drawing up plans for hospital closures and cutbacks” in an attempt to avoid a £20bn shortfall by 2020.

Mental healthcare has suffered disproportionately: unmanageably long waiting lists for secondary care, to take one example. Referrals to therapy or specialist units are hampered by a lack of available staff or by ward closures – which means that diagnosis of more severe conditions are delayed even further.

This is particularly striking when you consider that most young people wait on average 10 years between the onset of illness and an eventual diagnosis – and means that many are slipping through the cracks with neither diagnosis nor adequate care.

Similarly, cuts to community care have meant that more children than ever – 20,000 in 2015 alone – have been seeking emergency mental healthcare in A&E, in wards that are often staffed by stressed, overstretched teams who have no specialist psychiatric support to help them cope.

Treating children miles away from home

Cuts have led to the closure of many child and adolescent mental health wards – which, combined with a severe shortage of beds, has led to children being admitted to adult psychiatric wards and being sent hundreds of miles away in order to receive outpatient care.

A 2014 investigation from Community Care and BBC News found that 350 under-18s were admitted to adult wards in the first nine months of 2013 – a 36% increase from the previous 12 months; 10 out of 18 NHS trusts surveyed had sent children to units more than 150 miles away from their home in 2013-14, making compassionate and consistent care for young people impossible.

Cuts to school budgets

One of the key themes of Theresa May’s speech on mental health was a focus on the prevention of these problems, particularly in young people. Research backs this up – a recent study published in Lancet Psychiatry suggested that early intervention was a significant factor in presentation of depressive symptoms in young people.

What May’s speech didn’t mention, however, was how exactly this would be implemented, beyond a mention of “mental health first aid training”. Unsurprisingly, May also failed to mention the grimly inevitable cuts to school budgets that will make this strategy near to impossible anyway.

Earlier this week, a TES investigation found that a third of secondary schools are planning to “cut back” the mental health support offered to pupils because of what one headteacher described as “budgets at breaking point”. Early intervention is vital, but if teachers are untrained in mental health – because the resources aren’t there – then it simply isn’t going to happen.

There’s a research budget of just £8 per person affected by mental illness – compared with £178 for cancer

Lack of adequate research

Mental health research is, in general, an underfunded area. In 2014, the UK Clinical Research Collaboration found that mental health was only allocated £112m a year – which sounds like a lot, until you consider the nearly 15 million people in the country affected by mental illness. In context, this means a research budget of just £8 per person affected by mental illness – a startlingly low sum, especially when compared to less common conditions like cancer (£178 per person) or dementia (£110 per person).

Less than 30% of this research is focused on young people – meaning we haven’t even started to understand how to tackle mental illness in young people.

Failing to take adolescent mental health seriously

Young people are now pretty used to being the punchline of unfunny jokes made by Telegraph readers and the over-45s. Millennials, eh? We’re stupid! We’re narcissistic! We look at our phones all the time! We’re mollycoddled snowflakes! We expect to be given the moon on a stick! These might be hilarious ideas to people without crushing student debts and who have the means to own property – sure, but it’s all fairly tiring for young people.

It might sound facile – typical millennials, complaining about nothing – but it is an undeniable fact that young people are not being taken seriously and that this, in some cases, is severely impacting on their mental health. While researching my book, I spoke to young people up and down the country who told me they felt consistently let down by parents, teachers and healthcare professionals who wrote off their symptoms or failed to take action to prevent distress.

There was an understandable sense of reticence, caution and disappointment about the behaviour of supposed adults. This conversation has continued to follow me – only last week, a teenager messaged me on Twitter to eloquently and despairingly talk about how they and their friends had been consistently and systematically let down by their school.

It’s a familiar story to me – even as a confident young adult with a medical history full of psychiatric wards and prescriptions for antipsychotics, I’m often questioned by GPs and support workers on the veracity of my own experiences. The difference is that I’m used to overcoming barriers to care – younger people are not, and often fall at these completely unnecessary hurdles.

