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