When I’ve discharged patients, they’ve told me how “if only they taught DBT skills at school, I would never have needed to come into hospital.” We’re very proud of our dialectical behavioural therapy (DBT) groups: they teach mindfulness, distress tolerance, emotion regulation, and interpersonal skills. And now at last, we hear that the Department for Education (DfE) has invited bids to offer mental health training in more than 200 schools.
I’m deeply worried by what Sue Palmer memorably describes as the “toxic childhood” experienced by young people today. I agree with Theresa May that there is “burning injustice” in the impoverishment of mental health services compared with the rest of medicine. After the introduction of the government initiative “Sure Start” almost 20 years ago, which provided services for parents and young children, we’re at last addressing that second phase of critical brain development: adolescence. Most mental illness has its onset in adolescence, and when it comes to mental distress, Childline counselled 11 706 young people for anxiety in 2015-16—a 35% rise from the previous year.
It seems that this time around researchers have learnt from the flaws of Sure Start and will be monitoring and measuring outcomes. A current Wellcome study, involving the universities of Oxford and Exeter, will randomise thousands of pupils to either mindfulness or teaching as usual, try to discover the best age for receptiveness to the skills, and use brain imaging techniques as well as questionnaires to see what is happening.
Lord Layard (originator of the government’s initiative to improve access to psychological therapies (IAPT)) says that while we’re obsessed with measuring academic achievement, “the development of the character of children is an incredibly important issue.” I couldn’t agree more. But are Layard and the DfE conflating the notions of mental health, happiness, and good citizenship? Could these trial lessons really prevent serious mental illness? Are there ulterior motives behind the idea?
Laura Henry, an early years consultant and former Ofsted inspector, has suggested that the trials could save the government billions in future social care and housing costs. It is easier and cheaper to launch promising pilot projects than to spend more on social care, housing, and NHS mental health services. But couldn’t we at least try to prevent some of the many harms that are now part of the fabric of young people’s everyday experiences?
We drive them to school, sell off playing fields, cut budgets for specialist art and music teachers, leave them to the lure of fizzy drinks and takeaways rather than sitting down to eat together at school or home. We abandon them to the mean streets of social media without proper security systems because we’re not virtually streetwise ourselves. Secondary schools are getting bigger and becoming increasingly focused on academic results. For many adolescents, “play” and leisure time means all-nighters round electronic game consoles. Only 17% of an international sample of young people felt that they got enough sleep, exercise, rest, and time for reflection.
Psychological self-management techniques may provide a defence against some of this, but it demands huge individual responsibility in challenging situations. Rather than trying to instil in young people the skills to endure these stressors, wouldn’t it be a good idea to remove or mitigate them in the first instance?
I asked our current patient group over dinner what they thought of the government’s plans. They were witheringly scornful. Some felt that their schools used “mindfulness and dog petting sessions” in a desperate attempt to soothe the students’ extreme exam stress, which might interfere with their place in the league tables. Not all patients are the same.
This raises the question of whether it’s better to offer these lessons and techniques to targeted groups or to all young people. We don’t yet know what sort of intervention we are dealing with here. Is mindfulness psychological fluoride—something to be added to the tap water? Or is it the mental health equivalent of prescribing antibiotics to all children to prevent infections? I’ve noticed anecdotally that it’s harder to achieve good results with cognitive behavioural therapy (CBT) now that most people have used CBT based apps or had very brief interventions.
It’s worth remembering that powerful psychological techniques can harm as well as help. The structured therapies that emerged in the 1970s were tested in randomised controlled trials against antidepressant drugs. One trial of therapies for anorexia nervosa actually showed that patients did worse when treated with CBT or interpersonal psychotherapy than with ordinary supportive input. And school “healthy eating” interventions have failed to stem rising obesity rates, with some studies even finding that they may be fuelling the prevalence of eating disorders.
I asked my patients what they’ve learnt to manage stress better. They spoke about arts and crafts, puzzles and board games, music, walks, and “chilling” with friends. Being with their families is best of all. Parents spoke of the benefits of a period of “digital detox” and emphasised the need for other groups besides school: the band, the scouts, the choir, the Saturday job, the team, even the “gang.” If I had a big grant, my priority would be to buy time for families, schools, clubs, and child and adolescent mental health services to visit each other and offer mutual support rather than mass happiness lessons.
Jane Morris trained in Cambridge and London, but has spent nearly all of her working life in various Scottish cities. She has higher psychiatric training in medical psychotherapy and in child and adolescent psychiatry. She now specialises in eating disorders, chairing the Faculty of Eating Disorders for the Royal College of Psychiatrists in Scotland.
Competing interests: I am accredited in various psychological therapies and teach and supervise these.