This isn’t just a social problem, either – failure to acknowledge symptoms is a structural problem too. In 2015, the NSPCC suggested that nearly 40,000 young people were unable to meet the “too strict” criteria for receiving help – so even if teenagers pluck up the courage to ask for help, they still aren’t getting any.

Interactive

Young people are telling us that they’re unhappy. They are asking for help. What they want is simple too. For a start, don’t send them hundreds of miles away from home for treatment. And they don’t want GPs to tell them that their clinical depression is just “being a teenager”. They certainly don’t want to sit down with their neighbour and have a cup of tea, as Theresa May ridiculously suggested on Time to Talk – their focus, on the whole, is not on stigma at all.

What young people really want is actual, actionable, well-funded support. They want to be taken seriously; they want to receive the help that they need in a timely, compassionate, efficient and effective manner. They’re asking for it already – when are we going to start listening?

• Emily Reynolds’ A Beginner’s Guide to Losing Your Mind is out on 23 February

Five ways Britain wrecks young people’s mental health – and how to stop it | Emily Reynolds

Mario, you crossed into our world at the worst time – it’s no game over here | Emily Reynolds

Mario is coming to a street near you. His latest outing, Super Mario Odyssey, was unveiled in a Nintendo trailer earlier this month, and shows the moustachioed plumber gleefully sprinting around a facsimile of New York, hopping over taxis and scaling skyscrapers. Elsewhere, he swings through dewy forests and slides through realistically animated streams. The angry, sentient plant pots may be slightly less believable, but that’s besides the point – Mario has been plucked from the multicoloured fantasy of the Mushroom Kingdom and dumped into our much less palatable reality.

Unfortunately for him he appears to have crossed dimensions at the worst possible time. Super Brexit Odyssey doesn’t sound like a very appealing venture, though Boris Johnson’s foppish faux-blustering would probably slot disturbingly easily into a fantasy game. In an ideal world, Donald Trump would remain a harmless parody of the boorish, hard-to-beat final boss in a video game; in the real world he is the newly inaugurated president of the United States, and already having a marked and negative impact on people’s lives.

His picks for cabinet have included a raft of ardent anti-choice climate change deniers, including a vice-president who supports “conversion therapy” for members of the LGBT community, and believes women should have to state in writing whether aborted or miscarried foetuses should be buried or cremated. The real world is currently looking pretty overrated.

And not only that, there will be no predetermined paths for Mario’s coin collection anymore. Unlike previous iterations of the game, which have taken place in set, closed-off levels, players will be able to roam a more open-ended world. Mario can cross roads, climb ladders, scale buildings and hitch a ride on taxis. That might sound like a good idea until you consider some of the political decisions made by the general public over the last year – maybe a lack of choice is good for us after all.

Tortuous analogies aside, there may be some genuine benefits to ignoring the real world in favour of unashamedly escapist entertainment. Games have long been posited to help with anxiety and stress: alongside bucketloads of anecdotal evidence, numerous studies have found positive links between gaming and mental health.

One, from the universities of Oxford and Cambridge, found that Tetris helped reduce stressful intrusive memories in patients with post-traumatic stress disorder. A study due to be published in March’s edition of the journal Computers in Human Behavior also found that games could encourage positive, co-operative, pro-social behaviour.

‘Numerous studies have found positive links between gaming and mental health.’ Photograph: Wavebreak Media ltd / Alamy/Alamy

More evidence came in a 2012 study from Stanford University that found gamers “hyper-stimulating” the brain’s mesolimbic pathways (associated with goals and motivations) and hippocampus (linked to learning and memory).

In 2014, Dutch researchers suggested that gaming can “foster real world psychosocial benefits” – cognitive, motivational, emotional and social. There’s no lack of evidence to suggest the positive impact gaming can have, especially on someone experiencing low-level stress, depression or anxiety.

