Sunday, 24 July 2011

Teenagers and mental health

The next guest post in my feature on mental health comes from Angeli Sweeney who writes on the subject of adolescent mental health. Angie is a JNC Qualified Youth and Community worker, with a keen interest in adolescent cognitive development who has engaged with young people through detached street based work, centre based sessions and one to one intensive support.   Her project was funded by the Crime and Disorder department of the Home Office  to deliver targeted activities to young people who were engaging in or vulnerable to engaging in and committing anti social behaviour and crime. Her study experience includes Person Centered Counseling, Psychology, Forensic Science and Human Biology.

‘Young people are like waves; one moment crashing angrily against the rocks of parental authority and society, the next receding so quickly and so far away, you're not even sure they are there. Like the sea, they have many depths of complexity. Warm, bright, open patches of sun dappled brilliance with vivid and colourful reflections contrasted with dark, deep, cold areas of shadow. As parents, child practitioners and concerned adults, the trick is to be discerning enough to recognise when the tide/conflict is coming in, with what force and what it is bringing with it. If we miss the tide/conflict, we can lose vital indicators of development, and thus opportunities for support and mutual learning. But remember the tide always comes back…’

I have a lifetime of experience dealing with mental health. Let me explain; my mother, grandfather (deceased) and brother, close friends and for a brief period, myself, have all suffered from mental health issues. It is a topic and an experience I have lived with for as far back as I can remember. This, coupled with my innate need to find, explore and digest new information, has led to my understanding of mental health, its consequences and solutions, particularly in young people. 
When I was I initially asked to write this piece, I was at first taken aback, then humbled that I was actually approached to speak on the subject. Whilst writing it I struggled with objectivity as issues I write about are so close too and intermingled with, my own experiences. As a 14 year old, black, (uglyL) twin, who wore glasses, braces, had slow growing hair and wore non brand clothes, I was constantly ridiculed and taunted for my appearance. 
That coupled with the ongoing description of my character by my own family, as 'mady-mady', because of my impulsiveness and independence, I was a prime candidate for teenage depression. My saving grace came in the form of the word. I would write countless poems, songs, short stories, fill up diaries or devour 300 page books in a matter of days, all in order to get away from 'it all'.

Young People…Who are they?
During the stage of adolescence, the young person will exhibit behaviours almost alien to parents that can appear quite alarming, at times. A little distance from parents/carers is normal in this stage of development as young people seek to make their own decisions and pick their own friendship groups.  When it becomes a problem is when that distance and isolation starts to impact on normal, daily interpersonal interactions. Many young people react angrily and defensively when their space and choice to draw back is challenged, questioned, or sometimes violated. As young people develop and grow, they will on a cognitive level, push boundaries and try risk taking behavior. They will take their concrete operations learnt up to age of 11/12 years old, through observance and play, and begin to think abstractly, reason logically and draw conclusions from the information available, as well as apply all these processes to hypothetical situations.

 So when you ask you’re teen to do one thing and they do the other, it isn’t necessarily outright deviance, it’s merely that their response is ‘their’ response. Sometimes a teenager will do the exact opposite of what you ask, just so they can own their behavior. It is a healthy and necessary part of cognitive development and won't last forever. If the reaction is prolonged or unusually hostile, and even violent, then this obviously needs to be addressed.

Crazy Teens?
The subject of mental health has always been stigmatized and taboo. Though in 2011, we have come forward in leaps and bounds and made great progresses towards understanding and supporting mental health, there is still a long way to go in truly first recognizing and then helping to deal with this sometimes, highly debilitating and sometimes fatal illness. And it is an illness; anybody who says differently has a right to their opinion; but by definition, an illness is:

‘Poor health resulting from disease of body or mind; sicknesses.[i]

Present national statistics for mental health representation detail that in the quarter 1st Jan to March 31st, 2308, authorisation requests were completed. Of the total assessments, a higher percentage were female 1,238 (53.6%) and male being 1,070 (46.4%)[ii]Mixed anxiety and depression is the most common mental disorder in Britain and about 10% of children have a mental health problem at any one time. Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15[iii][iv]

The Mental Health Act of 1983 has been amended and updated to the Act of 2007 to encompass and include age-appropriate services. It will require hospital managers to ensure that patients aged under 18 admitted to hospital for mental disorders are accommodated in an environment that is suitable for their age (subject to their needs). This is on course to be implemented soon. This to me is a great stride in safeguarding the most vulnerable in our community and ensuring that the services they deliver are tailored and safe[v].

From when a child goes into puberty, their nervous, hormonal, endocrinal and physiological development goes into overdrive. Just like a newborn baby needs to sleep and eat a lot and be constantly stimulated, so to do adolescents. The massive and immense changes taking place in their bodies, takes precedent over nearly every facet of their lives. Girls will usually start puberty around 12-13 and boys around 14-15. Girls usually stop growing at a rate of 8cm a year around the age of 18, whilst boys on average grow 9cm a years and stop around the age of 20.

