What if we talked too much about teen mental health?

ANDEvery day, it seems, is Mental Health Awareness Day. In the United States, February is Eating Disorder Awareness Week. May is National Mental Health Awareness Month, which includes National Children\’s Mental Health Awareness Day. September is Suicide Prevention Month and in October we go global, with World Mental Health Day.

Mental health awareness campaigns work on a key principle, applied to everything from exam stress to suicidal thoughts: if we can get people to identify and understand their mental health problems, then they can access help and a effective treatment. Mindfulness is good, in other words, because it should ultimately ease people\’s distress.

The trouble is, nobody really knows if awareness initiatives actually work this way. There is some evidence that England\’s Time to Change 2009-2011 campaign improved attitudes towards people with mental health problems and led to more people saying they intended to seek help, which is important.

But from the data we have so far, these campaigns don\’t appear to be driving more people in realityobtainhelp. At the population level, rates of mental health problems are certainly not declining – quite the contrary.

It\’s one thing if mental health awareness efforts are simply ineffective. But as an academic psychologist researching mental health in adolescents in particular, I started asking a tricky question: What if these well-intentioned campaigns actually contribute to the problem? And if the more we encourage people, especially young people, to talk about their mental health, the worse they end up feeling?

If you think about it, it wouldn\’t be all that surprising. It is helpful to be aware that you have a problem only if it leads to a significant change. Right now, that\’s not happening: Many people who have mental health issues can\’t access the care they need. In the US, this could be because they don\’t have insurance or don\’t have the right insurance. In the UK, people are unable to access care because waiting lists are too long. This pushes up the threshold at which treatment will be offered, meaning that in some cases even people who are actively suicidal are turned away from services.

Yet these campaigns are encouraging more and more people to show up. In 2017, psychiatrist Simon Wessely said: Every time we have a mental health awareness week, my spirit sinks. We don\’t need people to be more aware. We cannot deal with those who already know.

Some of these people are seriously ill and in desperate need of help. But at the moment there is another, rather more subtle, problem: I think the current mental health conversation might be encouraging people to interpret their struggles as mental health problems when they aren\’t, in a way that is actively useless for the individual.

Take the example of anxiety having both physical symptoms (also known as panic) and cognitive symptoms (worry). The tendency to experience anxiety runs on a continuum across the population. Some people experience it very occasionally or not at all. As you move up the spectrum, you find people who experience it more frequently and more severely. Gradually, the anxiety causes more distress and becomes more difficult to control. In the extreme, anxiety becomes so destructive that it affects someone\’s ability to function in their life. At that point, we\’d say the person has an anxiety disorder.

But here\’s the thing: There\’s no dividing line between people experiencing normal anxiety and those experiencing clinical anxiety. It is a gradually changing spectrum with a thousand shades of gray. But this point gets lost in the public conversation. Campaigns and social media posts simply churn out the message that there is this troubling thing called anxiety, and then people start interpreting all the low-level stuff as symptomatic of a disorder. This in itself is pointless, some people find it scary and stigmatizing to believe they may have a mental disorder. But I think it could be worse than that: Playing common difficult emotions (like anxiety) could actually trigger these symptoms, in a self-fulfilling way.

If a person believes that their anxiety is a sign of a disorder, this can lead to changes in their self-concept, they will tell themselves and others that I am an anxious person or have anxiety. They may even start changing their behavior. In particular, they may start avoiding the things that make them anxious and the people around them support that. But in the long run, avoidance prolongs and exacerbates anxiety symptoms. In other words, changes in self-concept and behavior could actually generate anxiety in a self-fulfilling way.

So keep in mind that much of the public conversation centers around teenagers. Adolescence is a time of critical identity formation and adolescents are easily influenced by their peers. When I give talks on this topic, to academics and the general public, I am often asked the same question: Is it possible that it is now good for teenagers to have a mental health problem? One parent told me their teenage daughter says she feels left out because she\’s the only one of her friends who doesn\’t suffer from anxiety or depression. It could be that we have encouraged the destigmatization of mental health issues so much that we have drifted too far to the other side, and these labels have become desirable for some adolescents. This doesn\’t help anyone, not least those with debilitating mental illnesses, like schizophrenia, who keep being left out in the cold.

At the moment, this is only a guess. But there are many theories and related evidence that suggest I might be onto something. For example, when you (falsely) tell participants that they have elevated blood pressure, they end up reporting more symptoms. There are numerous studies showing that public health campaigns and school initiatives designed to reduce problems end up increasing them, from drug use to teenage pregnancy, but also, critically, mental health problems. Philosophers, psychologists and sociologists have long theorized that the way we label our symptoms may, ironically, exaggerate and exacerbate the problem.

In the coming years, together with my colleagues, I will test this hypothesis in more detail. One aspect of this will involve qualitative work: interviewing people, especially adolescents, to gain an in-depth understanding of how they interpret and respond to mental health awareness efforts. A second aspect will involve conducting experiments to examine whether exposing people to different information about mental health problems will affect the type and level of symptoms they subsequently report. If we can demonstrate this in the laboratory, it is a hint that this could happen on a larger scale in society as a result of awareness campaigns.

Let me be very clear: None of this means that mental health issues aren\’t real. There are a lot of people in need of mental health care right now who are being severely disappointed in the people and systems that are supposed to help them. And everyone deserves compassion and support, wherever they fall on the mental health spectrum: You don\’t need to meet the criteria for a mental disorder for your distress to count. But what us call that distress, and how we respond to it in ourselves and in others, really matters.

The way we are dealing with mental health issues right now is clearly not working. Maybe outreach efforts sometimes help reduce stigma and empower people to understand themselves. But things can be good and bad at the same time, and useful things can have unintended consequences. Perhaps awareness efforts are both worthwhileANDproblematic, depending on the context, depending on the individual. Right now, we really have no idea.

But as rates of mental health problems continue to rise, particularly in young people, it\’s time to at least start asking these tough questions. Because one thing is true: As awareness efforts proliferate, they certainly aren\’t solving the problem.

Lucy Foulkes, Ph.D., is an academic psychologist at the University of Oxford, UK. Her first book, Losing Our Minds: The Challenge of Defining Mental Illness, was released in the US in 2021.

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat988lifeline.org. For TTY users: Use your preferred forwarding service or dial 711 then 988.

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