And while Mario might not have a depression level yet – arch-enemy Bowser approaching asking “Have you tried yoga?” and saying “Cheer up!” – a growing number of games have been designed with mental health in mind. For example Sparx, a game designed to help residents of New Zealand with depression, which builds upon gaming’s mental health benefits to create something therapeutically valuable as well as fun.

Comments about how rightwing authoritarian regimes create the best conditions for creativity are obviously facile, especially now: people rightfully fearing discrimination need more than limp, empty reassurance that they needn’t worry because music, games or books are going to get really good again. When artists such as Amanda Palmer – white, able-bodied, rich, and privileged – say things like “Donald Trump is going to make punk rock great again” it’s a frustrating distraction from the potentially horrifying realities of the situation.

But that’s not to say that escapism isn’t a valuable tool if used correctly. Playing Mario – or any other game – is obviously not going to make you less miserable about the realities of any given political climate. What it can do, though, is provide a small amount of respite when you’re feeling stressed about something or you just want to pretend that the real world doesn’t exist for an hour or two. Perhaps Nintendo should bear this in mind when they design the next set of adventures for Mario – next time, maybe he should spend less time in our world, and we should spend more time in his.

Mario, you crossed into our world at the worst time – it’s no game over here | Emily Reynolds

Sea Hero Quest is of huge benefit to medical researchers. So what’s the catch? | Emily Reynolds

In tech circles, alongside words such as “scaleable” and “the gig economy”, you often hear the phrase “tech for good” bandied around. Sometimes it’s a fairly innocuous but ultimately toothless concept, essentially denoting the idea that technology has the potential to be a driver for positive social change but not doing very much about it. Other times it can take on a more creepily utopian tone, suggesting that should the world more closely represent the shiny libertarian enclaves of Silicon Valley, the world’s problems would be solved. And sometimes – just sometimes – it does what it says on the tin.

A new game, designed to test spatial navigation, appears at first glance to do just that. Sea Hero Quest, which involves navigating a boat through choppy waters, contains a diagnostic test for the early signs of Alzheimer’s disease. The game has now been played by more than 2.4 million people – which the team behind the game say makes it the largest dementia study in history.

It’s now set to be adapted for use in a clinical setting – data could be fed back to clinicians, allowing for earlier diagnosis, better understanding of how medication is working for a particular patient and a more accurate and precise measurement of a patient’s decline. It could even be incorporated into NHS programmes.

This, it goes without saying, is initially incredibly attractive. Understanding and managing an illness or being alerted when you’re at risk simply through the daily use of an app sounds simple, easy and most of all useful. Could this not be a genuine use of tech for good, rather than the banal and empty proclamations often heard from CEOs and founders?

In theory, yes. In practice: maybe not.

More than 2.4 million people have downloaded Sea Hero Quest to their phones. Photograph: The Sea Hero Quest/PA

As with any health data-driven project, it comes with stipulations. A recent study in Lancet Psychiatry suggested that data gathered on Facebook could provide a “wealth of information” about mental health, with a series of language analysis and facial emotion recognition algorithms providing “insights into offline behaviours”. This, too, sounds great. Having your health monitored and managed through the passive use of technology you probably already use – what more could you want?

But there are a number of concerns here: primarily, the safety of private health data. The addition of a private company in the latter study may make it feel different: a towering behemoth such as Facebook obviously feels more threatening than something set up for and run by clinicians. But to not have the same reservations just because the data was being sent to scientists would be incredibly naive.

Science, much like technology, is often presented as objective, reasonable fact, without mentioning the very obvious caveat that it is conducted by human beings, who are often neither reasonable nor objective. Multiple studies about statistical analysis are useful to recall here – the results of such analyses may seem completely objective, but often reflect the preconceived biases of those conducting them. That’s not to say that would be the case with Sea Hero Quest, of course: just that the results of such research can be fallible.

And it’s also important to remember that, should the Conservative party have its way, the NHS may be in the hands of several, separately operated and privately owned companies before too long. This adds further complications: who would have access to our health data? How would they use it? How would data be efficiently and safely communicated across different companies? Would their data protection processes be cohesive? Would they be meticulous enough to protect our most private, personal data? The idea of having your phone feed data to a central NHS database sounds great in principle, but these questions would need to be answered before that could safely become a reality.

