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The kids, it seems, are not alright. My colleague, Laura Perrins, recently drew my attention to the startling findings of a study published the Lancet which captured the alarming increase in emergency admissions to hospitals for children with mental health problems in England.
As The Times reported:
A rise in teenage girls self-harming and suffering “starvation from an eating disorder” has driven a dramatic increase in emergency hospital admissions for children with mental health problems.
Researchers at University College London found that in the decade to 2022 there had been a 65 per cent increase, to nearly 40,000 patients a year, in the number of 5 to 18-year-olds admitted to acute hospital wards in a mental health crisis.
This included a sixfold increase in the number of eating disorder patients needing to be hospitalised after arriving at A&E. The biggest rise was for girls aged 11 to 15.
Experts said the study, published in The Lancet Child and Adolescent Health, highlighted “the alarming deterioration in the mental health and wellbeing of our children and young people”, which has been linked to smartphones and social media.
The study found that increases in admissions to medical wards for mental health concerns were “greatest in females aged 11–15 years. Steep relative increases in admissions for mental health concerns were also seen in younger individuals aged 5–10 years, with striking rates of self-harm in females”.
Between 2012 and 2022, “mental health admissions for girls aged 11 to 15 more than doubled, from 9,091 to 19,349”, the study said. If anecdotal evidence is to be believed, it seems likely that those figures worsened again in 2023 and 2024.
“Children and young people admitted with mental health concerns are also staying longer in the hospital, with the proportion of admissions lasting more than a week nearly doubling since 2012–13,” the British research found.
NHS England estimate that almost a quarter – 22·6% – of young people aged 11–16 years were likely to have a mental disorder in 2023, an increase from 13·3% in 2017, with sharp increases in eating disorders, the study said.
Tragically, it also noted that “mortality from suicide in young people also increased over the study period, continuing a trend from around 2010”.
These disturbing trends “were likely to have been exacerbated by the COVID-19 pandemic” the researchers said, saying there was a “need to address underlying diverse social, environmental, and commercial determinants of mental health concerns in children and young people”.
I found the findings of the study both terrifying and predictable. The accelerating mental health crisis amongst young people has been long flagged, and healthcare services don’t seem able to keep up with the need for help that is growing at a rate we don’t really fully comprehend.
In Ireland, for example, we hear an awful lot about the need for public awareness around mental health, and perhaps not enough about the horrendous difficulties parents face in actually getting help for their child when they can see they are struggling, and sometimes even in serious danger,
Any parent who has faced the enormous – and frightening – frustration of being told that a child experiencing a mental health crisis is being put on a waiting list for help, must feel that much of platitudes around awareness are meaningless. In her independent review of CAHMS in 2023, Dr Susan Finnerty wrote that the rights of children with mental illness were being breached by” waiting lists, the lack of capacity to provide appropriate therapeutic interventions, the “lost” cases, the lack of emergency services and out of-hours services, the difficulties in accessing
Primary Care and Disability Services, and the absence of monitoring of certain medications”.
There’s no point in everyone applauding efforts by the state to grow public awareness about mental health difficulties if the same state can’t actually help people – including children- who are in desperate need.
The heartbreaking case of an 11-year-old girl, Milly Tuomey, who died by suicide, highlighted how her family’s desperate attempts to get help for their daughter’s suicidal ideation led to a “urgent referral to mental health services” but then a wait for an appointment which came too late for the child.
As we are seeing in other jurisdictions, it may be that the failure to provide these essential services is partly because the rate of increase in mental health difficulties in young people is so sharp – and so unprecedented – that services, provided by trained professionals and medical experts, simply cannot keep up.
The Health Research Board’s annual report on the Activities of Irish Psychiatric Units and Hospitals showed that, in 2023, for first time, eating disorders accounted for the highest proportion of all under-18 admissions along with depressive disorders.
The idea that children, and girls in particular, are suffering so profoundly from a depressive disorder that they are being hospitalised and treated for starvation in a rich, modern country is almost inconceivable. Again, the HRB review pointed to “underinvestment” in “appropriate services” having “devastating consequences for those who require urgent care”.
But the problem is that eating disorders aren’t the only mental health disorders in young people seeing accelerating rates of presentations. A special report commissioned by Lancet Psychiatry last year found that the sheer number of young people suffering mental ill health “has entered a dangerous phase”.
The Lancet Psychiatry findings, like the startling results of the new study, have to lead policymakers to address a hugely important question: why are we seeing this alarming spike, and what can we do to address the underlying causes.
Psychologist Jonathan Haidt has argued convincingly that smartphones and social media are a significant part of the problem, and is leading a global campaign to have their use banned in schools.
Amongst the figures causing many to listen attentively to Haidt are that suicide is now “the second-leading cause of death for people under 24 in the U.S., and a Centers for Disease Control and Prevention report last year found 20 percent of the country’s 12- to 17-year-olds had had at least one major depressive episode—results unlike anything the CDC had seen in thirty years of collecting such data.”
The average parent, I imagine, can see the sense in Haidt’s argument that a spike in mood disorders in young people correlated with a spike in phone use and the proliferation of social media apps that make bullying and isolating behaviour all the easier. But there are likely other factors in the spike in anxiety and depression we are seeing in young people, at a level which is overwhelming services that can help.
That’s a key point really: if the proportion of young people in need of serious mental health supports continues to rise, the system may simply be unable to cope. The ratio will become unmanageable. That should add a significant sense of urgency to efforts to understand the underlying causes for the alarming rise we are seeing in young people with mental health difficulties.
In addition to the effects of social media, many health bodies point to insecurity in children’s lives: concerns about job prospects, poverty, housing, and even climate change (for which those who drive hysterical claims of the world ending in 12 years should shoulder some blame) and feeling disconnected from a supportive community.
One factor, however, which doesn’t seem to get much attention is family breakdown and its effects on children, even though studies have repeatedly found that children are more likely to thrive in stable, secure, low-conflict families.
The Institute of Family Studies points to one study of several thousand families, which found that “children from divorced or single-parent families were 3.2 times more likely to experience an anxiety disorder, 2.8 times more likely to experience depression, and 1.9 times more likely to suffer from ADHD compared to children from intact families”.
Research in Britain using Millennium Cohort study data from 10,929 mothers with 14 year old children also revealed that mental health problems “are especially prevalent among children whose parents split up” – adding that “the influence of family behaviour on teenage mental health extends far beyond parental conflict”.
Such findings are sometimes considered thorny – even though polls indicate that public believes “the mental health epidemic is being driven by high levels of family breakdown” – partly because no-one wants to add to the distress that parents, especially mothers, are experiencing during the breakdown of a marriage or relationship. But perhaps being cognisant of the findings can help policymakers – and broader society – focus on ways to strengthen marriage and help families before ruptures begin or fractures deepen. And perhaps knowing the extent of the damage to children might help both parties in refraining from actions that might lead to irreconcilable differences in a marriage.
If we are facing a global and perhaps unmanageable mental health crisis in young people, it is incumbent on us to at least expend comparable energy in addressing the cause as the cure. We cannot be blind to the horribly incongruent reality of girls living in rich countries presenting at hospitals suffering starvation because of mental health crises.
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