I’ve struggled with my mental health for seven years. I’ve got anorexia, and depression and anxiety. It started at school when I was 11. I don’t remember the root causes. I just started being really anxious and restricting what I ate, and hiding food. I felt so worthless and horrible. I hated the way I looked. I started self-harming, my mood was really low and it all spiralled out of control.
I didn’t understand what was going on. After a while, I thought it was normal to feel like that. It’s only recently that I’ve started realising that a lot of people suffer.
When I was 14 a friend noticed I wasn’t eating and was really withdrawn and told a teacher. I was really angry and annoyed but, looking back, I’m glad she did that because I wouldn’t have said anything. They then told my parents and I was referred to child and adolescent mental health services. I still didn’t think anything was wrong with me.
My parents were heartbroken. I can’t imagine how hard it is for them. I’ve put them through so much. I was in hospital for just under a year and they had to visit me and see me in such a distressed state. I think they found it really tough and still do.
I felt I couldn’t go out for ages. Even now, when I go on public transport I get really anxious. At its worst I used to panic, my heart beat faster and I started shaking. My thoughts would race and I would think that everyone was staring at me and that something bad was going to happen. Everything was exaggerated. Most times, I felt like I deserved self-harming. It was like a punishment for eating or going out.
There are days when I feel more optimistic about my future. Things are still hard but I’m doing a lot better than I was. Quite a few people have told me that they struggle with anxiety. It’s not fair. I know some amazing and lovely people; they don’t deserve to be going through that.
Harvey Sparrow, 16, Badsey, Worcestershire
When I started my GCSEs, my school was really pushing everyone, saying we all had to do well and work hard. I’ve always been the sort of person who is very motivated but the stress started building slowly and I couldn’t handle it. The thought of going to school made me nervous and I felt like I wasn’t good enough. It carried on and I felt a lot of sadness and hopelessness. It was awful.
I started feeling really detached from myself. I didn’t feel in control of my body. It turned out that was a type of anxiety. My stomach felt like it was churning. I’d feel sick when I knew I didn’t have a stomach virus. I lost concentration and if there was even a small doubt about me doing well, I’d lose focus. I couldn’t deal with it. It got really dark at times. I felt there was no point in me being here because I wasn’t bringing anything to the world. I wasn’t making my life any better. I had a lot of suicidal thoughts. I told my dad and we went to see the doctor. It took a few appointments for them to take me seriously.
A lot of my friends have anxiety around school. I thought everyone else was OK because people didn’t show it. Some of them lose out on sleep, some sleep way too much and some are very depressed. They don’t see a point in living. I know what it’s like. But to hear them say things like that is shocking when in my eyes they’re amazing. I guess they would have said the same thing about me. It’s a weird situation.
When I talk to my dad he says he never wants anything bad to happen to me. Now I’m in a good place, I’m like: “Why would I ever think of ever hurting myself?” I don’t want to throw my life away just because I’m in a bad place.
• In the UK, Samaritans can be contacted on 116 123 or firstname.lastname@example.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.
In both the UK and US, services for young people are being cut, leaving those from marginalised groups at greatest risk of suicide.‘Whatever the language deployed to describe the scale of mental health challenges facing Britain’s young people, it has to be addressed immediately.`
One recent report called the problem a “silent catastrophe” while a survey of teachers labelled it an “epidemic”. But, whatever the language deployed to describe the scale of mental health challenges facing Britain’s young people, it has to be addressed immediately.
Of course, an increase in referrals over time may be, in part, an indication of more young people self-reporting and GPs being more receptive to it. Nevertheless, the warning flares on children and young people’s mental health have come thick and fast lately. In June, the NHS England boss, Simon Stevens, said a major expansion of serviceswas needed to deal with growing demand. A few days earlier, a report from the Association of Child Psychotherapists warned of “a serious and worsening crisis” following a survey of staff in child and adolescent mental health services (Camhs). Underfunding on top of service reorganisation was an ongoing threat to specialist services, it concluded. “There was never a golden age of funding” for young people’s mental health, as Andy Bell of the Centre for Mental Health explains, but help must include a concerted focus on groups that face additional inequalities, such as LGBTQ youth who are much more likely to experience common mental health problems. Research shows that almost twice as many young LGBTQ people in the UK (44%) have considered suicidecompared with heterosexual non-trans young people (26%).
In the US, concerns about young people’s mental health have come to the fore lately, too, including for common problems like anxiety, depression and suicide. Suicide is the second biggest cause of death for 10- to 24-year-olds in the US and 90% of those who die have a mental health condition. And research shows the proportion of young people treated at children’s hospitals for suicide attempts or suicidal thoughts more than doubled between 2008 and 2015.