In an ideal world, tech would be utilised to help us to diagnose and treat illnesses: anything that can efficiently and effectively help people manage long-term or life-threatening conditions can only be a good thing. Similarly, the idea of a National Health Service that is genuinely innovative, that uses new ways to help people and that has a strong grasp on data security while it does so is incredibly appealing. Unfortunately, as with most utopian ideas, you’re left wondering whether it might just be too good to be true.

Sea Hero Quest is of huge benefit to medical researchers. So what’s the catch? | Emily Reynolds

What could Facebook target next? Our mental health data | Emily Reynolds

It used to be that the eyes were considered the window to the soul. In 2016, you might have better luck checking someone’s social media. The tiny details we share about our lives have blurred the lines between “online” and “real life” – our Facebook accounts even get “memorialised” when we die.

According to a study published this week in Lancet Psychiatry, these seemingly innocuous tidbits can actually lead to quite a comprehensive picture of who we are, at least in terms of our mental health. Researchers from the University of Cambridge and Stanford Business School argue that data from Facebook – the photos we upload, the statuses we share, the frequency and content of the messages we send to friends – is “more reliable” than offline self-reported information, which is often considered to be inadequate or incomplete when it comes to understanding how mental illness is affecting someone.

Status updates in particular, they say, can provide a “wealth of information” about users’ mental health. A language analysis algorithm can pick up symptoms of mental illness, and could even flag early warning signs for conditions such as depression or schizophrenia. Yet more algorithms, these analysing pictures for “emotional facial expressions” could provide insights into offline behaviours. The next question is: what can we – and what can Facebook – do with that data?

Of course, a lot of the information the company has on us all is superficial at best – sure, it might be slightly uncanny to have advertisements served to us that perfectly reflect our taste in music or the TV shows we’ve discussed online, but it doesn’t really say anything very essential about who we are as people. Data about mental or physical health, however, cannot be treated so flippantly, either by those of us who are thoughtlessly supplying it or by the people collecting it. Discrimination against those with mental health problems is still rife; a recent NatCen British Social Attitudes survey, for example, found that 44% of people would be “uncomfortable” working with someone who’d experienced symptoms of psychosis. In legislative terms, this isn’t supposed to impact chance of employment or employment rights. In reality, there is a persistent and pervasive culture of distrust around those with mental health problems.

What if an algorithmic branding of ‘ill’ was shared with the world without our knowledge or consent?

Understandably, many people choose not to share the status of their mental health with colleagues or friends. But such privacy may be a luxury when “emotional facial expressions” can be neatly scanned and categorised by an algorithm, or when our heartfelt statuses are simply part of an input-output exchange. What if employers were able to use the same technology to scan our private posts, monitoring what we say and how we say it to avoid taking a risk on someone they may see as a “liability”? What if the data wasn’t secure, and an algorithmic branding of “ill” was shared with the world without our knowledge or consent?

As the study suggests, the internet can be a vital tool in how people express themselves about their mental illness, from the grandiose horrors of a serious breakdown to the minutiae of living day-to-day with a chronic illness. We can also foster genuine connections with others who might be experiencing the same things. And the potential benefits of the findings are clear – not least in the way we could be able to reach people such as refugees, the homeless or the elderly who are often shut out of traditional mental health services. We may even be able to find new therapeutic routes or platforms with which to help people.

What we can’t do, however, is continue to proceed the way that we are. The ethics of this particular study aren’t questionable; everybody involved in the study consented to their data being used, after all. But if it were to be used more broadly? The team suggests that detection of poor mental health could be a way for social networks to provide on-site support for users – in which case we may have a problem. For one thing, on a practical level, vulnerable users may not fully understand what their participation in such a scheme would mean, nor know the impact it could have on them. We need strict legislation about the ethics of gathering such sensitive data, and even stricter punishments should it be inadvertently or purposefully shared.

