Context matters: what’s needed for young people’s mental health?

Turning on the radio last month, I heard a caller to a consumer phone-in show describe her shame at being unable to afford to heat her sons’ bedrooms. Aged 18 and 20, these young men both work and contribute to bills, but rocketing energy prices had made heating more than one room in the house unaffordable. ‘I send them to sleep in the cold!’ said their mother, obviously distressed.  

This radio programme was centred on the experiences of the bill payer – the one making the decisions. It would have been easy to perceive these two young men as just additional mouths to be factored into their parent’s bitter ‘heating or eating’ equations: a source of parental guilt, rather than individuals with full lives of their own. But my work on the Young people’s future health inquiry made me listen to the story from the perspectives of the young men themselves. What were their experiences, I asked myself?  

Media stories about young people make for sombre reading, especially today – the start of Mental Health Awareness Week. ‘Mental health referrals for children surge by more than HALF during Covid’, reads one headline. ‘Swamped mental health services turning away children’, reads another. 

Such coverage reflects the growing numbers of young people with diagnosable mental health concerns, and a care system that is struggling to cope. Recent analysis by the Health Foundation’s Networked Data Lab showed that between 2017 and 2021, the proportion of 6 to 16-year-olds with a probable mental health condition increased from one in nine (11.6%) to one in six (17.4%). Recent QualityWatch analysis also highlighted a huge surge in demand for children and young people’s mental health services – with an 81% increase in referrals in April to September 2021, compared to the same period in 2019. This demonstrates the absolute and clear need for the NHS to be adequately resourced to provide services that work specifically for young people – current provision is not sufficient. 

The Health Foundation has invested in teams improving the quality of mental health services for a number of years, including the THRIVE model in London and the FREED eating disorders model. Yet focusing on the NHS side of young people’s mental health tells only part of the story. Mental health problems do not come into existence only at the point of referral to NHS services. The young people behind these statistics are part of wider society, workers or in education, and part of families, often families under strain. 

Young people advising our recently launched research programme told us about the complicated emotions that come with being part of a family under financial strain. Mostly they worry – worry about the stress their families are under, and the strain their own needs place on the household finances. ‘Why would I burden them with my problems?’ was a common refrain. 

And to be clear, these are young people who are facing challenges and problems of their own. There’s the challenge of ‘growing up’ – the years between the ages of 12 and 24 are a profound period of social, biological and emotional change. Added to that, the challenges of living now: this is a generation who lost out on months of schooling, and other important opportunities during lockdowns. Rising rents, high costs of higher and further education and uncertainty about the quality of work on offer to them mean pathways to their future are unclear. While the causes of mental health problems in young people are complex, this surrounding context is often overlooked in a medical model that emphasises diagnosis and cure.  

At the Health Foundation we have repeatedly emphasised the importance of contextual factors. Our COVID-19 impact inquiry highlighted research from the Mental Health Foundation which found disproportionate reasons to be concerned about young people from lower income households. Young people living at home with unemployed parents were more likely to feel down and depressed (34%) compared with young people living with parents who were working full-time (16%). Whether inequalities filter through to diagnosis and services is also being explored by our Networked Data Lab.  

But waiting for mental health to deteriorate is not good enough. Like good physical health, good mental health is an asset, both for young people themselves but also for society and for the economy. Our young people’s inquiry has always championed the building blocks of future health. For example, our funded research at the Resolution Foundation – exploring the relationship between work and mental health for young people – found that young people who had experienced mental health problems after the financial crisis in 2008 were more likely to be out of work 5 years later than those who hadn’t experienced problems. Supporting young people’s mental health is not just about the here and now, but also about building strong foundations for the future. 

Coming back to the radio phone-in programme, it is clear that whole families, including young people, are feeling the strain of increases in prices. There is a lack of research into how far the social and economic context surrounding a family affects the emotional support that the family is able to provide to the young people within it. Our new research programme – Emotional Support for Young People – will help develop the evidence base on what shapes the emotional support that young people experience, and the effect this has on their mental health outcomes. The call is now open to find up to six teams across the UK to complete research projects over 12–18 months.  

By the time next year’s Mental Health Awareness Week happens a year from now, the context will be different again, maybe in ways that we currently predict, and maybe in ways that we can’t foresee. But we will have learned more about what’s needed to support young people as they grow mentally as well as physically – which we hope will help families advocate for the conditions to enable young people to thrive. 

Martina Kane is Policy and Engagement Manager in the Healthy Lives team at the Health Foundation.