The 2018 State of Mental Health in America report tells a story similar to Britain’s. “Rates of youth with severe depression increased from 5.9% in 2012 to 8.2% in 2015,” it reports. And again, access to treatment is a problem as budget cuts put pressure on insurance coverage and services. “Even with severe depression, 76% of youth are left with no or insufficient treatment.”
And, as in Britain, for youngsters from marginalised groups the picture is especially challenging. Amit Paley, chief executive of the Trevor Project, which offers suicide prevention and crisis intervention support for young LGBTQ people in the US, points out that the rate of gay, lesbian and bisexual young people who have seriously contemplated suicide is around three times that of heterosexual young people. The evidence tells us that early identification and intervention can mitigate damage to young people’s mental wellbeing. We know, for example, that if children’s centres and young people’s services and schools are better equipped to promote wellbeing they can make a difference.
When it comes to young people in extreme distress or at risk of suicide, effective crisis services and access to support are utterly essential. But so too is preventing youngsters from reaching a crisis in the first place.
• In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.
The report said data on students was rarely shared fully between universities and local health services, which could lead to students accessing “treatment and support with incomplete information, or not accessing it at all”.
The report added students leaving their family homes to attend university often enrolled with a new GP.
They would then return home during holidays, meaning they were without their bespoke GP care for several weeks or months.
What is Universities UK suggesting?
Universities and local NHS services should communicate more about students who may need mental health services
Local services and universities should assess the need for mental health services for students in specific towns and cities
Institutions should promote positive mental health, make reasonable adjustments for students with pre-existing conditions, and reduce the stigma of mental health
Create “student mental health teams” with NHS providers to improve referrals to specialist services
Universities UK’s head of mental health, Professor Steve West, said the system had to be “radically changed”.
“If we ignore it we will have failed a generation,” he added.
“We will be setting ourselves up for huge costs and burdens on the NHS, but more than that we will be destroying lives.”
Chief executive of Tavistock and Portman NHS Foundation Trust Paul Jenkins said: “We need to improve the links between local NHS services and the support that universities provide.
“It is essential that these young people are provided with the right support at each step of the pathway.”
The National Union of Students (NUS) said that mental health services in higher education were “strained” and “at times non-existent”.
It welcomed the report, adding: “A joined-up and coherent approach between the NHS and universities is exactly what students need.”
‘Young adults struggle with transition to adult services’
By Hugh Pym, health editor
Some of the issues highlighted at universities are linked to the state of child and adolescent mental health services.
Young people who may have struggled to get treatment from these NHS services may find that problems resurface when they get to university.
Alternatively, the transition to adult mental health provision at 18 will coincide with the start of student life away from home – and that can be disorientating.
Universities have been criticised for not investing enough in counselling services and not promoting more general well-being in student life.
But they argue that a wider strategy involving the government and the NHS as well as higher education is essential.
Schools struggle to get pupils seen by qualified mental health professionals because training for counsellors focuses too much on treating adults, warns the head of a children’s mental health charity.
Patrick Johnson, the director of learning at Place2Be, told a meeting of headteachers, charities and academics in parliament last week that it was “no surprise” there were shortages of qualified staff “given that approximately 90 per cent of formal counselling training courses are for those working in adult mental health, not with children specifically”.
Dean Johnstone, the chief executive of another charity, Minds Ahead, argued for youth mental health work to be “transformed into a career of choice for young graduates”.
Last year, Schools Week revealed that the number of educational psychologists working with schools fell 13 per cent over five years. The number employed by local authorities dropped from 1,990 in 2010 to 1,650 in 2015.
This doesn’t mean insulating young people to some of the inevitable pressures and stresses of school life
According to research by the Care Quality Commission (CQC), young people in some areas can wait up to 18 months to receive the mental health support they need.
Earlier this month, the CQC called on Ofsted to rate schools on how well they responded to the mental health needs of pupils.
According to Julian Astle, the director of creative learning and development at the Royal Society of Arts, schools had to choose between depth — expert provision from a professional — and breadth — where all school staff were trained to support young people presenting with mental health issues.
“In the RSA academies, we are purposefully going for greater breadth with an ongoing programme of training for all staff, non-teaching as well as teaching.”
At the meeting, hosted by the Liberal Democrat MP and former health minister Norman Lamb, the headteacher of Reach Academy Feltham, Ed Vainker, spoke of the “mistaken belief” that schools “are either rigorous, have high expectations and excellent results, or are supportive, nurturing and place mental health at their heart”.