 A point to remember is that during this time, an adolescent’s centre of gravity is actually lifted up and the brain struggles to interpret this. This can be displayed as clumsiness, laziness and general willfulness. Parents who are not fully aware of these changes and there consequences, can interpret them as bad behavior, leading to outbursts, arguments and sometimes violence and abuse. 
Imagine the stress and anxiety a young person feels, like they are being victimized and attacked, for just being themselves. It can and does lead to depression and the need for the young person to break away from what they deem as a hostile environment. On many occasions, I have worked with young people who congregate until late at night, abuse alcohol and drugs; because they feel their parents/care givers are unfairly treating them.

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence through to adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity[vi]. Obsessive Compulsive Disorder is the 4th most common form of mental or anxiety disorder, with cognitive therapy and/or medication used to successfully treat it, in most cases. Most of these conditions can be diagnosed by a medical doctor or GP, but in some cases, young people will be statemented by child psychologists and psychiatrists at the bequest of a GP, educational establishment or parents. 

 In my professional experience, it seems that young people who get involved in anti social behavior and/or criminality, usually present with some form of mental health problem, the least being depression and anxiety.
30 percent of all young people given an ASBO have some form or mental health issue or learning difficulty.

Is It The Drugs…?
In my own experience, my brother withdrew so entirely from family life; I actually forgot he existed for a while. He was moody, insolent, harsh, cruel and continually feeling sorry for himself. Looking back, I didn't realise it was mental illness forming in his psyche; I couldn't comprehend as a child myself that he was slipping into a dark cave of helplessness. The times he did surface were only to eat, and go and congregate with friends, smoking, what I now know to be was Marijuana.
 We know there have been countless studies into the effects of marijuana and mental health; I myself used it for several years, only stopping abruptly when after an evening of smoking with friends, I went to bed and was awakened by nightmares and hallucinations that there was a killer dwarf in my pots and pan cupboard in the kitchen!

Weed has recently been declassified and is relatively easy to get hold of so many young people will experiment with the drug recreationally. Some people will say that it is harmless, while others maintain that in the adolescent psyche, which is still forming into adulthood, regular weed smoking can have disastrous effects on the mental health of that person in later life.

I've seen countless friends succumb to the illusionary effects of weed; one actually acquired a gun and came round to my university flat to kill me after he 'saw' me murder my then boyfriend on a Wednesday episode of The Bill! He was quickly picked up by his mother and sent to a psychiatric unit to recover. 
I can happily say that we still speak today. The ever increasing varieties and stronger forms of marijuana are contributing to higher than average case of psychosis amongst young people, in particular, young men.

 Young men seem to gravitate towards weed smoking because of their friendship groups, kudos or the curiosity and risk taking factor. Many believe that marijuana can be a gateway drug to harder drugs. This is not always the case, and most young people try it for a time and then leave it behind as they enter adulthood. What can not be ignored is that young people who use it, have a higher than average predisposition to mental health issues, which in some cases are actually drug resistant.

Establishing Need…
Maslow’s hierarchy of need details that 5 levels of need must be satisfied in order for in order to be comfortable in their environment, and even within themselves.
Physical – need to satisfy hunger, thirst, sleep, etc.
Need to be secure and safe and out of danger
Emotional – Need to belong, love and be loved. Need to achieve to be recognised
Aesthetic – Need to know, to explore, and to understand
Self fulfilling – need for self actualisation

According to Jo Frost Extreme Parenting Show, parents are not spending quality time with their children.  An average of 49 minutes per day was the figure furnished. This is shocking and deeply saddening, but in this increasingly hectic and chaotic society, where parents work in order to live, how can this be rectified? Couple this with family breakdown, or divorce and the child’s needs are being severely neglected. 

If Mum and Dad separate, or if older brother falls out with older sister and no longer comes to the house, whose fault is it? Often times, adolescents will shoulder the burden. Why? Because part of their cognitive development tells them that life is black and white, so if mum, dad, big sister, and big brother are not to blame, then they must be to blame. Feelings of insecurity, shame, guilt, anger, isolation and helplessness are created and then turn to anxiety, stress and depression.

We Don’t Need No Education…!!!
Howard. S. Beckers Labeling Theory[vii] ‘holds that defiance is not inherent to an act, but instead focuses on the linguistic tendency of majorities to negatively label minorities or those seen as deviant from norms. The theory is concerned with how the self identity and the behaviour of individuals may be determined or influenced by the terms used to describe or classify them, and is associated with the concept of self fulfilling prophecy and stereotype’.

His theory backs up my own experience as a professional youth practitioner; in most cases, young people, become anxious and depressed because they feel that they don’t fit the social roles and what is classed as the norm in society. It has been a constant frustration for me as an individual and professional, that adults label young people with the 'hoodie', 'yob' or 'deviant' tag, and this is becoming readily accepted and perpetuated by the media and society in general.
 Long story short, if we repeatedly label our youth as bad, guess what they’ll be?

