#13 The Kids Aren't Alright

What is happening with our Youth Mental Health crisis and what do we need to do to solve it.

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Hi friends,

I’m finally back in Sydney! The jet lag is rough so please excuse the tardiness of this week’s email - we’ll be back to regularly scheduled programming (Thursday emails) from next week!

I want to start this week’s edition with a personal story…

When I was eleven, I was diagnosed with OCD. It was a pretty rough experience for me. I remember being stuck in my head all the time, completely tormented by these compulsive thoughts and not able to imagine a world where I didn’t feel that way. It was hell.

Thankfully, I had extremely caring, astute parents who realised something was up and were able to get me the help I needed.

I responded well to treatment and was able to get rid of all my symptoms within a few months.

This is one of the reasons I care so much about Mental Health - because I know what it’s like to feel like complete shit in your head. And I also know that people can get better when they get the right treatment.

When I see a young person struggling with their mental health, my heart actually breaks.

Mental illness is tough for people of all ages, but there’s something about a kid struggling with anxiety or depression that feels so wrong.

Shouldn’t childhood be care-free, full of play and exploration?

But the rates of mental disorders in young people has been skyrocketing.

In Australia, 32% of Young People experienced an anxiety order and 14% experienced a depressive disorder in 2022. This has increased significantly since 2007.

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But there’s one fact that shocked me more than the rest..

In the US, 7%-8% of adolescents attempt suicide each year (source).

I want you to hear that stat again because we tend to just brush over these numbers sometimes…

7%-8% of US adolescents attempt suicide each year.

What’s more, suicide is the second leading cause of death among young people (source).

This is so terribly sad.

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The challenge of mental health is even worse for females, experiencing anxiety and depressive disorders at around twice the rate of their male counterparts.

Minority groups are struggling even more - almost 60% of gender diverse young people experiences depressive disorder symptoms in the previous 12 months.

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This makes me so upset.

How are we letting this happen to our kids? What’s going on and what do we need to do to address this really disturbing problem.

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What’s causing this problem?

I spent hours reading research papers to try and understand what is causing this problem. Unfortunately, the short and extremely frustrating answer is that we don’t really know.

One of the best papers I read was an Annual Research Review on the Secular Trends in Adolescent Mental Health. Here is there conclusion on what is causing the increased in mental illness in young people;

“It is clear that multifactorial models are needed to account for mental health trends. Psychiatric diseases represent complex phenotypes with multifactorial underpinnings. Trends in mental health are likely attributable to a variety of countervailing social trends that have impacted on children’s risk for mental health problems in divers ways, some for the better and some for the worse.“

In english… this is super complex and we’re not really sure what’s exactly happening.

A more recent study analysing trends in the mental health of young people in Norway made a similar conclusion

“The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.”

We are just not that good at understanding the root causes of mental illness.

I mean, I guess I have to accept this fact, but boy is it frustrating.

So, when facing a problem whose causes we don’t fully understand, what can we do?

First, (excuse me for stating the obvious) we need more research to understand what the causes actually are.

Yes, this is a complex, multifactorial problem.

Yes, these problems are hard to study.

But surely it is one of the most worthy pieces of research we could ever conduct. We’ve got 8% of adolescents attempting suicide every year, we don’t know why, and we aren’t doing that much to understand why.

There are people working on this around the world and I commend them. But however many people that is, it clearly isn’t enough. We need more money and more talent dedicated to this research.

The paper I referenced called for significantly more research in this area with specific recommendations. That was written ten years ago. Since then, more young people are struggling every day and we still can’t say why. We shouldn’t accept this.

Imagine there was a virus that was the leading cause of death among young people every year. And every year, it was becoming more prevalent. Would we just accept not knowing where this virus came from and why it’s growing?

Of course not.

Second, we need to act on the evidence we do have.

While we are trying to understand what is causing this problem, we cannot afford to sit around and do nothing. We have to act now. So what can we do in this situation?

We can act on the evidence that we do have.

There is evidence to show that the following areas can act as protective factors for young people’s mental health (and even if the evidence of being positive factors on mental health, it is extremely unlikely that they will cause any negative effect). Therefore, the expected outcome is positive and we should act accordingly.