And, as we must never forget, Facebook makes money from our data. Slotting us into neat little boxes may be OK when it comes to things such as gender or age – what does that say about us, really? – but the idea of being neatly categorised as “mentally ill” or “mentally well” simply because of the things we choose to share online is both unethical and potentially dangerous. At best, of course, we could receive help that is currently unavailable to us. At worst? It doesn’t bear thinking about.

What could Facebook target next? Our mental health data | Emily Reynolds

Emily wanted to die when her son was taken. Nurses gave her a future

“If my children were ever taken off me, I wouldn’t survive the day,” was my sister’s emotive, yet understandable, comment when we were discussing the impact losing your children could have on your mental health. It made me think of a woman I had worked with, Emily.

Emily had her son taken off her after she had attempted to kill herself. The boy, Jacob, was pre-school, and the decision by social services was made in her best interests. Emily had been in an abusive relationship and was struggling to cope. She had serious mental health problems as well as a history of childhood abuse, so coping was not something she was good at. She had always refused to engage with mental health services for fear that it would result in Jacob being taken away. The tragedy is that engaging with services was probably the only thing that would have kept their family together.

After further attempts to take her own life, Emily was detained under the Mental Health Act and admitted to the mental health ward where I worked. At this point, Jacob had been taken away by social services. Emily was told Jacob would be adopted; she could have phone contact until then and one final visit to say goodbye.

Initially she could not accept this and just wanted to die. It was one of the hardest cases I have experienced. She was right – what did she have to live for now she had lost Jacob? How could she continue feeling this pain and despair for life? As a team – nurses, doctors, occupational therapists and psychologists – we worked tirelessly with her to instil some sense of a future. Jacob was going to grow up loved, in a safe and secure environment unlike anything Emily had ever experienced. Her son had a positive future and she could take some comfort in that.

We focused on preparing Emily for her last contact with her son. She made her own plans about what she wanted for the two of them, and we supported her to achieve it. Emily was brave and made sure she could hold it together until Jacob had left, and then her world came crashing down.

Part of the preparation included talking to Emily about her suicidal thoughts and talking to her about what we could do to minimise the risk. We kept her safe while she grieved the loss of her daughter. We then worked with her to create the positive future she wanted for herself. This started with her keeping herself safe on the ward, one day at a time. We then looked at a longer term placement where she could get the intensive psychotherapy she needed to manage her mental health issues, heal from the hurt of the past and come to terms with losing Jacob.

Every day mental health nurses help people like Emily, who feel they have nothing to live for. Every day mental health nurses save lives. According to a report by the Mental Health Taskforce Strategy (2016) more than 14,000 people who have killed themselves between 2003 and 2013 had been in contact with mental health services; this is only just over a quarter of all suicides in that time. The same report acknowledges that suicide rates for mental health inpatients are declining, but sadly it is only the people we don’t manage to save that make the headlines. I am glad that we were able to help Emily and she hasn’t become another statistic.

Names and some details have been changed

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Emily wanted to die when her son was taken. Nurses gave her a future

Loneliness will be the next great moneyspinner | Emily White

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Isolation among young people is increasing, spawning a new industry in companionship. Soon paying for walks, dinners and dates will feel normal

Chuck McCarthy, we heard last week, is an LA man who charges a per-mile rate to walk and talk with customers. Billed as a novel form of social interaction, his business is expanding – he now has five assistant walkers – and the service he offers is part of an emerging trend. Like others in what might be called the companionship industry, McCarthy is packaging up social connection into something we can buy.

Related: ‘We need human interaction’: meet the LA man who walks people for a living

Related: A literary cure for loneliness

Continue reading…

Loneliness will be the next great moneyspinner | Emily White

A digital detox sounds great. But using the internet mindfully is better | Emily Reynolds

Last week, in a largely futile attempt to actually do some work, I installed a browser extension that blocked pretty much any website I could possibly distract myself with. Twitter: gone. Facebook: gone. Even my emails, which I obsessively tend to in order to feel moderately productive, were off limits for an hour.