The educational system in Britain, is very domesticated, young people are expected to conform to one way system of learning. Young people spend a over half of their walking day in a classroom environment. Any youth practitioner worth their salt should be aware of the various learning styles that people, particularly young people have. Whilst one young person can assimilate information through written and spoken word, another can only process it through seeing and doing it. Anxiety of learning is a very real and increasingly common phenomenon. 
It’s not just the fear of not being seen as good enough or being labeled as ‘dumb’, it goes as far as young people, psychologically being unable to enter school grounds because of the stress and fear of not being able to receive the information taught by teaching staff. Some say this is a cop out, or an imagined threat. Let me tell you I’ve seen countless young people, on approach to school gates, physically shake, become agitated and loud and sometimes verbally and physically abusive, in order to get out of attending, as a counter attack to the war they feel they are about to fight. Studies have shown that young people who skip school are more likely to be involved in anti social behaviour.

Paulo Freire (1970), a Brazilian born philosopher, stated that poverty and hunger affected his ability to learn. He also spoke about the education system being a political tool. He is best known. For his 'banking concept on education', in which the student was viewed as an empty vessel to be filled by the teacher. He notes that “it transforms students into receiving objects; it attempts to control thinking and actions, leads men and women to adjust to the world, and inhibits their creative power".

School policies on bullying and inclusion may well be robust, but bullying can be so slight that it is not picked on by teachers trained or briefed to recognise the signs or triggers. Because of the highly sensitive nature of young people, a look, tone of voice, body gesture, can rightly or wrongly be perceived as aggressive or hostile. Peer pressure is not always necessarily linked to bullying.

 It’s more to do with the group mentality and the individual feeling ostracised if they do not copy, emulate or go along with what the other group members are doing. It’s about the young person feeling the need to belong to a group that he/her has chosen, and in turn, have chosen them.

According to a recent report published on Children and Young People Now website, the The Wasted Generation report details that one in four young people not in education, employment or training. The online mentoring service Future You who undertook the study goes on to state that 69% believe their talent is being thrown away. In addition, one in five (22per cent) admitted to abusing alcohol with 13 per cent resorting to taking drugs. Employment figures released in April showed that 963,000 16-24 year olds were out of work[viii]

So if young people are feeling so despondent and turning to drink, drugs and contemplating suicide, is it any wonder there are alarmingly increasing numbers of adolescent mental health cases. Chorlton Youth Project in Manchester has just finished a piece of consultation work (July 15th) asking 107 young people the biggest causes of adolescent mental health. The results were two fold; lack of employment and related self esteem, monetary issues and drugs.

Our House….
Camilla Batmanghelidjh of Kids Company states young people become traumatised by inner city, urban living and are exposed to threats, abuse and neglect within the home, but also outside of the home.  Kids Company seeks to provide practical, emotional and educational support to young people, as well as to parents who are unable to provide practical and emotional support for their children. 
I believe these threats and risk factors are linked to higher incidences and particularly, disproportionate amount of young black men represented within the mental health care system.

I’ve worked with some young people who have Border Line Personality Disorder, OCD and evident psychosis caused by emotional trauma from physical, sexual and neglectful abuse. Young people subject to sexual exploitation, molestation and incest, will almost always present with some form of emotional, behavioural and/or mental health condition. Sexual abuse is real, ever present and regrettably ever increasing. 

It can be argued that the current figures indicate a rise in these cases of abuse, or a increase in the number of young people reporting it or alerting an adult to it.
Iylana Vazant, in her book; Peace from Broken Pieces, speaks about the families pathology of dysfunction being repeated in behaviours of children, and if the cycle is not broken, it will lead to fractured minds, bodies and psyches, and a repeat of this destructive cycle.  I believe that cycle needs to be broken by adults in society, who are inherently charged with the task of safeguarding and ensuring the well being of our youth.

I can truly testify to this sentiment, as I and many other young people, witnessed and endured a mother with psychotic episodes. The feeling of helplessness, anger and sadness is colossal; a young mind doesn’t register the underlying issues and reasons behind the behavior; they just want and need to be loved.
 Low selfesteem and confidence resulting from ineffective methods of parenting, which do not instill pride and a sense of achievement in young people, is one of the primary contributing factors to adolescent mental health.

Lastly mental health problems due to genetic predisposition are becoming increasingly common, some forms of schizophrenia are actually inherited from a parent or parents. Though the Nature vs. Nurture debate is a hotly debated and long standing arena of argument, one cannot ignore the fact that familial culture and behaviours have a huge impact on young people’s mental state.

An old African adage states; ‘it takes a village to raise a child’. This for me is at the heart of recognizing, treating and supporting mental illness when presented in young people. We all have an individual and thus collective responsibility to raising the children of today. I am not yet a parent; I have yet to truly appreciate the joys and hardships of raising children. What I am is a proud and heavily involved auntie and God mother. What I am is mentor and available loci parentis when needed. What I am is a concerned, discerning, professional and experienced child and youth practitioner who is constantly learning and striving to create a better community for the young people I work with and encounter every day.


[ii] Mental Health Foundation
[iii] Health and Social Care Information Centre, Community and Mental Health Team. 
[iv] Mental Disorder More Common In Boys, National Statistics Online, 2004




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