Specifically, we should;

• Improve socio-econmic conditions and decrease inequality; we know that low socioeconomic status contributes to mental health disparities in young people. And there is evidence to suggest that these health inequalities have been getting larger. Talking about improving economic factors for families feels weird in this context, but it is actually exactly what we need to do.
• Tackle child mistreatment; child mistreatment and abuse is one of the leading risk factors for child mental health (as well as a bunch of other health and behavioural challenges). Whilst child mistreatment has been reducing in most countries, we must focus on continuing to drive this down. In fact, until it is zero, we should not settle.
• Encourage protective behaviours in children; specifically good sleep, exercise, nutrition and positive social connections.
• Sort out our own shit; I asked one leading clinical psychologist what was the one thing we would do to put the biggest dent in mental illness. He said it was to improve the mental health, relationship skills and parenting abilities of the next generation of parents. Negative family environments, poor parenting behaviours and parental depression are all risk factors for children and their mental health. The more we can deal with our own challenges and become better parents for our kids, the better chance they have of avoiding mental illness. If that isn’t a motivator for us, I don’t know what is…
• Continue education and stigma reduction; we’ve significantly decreased the stigma around mental health but need to continue the good work. We can also help by increasing education and skill building in children, specifically around emotional regulation, resilience and coping skills and problem-solving skills. (I am quite close to an Australian based program that supports elements of this in after school care and have found the results impressive).
• Solve problems for them (e.g., climate change); young people are increasingly exposed to environmental stresses in our society (e.g., the climate crisis, the housing crises, the cost of living crisis) and these are causing anxiety and fear. We should be solving these crises anyway, but this is just another reason why they deserve our attention.
• Reduce phone and social media usage. This is one of the more controversial topics… While we don’t yet have an clear understanding of the exact benefits and harms of different technologies, there is mounting evidence that for certain age groups, phones and social media usage is contributing to mental health issues. If you haven’t heard Jonathan Haidt speak about this in the last few months, you must be living under a rock (Haidt would probably like that actually). Haidt has four core recommendations;
  • No smartphones before high school.
  • No social media before 16.
  • Phone-free schools.
  • More independence, free play and responsibility in the real world
• Whether these specific recommendations are the right ones or not is up for debate, but I find it very hard to make the argument that ignoring these entirely and continuing with unfettered internet access for young people is a good idea.

• Give young people alternative ways to satisfy their needs. One of the reasons young people are spending so much time online is that it is satisfying many of their core needs - to connect with peers, to express themselves, to search for praise and affection. Many of the social platforms offer this but do so in a harmful way. In addition, they often hijack the initial attention of users and misdirect it to other, more damaging content. This is true even for myself. I want to use Instagram to chat with my friends and see what they’re up to. But then 30 seconds later I’m watching reels and Insta are throwing Andrew Tate videos in front of my eyes. We aren’t going to be able to remove the core needs of young people (nor should we), but we need to offer them healthier alternatives they can use to satisfy those needs. Yes, abstention from certain platforms may work, but substitution is more likely to deliver the mass behaviour change needed.

Finally, while we’re trying to address the root causes, we need to also provide better treatment for those people who are suffering.

Unfortunately demand for mental health services vastly outstrips supply. Treatment is expensive, hard to access and not always that effective. We need to do a much better job at providing the care needed to help young people get better. The majority of this responsibility lands on government, but other sectors can also help by finding innovative, more tailored, more scalable ways to treat young people and improve their mental health outcomes.

Over the past few years I’ve been lucky to work with a bunch of extremely passionate and talented people trying to tackle this problem. And I’ve seen just how hard it is for them. They are under-funded, under-resourced and lack the insights they need to make the kind of change they want to see, to make the kind of change we all want to see.

While there are so many unknowns in this area, there are few things I know for sure.

I know it’s a huge problem.

I know the only way to solve it is by a bunch of talented people working their asses off.

And I know that if our efforts result in helping just one more kid, one more eleven year old struggling with shit going in his head, or in preventing one 14 year old from attempting suicide, then that is one of the most meaningful things we can do with our lives.

That’s all for this week.

Keep fighting the good fight!

Steve

Founder of The Hemingway Group

P.S. feel free to connect with me on LinkedIn