Having found new and imaginative ways to waste my own time, what surprised me most was not how much more work I did, but the sheer frequency with which I attempted to access the internet. I’d incessantly tap “twitter.com” into the address bar, somehow immediately forgetting it was blocked. I’d click on my still-open Facebook tab to check my feed before remembering there was no point. Every time I finished a sentence I’d flit away from my work again, trying to exchange 10 seconds of productivity for 10 minutes of distraction. I knew I spent a lot of time online – but not this much.

Related: Five ways to curb your internet use and get your life back | Rhiannon Lucy Cosslett

It turns out I’m not the only one who has what could probably be regarded as a mild internet addiction. A new study from Ofcom has found that on average, UK adults spend 25 hours a week online – a pretty sharp increase from the nine hours we spent on the internet back in 2005. Since then, the lines between “real life” and “online” have become increasingly blurred, and IRL (in real life) has started to sound as much of an outdated relic as ASL?, AFK or ROFLMAO.

This ubiquity is getting to us. According to the study, 59% of people feel they’re “hooked” to their devices. 48% said they neglected housework because they spent too much time online; 47% missed out on sleep. Around 30% said their friendships and relationships had suffered because of their internet use. This has led to an increase in what Ofcom have termed “digital detoxes”, with 15 million people seeking “a period of time offline” in order to break their habit.

This isn’t just a social issue: internet addiction can have an impact on our brains and mental health as well as our relationships and our sleep patterns. Some studies have suggested that the same neurobiological processes present in gambling and drug addiction may also be linked to internet addiction; pilot studies have been run to identify the role of dopamine in internet addiction; and in 2009 a study claimed that internet addiction is associated with “structural and functional changes in brain regions involving emotional processing, executive attention, decision making and cognitive control”. The American writer Nicholas Carr has even said that the internet impacts our creative capacities.

I know from my own experience how overuse of the internet affects mental health. When I’m having a major episode of depression I spend hours online, scrolling blankly through articles and newsfeeds and timelines as a way of distracting myself, using Twitter as a shield to avoid face-to-face interaction. Everything I need is online. I can order food rather than leaving the house, I can talk to strangers instead of seeing friends to fulfil my severely diminished social drive. It may seem like the perfect solution, but can often serve to isolate one even further.

Related: Turning off technology is about mental wellbeing – not being a hermit

It is a problem of which the mental health charity Mind is aware. Triggering websites or damaging online relationships can exacerbate or perpetuate existing problems. The charity, like Ofcom, also recommend that users take a break from the internet when it has “stopped being a positive thing” or is fostering unhealthy feelings, thoughts or behaviours.

If you take all this at face value, logging off seems like a good idea. Scaremongering would be easy, the nebulous spectre of ill-health being used as a tool to undermine those who spend a lot of time online (namely young people). But the internet is also an extremely powerful tool for good, especially for the mind. Though I can often get sucked in, it can also act as a lifeline in times of severe distress, providing comfort, distraction and sometimes even emergency support.

The problem is that the internet is so omnipresent that we forget or even preclude ourselves from experiencing these positive elements. Like many young people, my online life is tightly intertwined with my offline one: I met most of my friends online, I use Twitter to promote my work, I consume almost all of my media, including books, via a smartphone or tablet. It’s so normal that I barely register the fact that there’s a difference between the two.

In some cases, though, there is. Texting someone when I’m feeling depressed just doesn’t have the same impact as a real-life conversation, and shutting myself inside a wall entirely made of snarky tweets actively prevents me from seeking genuine help.

It might sound boring, but in the end, it’s a matter of balance. It’s not a matter of giving up Facebook for weeks at a time or ignoring rafts of emails. Rather, being mindful of the way we use the internet, and the negative impact that it can have on us, may provide a better solution than switching off completely.

A digital detox sounds great. But using the internet mindfully is better | Emily Reynolds