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Has the mental health of young people really deteriorated?

Guillaume Bronsard
Guillaume Bronsard
Child and adolescent psychiatrist at Université de Bretagne Occidentale
Key takeaways
  • Since 2020, a number of national and international reports and organisations have been warning of an increase in psychological suffering among children and adolescents.
  • This increase in the need for psychiatric care can be partly explained by the Covid-19 crisis, which has made young people who were already vulnerable, even more so.
  • Young girls are particularly affected by internalised disorders.
  • The situation is deteriorating, but only for a minority of them, who need more and better help than before.
  • The false impression of “generalised deterioration” can be explained by a better understanding of mental health issues.
  • For a number of years, child psychiatry has been faced with a major shortfall in the provision of mental health care, leading to a saturation of reception facilities.

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.”

Already precarious situations have worsened

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.

Informing and raising awareness, but not alarm

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.

A societal shift that began in the 1970s

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

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