Vainker said that his organisation believed those two elements “can go together and that excellent outcomes for pupils require a warm, nurturing, supportive environment for the pupil and their family”.
Jon Brunskill, a teacher at Reach Feltham, said there was “more that teachers should, and can, do”, but said ultimately the increased challenge “will only be met with a co-ordinated, multiagency approach with the child at the centre”.
David Hall, from the University of Exeter, said there was an “urgent need to lower the level of pressure on schools and children.
“This doesn’t mean insulating young people to some of the inevitable pressures and stresses of school life, but it does mean that these should be kept within tolerable levels.”
Evidence heard at the meeting will form the basis of a “call to arms” report by Minds Ahead and the education think tank LKMco, which will be published “soon”.
“So many of the issues we explore in our research trace their origin back to a youth mental health crisis that has been neglected for too long. Today’s session was an attempt to tackle the underlying issues head-on,” said LKMco director Loic Menzies.
A government consultation on young people’s mental health closed earlier this month. Proposals include £95 million funding for schools to appoint and train designated senior leads for mental health from 2019, and £215 million for new mental health support teams to work between schools and the NHS and treat pupils in the classroom.
Fears for rough sleepers as specialist north London unit faces 42% budget reduction
NHS bosses are under fire for cutting back a team of doctors and nurses who provide mental health care to one of Britain’s largest groups of homeless people.
Camden NHS Clinical Commissioning Group (CCG) in north London is giving the Focus Homeless Outreach team £219,866 less a year starting on 1 April, a leaked CCG document reveals. One of the team’s two psychiatrists and one of its six nurses will lose their jobs as a result.
The CCG is pressing ahead with the 42% cut to the £521,000 budget it gave the team this year despite a storm of protest from local GPs, psychiatrists, homeless charities and managers of hostels where rough sleepers sometimes stay. Camden had the third highest rate of rough sleeping in England in 2017, recent government statistics showed – more than Manchester, Bristol and Cornwall.
Focus, set up 25 years ago, helps treat the high levels of depression, psychosis and other mental health conditions found in rough sleepers, hostel dwellers and “sofa surfers”, including some asylum seekers and people who have been trafficked. Its budget is being reduced even though it is regarded by NHS, local council and social work bosses in London as a model of good practice of how to reach the kind of group that often shuns traditional NHS services.
Consultant psychiatrists at Camden and Islington NHS trust have privately criticised cutting Focus’s budget as a “terrible” blow to a “priceless” service. “Yes, there are unprecedented financial challenges, but it’s pretty appalling that a vulnerable and voiceless group would be left so unsupported,” said one.
Another said: “I find the decision extremely hard to understand, given the high number of homeless people in Camden. Without the Focus team, some of the worst-off members of society will lack proper access to psychiatric care.” Another warned that untreated mental health problems could also potentially lead to incidents of crime and violence.
Family doctors at Camden Health Improvement Practice, a GP surgery near Euston station which treats homeless people’s physical health needs, have told the CCG in a letter that they are in a state of disbelief about Focus’s budget cut. It gives essential mental health support to homeless people when they are arrested or admitted to hospital as an emergency, they said.
Prof Roland Littlewood, an emeritus professor of psychiatry at University College London who used to work with Focus, said: “The proposed cuts cannot be clinically justified and I would consider them quite dangerous. When we in the future contemplate the increased number of preventable deaths in the service, it will be too late.
“If May and Hunt are promising increased support for mental health services, then where is it? The homeless are the most vulnerable to declining social and medical support.”
Camden CCG originally planned to cut £421,000 (81%) of its funding to the team to help meet its savings target under the NHS-wide Quality, Innovation, Productivity and Prevention plan, but reduced that to £219,866 after opposition. It claims other services will provide support for the work Focus can no longer do, but failed to provide any details.
Senior figures at University College Hospital in Camden are worried that limiting Focus’s work will lead to more rough sleepers turning up at its A&E in a state of mental health crisis.
Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, praised national health service leaders for giving mental health greater priority. But, she added, Camden CCG’s decision “confirms once again what mental health trust leaders have been telling us about the growing gap between the government’s welcome ambition for the care of people with mental health needs and the substantial challenges facing core mental health services.
“Money earmarked for mental health is not consistently reaching the frontline. It is particularly important that vulnerable people such as the homeless are able to access mental health services.”
