Mental health in young people is a growing concern across many countries. GPs are seeing more young people with psychological complaints, but does this automatically mean there is an epidemic of mental illness?

That is too short-sighted. Part of the reason for the incline is that young people have become better at expressing their psychological suffering. They find it easier to talk about their experiences, support each other with this, and use psychological language more often. More language about suffering doesn’t automatically mean more illness. It could be a sign of awareness and openness. And that is quite a difference.

If you look at the broader indicators – school dropout rate, unemployment amongst youth, delinquency, you’ll see that in many countries there has been a decrease rather than an increase. That doesn’t fit into the picture of a generation that is falling apart mentally. After Covid, there was a clear increase of anxiety and depression, but we don’t know yet whether that is a permanent rise, or an adequate reaction to a disruptive period.

The problem with the DSM labels

It is tempting to just stick a DSM-label on every young person that walks through the door. But the DSM describes, and doesn’t explain anything. It doesn’t tell you why this youngster is feeling stuck, why these symptoms occur in this context, and what is necessary to get moving again. In fact, research shows that young children with ADHD-like symptoms, that were diagnosed at a young age, had more emotional and social challenges and lower self esteem, than undiagnosed people by the time they were 13. This is a very good reason to be careful with early diagnoses.

Understanding Psychological Suffering in Young People

Psychological suffering is easier to understand as a misalignment in how someone relates to their feelings, thoughts, and desires. A feeling or thought stops being something you observe, but something that controls you. The panic makes you scared of going to school. The emptiness you feel tells you you have no future. The girl that can only see herself as traumatised, burned out, or a person with ADHD. Behind those words is not just the pressure of the symptoms, but also an experience of being stuck in a tunnel.

First context, then label

If psychological suffering is contextual, you have to look at the context. That also goes for young people. What that means is: first you need to understand what is happening in the young person’s life. What’s their home-life like, how are things at school, online, in friendships, identity, how do they sleep, and what are their expectations for the future. Where did they lose grip, which environments are disrupted, and which ones help.

Mental health in young people: Vulnerabilities and talents

This approach also works when looking at neurodiversity. Instead of just looking at what disorder someone has, you could also ask: what vulnerabilities and talents has this person? How does this person struggle with their environment, what do they find difficult, and what goes well for them? This approach doesn’t necessarily turn everything into a medical issue, without minimalising the suffering. Work needs to be done, but it is worth the effort.

Young people as a canary in a coal mine

There is another reason why a mere individual diagnose doesn’t suffice. Young people are sensitive to what is happening in the world. Climate change, wars, housing crisis, pressure to perform, constantly trying to live up to social media, and losing belief in progress. Part of psychological suffering is a result of society. Not everyone with mental health issues has a disorder. But it’s easier to diagnose a patient than to talk about society, but much of our psychological suffering has a rational, social, and lifestyle context. Pressure to perform, exclusion, loneliness, and loss of connection are often thought to come from an individual and as psychological problems, whilst they are partly produced by our society.

How to Support Mental Health in Young People: 4 steps

1. Don’t just count symptoms, but ask what the young person is experiencing, when the disruption occurs. What happens in their bodies and relationships. That is not just informative, it can also be a relief for the patient.
2. Make the context explicit. What environments cause disruption, who can support the patient, what’s their sleep, rhythm, loneliness, and pressure in school like.
3. Look at the profile; sensitivities and talents. Can the environment be adjusted before we activate a whole care circuit?
4. Realise that not every young person needs help from mental healthcare professionals. Sometimes it’s more useful to use other sources. For example, a trusted adult for support, support from parents, adjustments in school, and informal support. There are plenty more sources available other than the mental healthcare sector.

Not just the consultation room, but also society

When psychological suffering is partly caused by society, you can’t fix it in the consultation room alone. You also have to change the circumstances in which the youngsters grow up. That sounds vague, but it doesn’t have to be. In Iceland they’ve done exactly that. The government and schools made large-scale investments in sport, involvement of parents, and organised pastime for youngsters. No diagnoses – just making sure that young people feel like they belong somewhere, keep busy, and are surrounded by grown ups who are involved in their well-being. The result was spectacular: drug use and mental illness decreased massively.

Compare it to cardiologists work. They have developed fantastic techniques, like heart surgery, transplants, and stents. But they say so themselves: the real solution lies in the simple message that everyone knows: don’t smoke, eat healthy, exercise.  Thank to the public health message heart disease has decreased greatly in the Netherlands, and went from the first cause of death to the second.

Psychiatrists and psychologists haven’t taken that step yet. What they say explicitly is: only we can help you with you your problems. Whilst we have known for a long time that exercise, sleeping well, social connection and rhythm can have a big effect on your mental health. That message – what can you do yourself? – should be the main message. Not a footnote in the brochure.

The DSM in its place

The DSM shouldn’t just be dismissed. But it’s time to ‘put it in its place’. Young people who suffer psychologically aren’t always mentally ill. They often show that their relation to their feelings, thoughts, relationships, and future is disrupted. So less labelling, more understanding of what exactly went wrong in this young person’s life.