Stuff Digital Edition

The grey areas of youth mental health

Are the general ups and downs of adolescence and youth being treated as an illness? Sarah Catherall reports.

‘‘Young people need to know that there is a difference between being anxious and having an anxiety condition,’’ says academic Kerry Gibson. The associate professor, Auckland clinical psychologist and expert in youth mental health, tackles these and other delicate areas in her groundbreaking new book.

She’s talking about 15 to 24-year-olds, a cohort she says face high expectations from parents and society to be successful and fulfilled. In her book, What Young People Want from Mental Health Services, Gibson studies youth mental health services and pressures on young people.

Based on 400 interviews, it comes at a time when poor youth mental health is worryingly on the rise, particularly for females, Ma¯ ori and youths in lowdecile communities. One in five youths have suffered mental health issues in any one year. According to the Youth19 study, the proportion with depression alone surged from 13 per cent in 2012 to 23 per cent in 2019, and a growing number are being prescribed medication.

Gibson makes a number of recommendations: a less medicalised approach to mild and ‘‘situational’’ mental illness; less pressure from parents and society on young people to achieve; reduced waiting times for those seeking help; and a youth-friendly mental health service, both on and offline, which is accessible and responsive.

She thinks labeling a young person as depressed or anxious if they’re at the mild end of the spectrum can be damaging, along with putting them on antidepressants as a cure.

‘‘The boundary between being well and having mental health problems is a much more blurry boundary than we think. I’d like to see a more normalised language when we’re talking about young people’s difficulties, where you don’t need anxiety or depression as a passport for getting help. I would like us to find ways to talk about mental health with young people where it didn’t have to take on this illness identity to get help. Where they could just say, ‘I’m struggling with my friends or I’ve fallen out with my boyfriend’. There are a lot of people who are struggling who we don’t reach.’’

It’s a point backed up by Wellington clinical psychologist Dougal Sutherland, who talks of ‘‘a definitional drift’’ over the past decade. ‘‘Ten years ago, anxiety had a particular clinical meaning and so did depression and trauma. They’ve drifted a bit to become widely encompassing terms so ‘I’m not just sad anymore, I’m depressed’. But being depressed is not the same as being clinically depressed.

‘‘There is growing public awareness around psychological wellbeing, which is great. But we need more nuanced terms. We want people to understand that feeling stressed or worried or nervous is a normal part of life.’’

The danger is that being anxious or depressed can become part of one’s identity, which can be difficult to shake, he says. ‘‘A diagnosis can lead to a feeling of helplessness: ‘I can’t do anything about it because I’ve got anxiety’. For some, their identity becomes strongly identified with their mental health and it might lead to questions like: ‘Who am I if I’m not known as anxious or depressed?’ It can also potentially invalidate those with serious mental health problems, when you have someone else saying, ‘Look at me, I have anxiety or depression and I also have millions of followers on YouTube’.’’

Gibson’s book builds on research she began in 2012. She writes that youths are examined in a way adolescents and young adults weren’t a generation ago. They self-evaluate and judge themselves and each other.

They’re told they must be driven and successful, and should take on new challenges and demands, while at the same time they should walk around feeling happy, relaxed and fulfilled. They should ‘‘be chill’’ while also achieving, she says.

‘‘The young people that we interviewed seemed aware of how this cultural milieu restricted their ability to speak about unhappiness and described how this permeated their relationships with those close to them. We heard a number of young people talk about how they struggled to live up to others’ expectations that they should be content and successful.’’

These pressures start at school and are fuelled by parents. ‘‘There seemed to be little option for young people to just be doing ‘OK’. It is no coincidence that the word ‘average’ is often used in New Zealand as an insult, an acceptance of mediocrity.’’

Twenty-two-year-old Scarlett Kean agrees. At 16, she was diagnosed with social anxiety and generalised anxiety. She went to a private school in Auckland, excelled at her grades and was a talented artist and actor.

On the surface, Kean seemed to have it all. But she regularly suffered panic attacks, and felt she was being judged and didn’t measure up. It wasn’t her

‘‘We need more nuanced terms. We want people to understand that feeling stressed or worried or nervous is a normal part of life.’’ Dougal Sutherland

parents who applied this pressure, but herself.

‘‘At school, I had really high expectations of myself, and I was often very disappointed with my results. I suffered terrible self-doubt.’’

Now studying at Unitec, she is concerned about huge pressures on young people to be extraordinary. Social media has a lot to blame. During lockdown, she deleted all her social media accounts. ‘‘Instagram is the worst and I really believe that if it didn’t exist we wouldn’t have all the problems we have. We really struggle to know who to trust and what to believe any more. We will often see people doing these incredible things who are our age, like Lorde is 24 and look at her, and I’m 22. It’s in our face. We are constantly comparing ourselves to others.’’

