Embargoed 00:01 Wed 28th Nov 2018
Are 1 in 8 children and young people really ‘mentally disordered’?
Mental health organisations challenge the language of illness and disorder – On November 22nd 2018, NHS Digital released a widely publicised report on children and young people’s mental health, which found that one in eight children and young people aged between five and nineteen, meet the criteria for at least one psychiatric condition such as depressive disorder, anxiety disorder or bipolar disorder.
Shame, stigma and failure
Consultant clinical psychologist Dr Lucy Johnstone appeared on Sky News that evening endorsing many of the findings, but cautioning against the use of the language of illness and disorder to describe what can be seen as children and young people’s understandable responses to life circumstances.
Watch the interview – here.
The report gave much evidence that many of these children and young people are facing difficult events such as parental separation and bullying, and come from families that are struggling emotionally and financially. Dr Johnstone said that in these contexts it may make little sense to call children’s reactions ‘illnesses’ or ‘disorders’, and indeed doing so may add to their sense of shame, stigma and failure.
Mental health organisations A Disorder for Everyone (AD4E) and Safely Held Spaces (SHS) both point out that there is little evidence that these very real and difficult experiences are best understood as disorders and illnesses caused primarily by chemical imbalances or genetics.
They can instead be seen as the result of different interacting factors: there is a great deal of research showing that these experiences of mental and emotional distress are related to life events such as trauma, loss, neglect and abuse, as well as wider social factors such as unemployment, discrimination, poverty and inequality.
What happened to you?
The key question then, when we encounter children and young people’s mental and emotional distress, might rather be What happened to you? and not What’s wrong with you?
Few people are aware that our current diagnostic categories have been described as ‘not valid’ and ‘unscientific’ by members of the very committees that drew them up. A coalition of professionals from all backgrounds, along with people who have used psychiatric services, has for some time been calling for alternatives. While recognising that diagnosis is useful for some people, and will continue to be necessary for some practical purposes, they argue that language like mental and emotional distress, low mood and hearing voices is preferable to medical terms like mental illness, symptom and disorder and opens up the possibility of a wider range of understandings.
Dr Lucy Johnstone says:
‘These children and young people are obviously in great distress. But are they suffering from medical illnesses which need diagnosing? Or do we need to look at their life circumstances for explanations of their difficulties?
‘Children are a barometer of our society – we cannot go on waiting until every child in the country is labelled with a disorder and on a clinic waiting list’
‘Diagnosis tends to obscure the root causes of this epidemic of distress in our children and young people. So an important start, as we are seeking to do here, is to challenge the language of illness and disorder, so we can recognise this distress as understandable in the context of children’s lives.’
‘We need to direct far more effort and resources towards tackling the root causes, or else we are simply mopping the floor while the tap is running. A recent United Nations report found unprecedented levels of hardship and distress in poorer families, up to and including suicide, which was impacting particularly strongly on children. In this report NHS Digital has identified some of the inevitable consequences of this for children’s well-being.’
Professor Allen Frances, Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine. Chair of the Diagnostic and Statistical Manual of Mental Disorders (DSM)Task Force and principal investigator on the DSM-IV says:
‘In my opinion, the DSM-5 process has been secretive, closed and sloppy –
with confidentiality restraints, constantly missed deadlines, botched field testing, the cancellation of an important quality control step, and a rush to publication. A petition for independent scientific review endorsed by 56 mental health organisations was ignored. There is no reason to believe that DSM-5 is safe or scientifically sound.’
Dr Thomas Insel, former chair of NIMH, the world’s largest funding body for mental health research:
‘The weakness is its lack of validity… That is why the National Institute for Mental Health will be re-orienting its research away from DSM categories.’
Available for interview or comment:
Dr Lucy Johnstone
Consultant Clinical Psychologist
Dr Katie Hunt
Clinical Child Psychologist and Paediatric Clinical Neuropsychologist www.katiehuntpsychology.co.uk
To arrange interviews or comment please contact:
07850 172 206
07769 158 565