Has the mental health of young people really deteriorated ?

Since the Covid-19 pan­de­mic, the men­tal state of young people has been a cause for concern. The sub­ject was even cited as one of the government’s major causes by French Prime Minis­ter Gabriel Attal in his gene­ral poli­cy speech last Janua­ry. In March 2023, the French High Com­mis­sion for Child­hood and the Fami­ly publi­shed a report on the increase in men­tal dis­tress among young people, high­ligh­ted by seve­ral natio­nal and inter­na­tio­nal bodies. At the same time, the Court of Audi­tors noted a “high inci­dence of men­tal disor­ders among chil­dren and ado­les­cents in all indus­tria­li­sed countries.” 

“There has been a signi­fi­cant increase in the demand for psy­cho­lo­gi­cal help, which can be recei­ved in medi­cal-psy­cho­lo­gi­cal centres, youth centres, medi­cal emer­gen­cies and pae­dia­tric wards,” explains Guillaume Bron­sard, head of the child psy­chia­try depart­ment in Brest and chair­man of the Ile-de-France School of Parents and Edu­ca­tors in charge of the Fil san­té jeunes (EPE-IDF).

There is no gene­ral or wides­pread out­break of men­tal health problems.

Fol­lo­wing the pan­de­mic and lock­downs, nume­rous reports poin­ted to an increase in psy­cho­lo­gi­cal disor­ders among chil­dren and ado­les­cents. The Cour des Comptes (French Natio­nal Audit Office) points to an increase in anxie­ty and depres­sive symp­toms, psy­cho­lo­gi­cal dis­tress and sui­ci­dal thoughts. Bet­ween 2016 and 2021, the num­ber of emer­gen­cy room visits for men­tal disor­ders among minors rose by 65%. In com­pa­ri­son, for the same age group, the ove­rall num­ber of emer­gen­cy room visits – for all other rea­sons com­bi­ned – rose by 4%.

Howe­ver, accor­ding to Guillaume Bron­sard, it would be dif­fi­cult to infer from these fin­dings a gene­ral state of men­tal health among young people. “We can­not infer that there is an out­break of men­tal health pro­blems (as we are often told) that is wides­pread, gene­ra­li­sed and uncon­trol­lable.” Indeed, the Cour des Comptes notes that “changes in the pre­va­lence of men­tal disor­ders among chil­dren and young people over time have not been docu­men­ted, and do not allow us to conclude that there has been an ove­rall decrease or increase.”

The so-cal­led gene­ra­li­sed dete­rio­ra­tion actual­ly conceals a hete­ro­ge­neous situa­tion. The increase in requests for psy­cho­lo­gi­cal help is not even­ly spread across France. For example, there are more requests in places where there are more child psy­chia­try ser­vices. Accor­ding to Guillaume Bron­sard, this high­lights the lack of cor­re­la­tion bet­ween the num­ber of requests and the actual state of suffering.

The increase in requests for help since the pan­de­mic has main­ly concer­ned people who were alrea­dy vul­ne­rable. “During this per­iod, many points of refe­rence have been sha­ken up and situa­tions have wor­se­ned. Howe­ver, the majo­ri­ty of young people show no par­ti­cu­lar signs of suf­fe­ring. It’s more a ques­tion of an inten­si­fi­ca­tion of an alrea­dy vul­ne­rable mino­ri­ty sub-group, rather than an abso­lute increase in the num­ber of people affec­ted,” explains the doctor.

What’s more, this increase par­ti­cu­lar­ly affects young girls. “Gene­ral­ly spea­king, young girls in their teens have for a very long time been much more prone to inter­na­li­sed disor­ders, i.e. sui­cide attempts, sca­ri­fi­ca­tion, dama­ged rela­tion­ships with their bodies and so on. This is lin­ked in par­ti­cu­lar to the rea­li­ty of puber­ty, which is more intense in young girls than in young boys. This is a well-known and long-stan­ding phe­no­me­non, which the Covid-19 per­iod has exa­cer­ba­ted,” explains the child psychiatrist.

Accor­ding to Guillaume Bron­sard, it is untrue to say that young people are in a bad way. What’s more, fuel­ling unjus­ti­fied concern could have nega­tive conse­quences. “This sta­te­ment may be the result of adults pro­jec­ting them­selves onto young people. The rela­tion­ship bet­ween the gene­ra­tions has always been one of ambi­va­lence, and we mustn’t allow it to become one of inter­ge­ne­ra­tio­nal aggres­sion mas­que­ra­ding as com­pas­sion,” warns the pre­sident of the asso­cia­tion in charge of the Fil san­té jeunes.

In recent years, awa­re­ness of men­tal health issues has become more wides­pread. Com­mu­ni­ca­tion cam­pai­gns have been set up, in addi­tion to media cove­rage of cer­tain situa­tions such as aggres­sion and harass­ment. “All this is posi­tive, as long as there is com­mu­ni­ca­tion about where to go for help and care. This will increase demand, which is all to the good. Howe­ver, we need to be care­ful to inform and raise awa­re­ness, without cau­sing alarm,” warns Guillaume Bron­sard. He points out that, at the same time, there are a num­ber of social trends that attest to good men­tal health, such as poli­ti­cal enga­ge­ment among­st tee­na­gers, which used to be much rarer.

Accor­ding to the child psy­chia­trist, the cur­rent situa­tion can­not be explai­ned sole­ly by the pan­de­mic, or by grea­ter awa­re­ness of the impor­tance of men­tal health. Demand for child and ado­les­cent psy­chia­try began to rise at the end of the 1990s, and sta­bi­li­sed around 2010. Guillaume Bron­sard explains that this is pri­ma­ri­ly due to a major change in the orga­ni­sa­tion of fami­lies and schools, which began in the 1970s : “Many ano­ma­lies or dis­tur­bances used to be dealt with in the pri­va­cy of the fami­ly. Dis­rup­tive beha­viour was not trea­ted medi­cal­ly, because fami­lies or schools dealt with it, gene­ral­ly in an edu­ca­tio­nal, often puni­tive and some­times violent way. On the whole, it was a posi­tive change in our socie­ty,” says the doc­tor. Since then, there has been grea­ter recog­ni­tion of psy­chia­tric disor­ders in chil­dren and ado­les­cents, bet­ter scree­ning for lear­ning disa­bi­li­ties, and medi­cal treatment.

“These fac­tors have led to a ten­fold increase in demand, yet there has been no suf­fi­cient increase in child psy­chia­try resources,” laments Guillaume Bron­sard. “In the 1990s, sup­ply and demand were clo­se­ly ali­gned. Today, demand has increa­sed dra­ma­ti­cal­ly, but there is too lit­tle sup­ply, giving rise to the wai­ting lists and bot­tle­necks that we see in child and ado­les­cent psy­chia­try.” For seve­ral years now, pro­fes­sio­nals in the sec­tor have been war­ning about this lack of psy­cho­lo­gi­cal care, par­ti­cu­lar­ly for young people. Accor­ding to an article publi­shed in Le Monde in April 2023, of the 1.6 mil­lion chil­dren and ado­les­cents suf­fe­ring from men­tal ill­ness, only 750,000- 850,000 receive spe­ci­fic care from child psy­chia­try professionals.

Sirine Azouaoui

Refe­rence : the Court of Audi­tors : https://www.ccomptes.fr/sites/default/files/2023–10/20230321-pedopsychiatrie.pdf