However, Gibson argues the internet is not the cause of young people’s distress. She thinks social media get a bad rap, when they can be a lifeline for those struggling to express their identity and to reach communities they can’t find in real life.

However, she also points out the dangers: images of perfect, curated lives can make those who are struggling feel even worse.

That was the case for Shania D’Cruz. The 20-yearold psychology student grew up on Instagram, but cut all social media accounts for a year when she struggled with anxiety. ‘‘You see all these people who are supposedly having the time of their lives and you don’t know if that’s true and it just makes you feel worse about everything. When I stopped it, that really helped my mental health.’’

D’Cruz was 16 at the time. She found life so overwhelming she had thoughts about ending it all. She had panic attacks and struggled to go to school. She had health problems – endometriosis and physical pain – and general low self-esteem. ‘‘I felt worthless and I didn’t want to hang out with my friends. I was the lowest I’ve ever been.’’

Gibson writes about long wait times for help. It took seven months for D’Cruz to get therapy. Looking back, she was grateful to be diagnosed with anxiety as a therapist gave her the tools to get well again. ‘‘I’m still quite an anxious person. I’m anxious about what might happen next. A lot of people I know have general anxiety about their careers and what they’ll do next and about the uncertainty of the world and climate change. People seem anxious about their gender identity and sexual identity.’’

When young New Zealanders finally reach the top of a waiting list for therapy and help, they fall in the cracks between child and adult mental health services. According to Gibson, mental health services for adolescents and young adults are inadequate and they haven’t evolved enough to meet this digitalsavvy generation. A person under 18 is lumped in with children, while someone older than that is mixing with adults, many with severe mental health issues.

They need their own targeted, youth-friendly service, as happens in Australia.

It’s a point backed up by Sutherland, in Wellington, who says: ‘‘It’s not appropriate to put a 19-year-old in a ward with an older person with severe psychosis or a 16-year-old in a place where there are coloured pictures on the walls to appeal to children. They are a distinct group.’’

If people in this age group want therapy, however, they’re used to instant 24/7 availability. They’re digitally savvy, so sometimes prefer to connect with a therapist or counsellor via text or an app. Youthline has introduced a texting and webchat service which Gibson says works well.

Often, though, only patients with severe problems get help. According to 2019’s Youth19 survey, around a fifth of students had difficulty getting help.

It was only when Ethan Clemons Molinia reached out to a school counsellor and revealed he was cutting himself and had suicidal thoughts that he was finally referred to a psychologist.

‘‘I was using words like ‘suicide’ and ‘self-harm’ and that was when I was considered bad enough to be seen. That’s something I hear from others: that it’s only the extreme cases who are helped by the system, and that’s something which really needs to change.’’

Aged 16 and in Year 11 at Auckland Grammar, he felt depressed, anxious and suffered low self-esteem. A sporty teen, he played basketball, was clever and got good grades, but he often felt anxious and stressed about his academic performance.

Clemons Molinia knew he wasn’t in a good place, but he didn’t want to talk to his parents, even though they wanted to help him.

‘‘Some people were getting insane exam grades, but that wasn’t enough. I had a friend who was an incredible basketballer, but the pressure to be the best got too much for him so he dropped out of the team. Thoughts about suicide were really just thoughts about escaping. I didn’t think my life was worth living at the time. That was why I started cutting [myself]. That was a way I could release intense emotional pain.’’

Now 19, he’s about to finish his second year studying a psychology degree at Auckland University and wants to work as a clinical psychologist to help others suffering like he did.

He was put on antidepressant fluoxetine, (also known as Prozac), but didn’t like it and went off it after a few months. Instead, he thinks cognitive behavioural therapy saved him.

A decade ago, a young man like him would probably have stayed silent – or may not have aired his story in national media. The good news is that mental illness is being destigmatised, and those suffering or experiencing hard times are more able to talk about it. Gibson doesn’t want us to overlook the struggles of those who are clinically unwell, and says it’s important they get help, rather than waiting for months.

The final word goes to Shania D’Cruz: ‘‘Whether someone is diagnosed or not shouldn’t dictate the severity of their struggle. We need to focus on creating room for people to talk more freely without judgment.’’

News

en-nz

2021-09-19T07:00:00.0000000Z

2021-09-19T07:00:00.0000000Z

https://fairfaxmedia.pressreader.com/article/281968905822287

Stuff Limited