Camden CCG said: “Due to significant financial challenges, the NHS is having to make difficult decisions and it has been necessary to reduce funding of the Focus homeless service. Camden CCG have worked with Camden & Islington NHS Foundation Trust to reconfigure the service so that it dedicates it efforts to helping those with the most complex needs. Those with less complex needs will be signposted to other suitable health and care services in Camden.”
A lack of essential nutrients is known to contribute to the onset of poor mental health in people suffering from anxiety and depression, bipolar disorder, schizophrenia and ADHD. Nutritional psychiatry is a growing discipline that focuses on the use of food and supplements to provide these essential nutrients as part of an integrated or alternative treatment for mental health disorders.
But nutritional approaches for these debilitating conditions are not widely accepted by mainstream medicine. Treatment options tend to be limited to official National Institute for Care Excellence (NICE) guidelines which recommend talking therapies and antidepressants.
Use of antidepressants
Antidepressant use has more than doubled in recent years. In England 64.7m prescriptions were issued for antidepressants in 2016 at a cost of £266.6m. This is an increase of 3.7m on the number of items prescribed in 2015 and more than double than the 31m issued in 2006.
A recent Oxford University study found that antidepressants were more effective in treating depression than placebo. The study was led by Dr Andrea Cipriani who claimed that depression is under treated. Cipriani maintains that antidepressants are effective and a further 1m prescriptions should be issued to people in the UK.
This approach suggests that poor mental health caused by social conditions is viewed as easily treated by simply dispensing drugs. But antidepressants are shunned by people whom they could help because of the social stigma associated with mental ill-health which leads to discrimination and exclusion.
More worrying is the increase in the use of antidepressants by children and young people. In Scotland, 5,572 children under 18 were prescribed antidepressants for anxiety and depression in 2016. This figure has more than doubled since 2009/2010.
But according to British psychopharmacologist Professor David Healy, 29 clinical trials of antidepressant use in young people found no benefits at all. These trials revealed that instead of relieving symptoms of anxiety and depression, antidepressants caused children and young people to feel suicidal.
Healy also challenges their safety and effectiveness in adults. He believes that antidepressants are over-prescribed and that there is little evidence that they are safe for long-term use. Antidepressants are said to create dependency, have unpleasant side effects and cannot be relied upon to always relieve symptoms.
Nutrition and poor mental health
In developed countries such as the UK we eat a greater variety of foodstuffs than ever before – but it doesn’t follow that we are well nourished. In fact, many people do not eat enough nutrients that are essential for good brain health, opting for a diet of heavily processed food containing artificial additives and sugar.
The link between poor mental health and nutritional deficiencies has long been recognised by nutritionists working in the complementary health sector. However, psychiatrists are only now becoming increasingly aware of the benefits of using nutritional approaches to mental health, calling for their peers to support and research this new field of treatment.
It is now known that many mental health conditions are caused by inflammation in the brain which ultimately causes our brain cells to die. This inflammatory response starts in our gut and is associated with a lack of nutrients from our food such as magnesium, omega-3 fatty acids, probiotics, vitamins and minerals that are all essential for the optimum functioning of our bodies.
Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B and D3 can help improve people’s mood, relieve anxiety and depression and improve the mental capacity of people with Alzheimer’s.
Magnesium is one of most important minerals for optimal health, yet many people are lacking in it. One study found that a daily magnesium citrate supplement led to a significant improvement in depression and anxiety, regardless of age, gender or severity of depression. Improvement did not continue when the supplement was stopped.
Omega-3 fatty acids are another nutrient that is critical for the development and function of the central nervous system – and a lack has been associated with low mood, cognitive decline and poor comprehension.
These over-the-counter” supplements are widely available in supermarkets, chemists and online health food stores, although the cost and quality may vary. For people who have not responded to prescription drugs or who cannot tolerate the side effects, nutritional intervention can offer hope for the future.
There is currently much debate over the effectiveness of antidepressants. The use of food supplements offer an alternative approach that has the potential to make a significant difference to the mental health of all age groups.
The emerging scientific evidence suggests that there should be a bigger role for nutritional psychiatry in mental health within conventional health services. If the burden of mental ill health is to be reduced, GPs and psychiatrists need to be aware of the connection between food, inflammation and mental illness.
Medical education has traditionally excluded nutritional knowledge and its association with disease. This has led to a situation where very few doctors in the UK have a proper understanding of the importance of nutrition. Nutritional interventions are thought to have little evidence to support their use to prevent or maintain well-being and so are left to dietitians, rather than doctors, to advise on.
But as the evidence mounts up, it is time for medical education to take nutrition seriously so that GPs and psychiatrists of the future know as much about its role in good health as they do about anatomy and physiology. The state of our mental health could depend on it.