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Life as a teenager can be tough. Most go through periods when they are demonised by society, bullied by peers, tormented by self-consciousness or flooded with disruptive hormones. No wonder about one in 10 has a mental health problem.

The lack of specialist mental health services for young people in the 12 to 19 age group is well documented. But teenagers can be their own worst enemies, shying away from seeking help because they fear the stigma attached to having a mental health problem.


This fear is understandable. If the idea of talking to your middle-aged GP about the way you feel is frightening, the realisation that your classmates could find out you have been sent to a "shrink" is utterly horrifying. Teenagers know that, if they are lucky, it will be jokes about "the loony bin" and "being taken away by men in white coats". For the unlucky ones, it may be bullying, vicious gossip or complete ostracism.

Recent research presented at the Royal College of Psychiatrists' Faculty of Child and Adolescent Psychiatry annual conference confirmed that attending a psychiatric outpatient clinic was deeply stigmatising for young people._¹ The study interviewed more than 40 recently discharged teenagers and found that most felt they had benefited from the experience.

But as author Michael van Beinum, honorary senior clinical lecturer at the University of Glasgow, says: "We found that young people are pretty stigmatised by referral to a psychiatrist. When referred, they often don't have much information to go on, and quite a few said that they didn't realise that psychiatrists dealt with less serious problems such as depression. They thought all they did was the big stuff like schizophrenia. So when they were referred to a psychiatrist they thought it meant they might be mad."

Van Beinum suggests that young people need more information about what is happening and what to expect from statutory mental health services to reduce the confusion and anxiety. He also suggests that the way mental health services are presented is crucial. He says: "If you imagine that these kids are scared and they don't know where they are going, the location of these clinics is pretty important. People take their cues from the way a place looks and feels. So putting clinics in dodgy parts of town is not a good idea. We ought to be asking young people where they think services should be based rather than second-guessing them all the time.

"Stigma mainly comes from young people's peer groups. They are worried their peers will reject them and bullying is quite common. But it's different at different age groups. It's particularly difficult at 12 to 15 because they're often desperate to seem the same as everyone else. Under 12 their parents make the decision for them, and at around 16 to 17 teenagers are more interested in being different, so it's OK to see a counsellor.

Van Beinum continues:"Girls handle it differently. They talk to their friends about it and giggle about what their counsellor is like. Boys don't do that. They feel they should not have any difficulties and have to be cool. It is not masculine to have problems. So they tend to tough it out, which makes it more difficult for them to get help."

For young people who are worried about what is going on in their heads, but reluctant - or unable - to seek help from the statutory mental health system, there may be other options. In a few areas there are multi-agency centres set up in schools to which students can self-refer for counselling and advice with supported referrals to mainstream mental health services. Many GPs also now have primary mental health specialists on site or easily available, which reduces the stigma of having to go through a door marked "mad people only".

Youth Information Advice and Counselling (Yiacs) centres are another option. The centres offer an array of services - including counselling and advice about issues from homelessness to sexual health - under one roof and usually behind a shop frontage.

Catherine Wilson, national development manager for mental health at Yiacs umbrella group Youth Access, has published a paper on the barriers to good mental health care of 16 to 25-year-olds.² She says the centres can offer significant advantages for those worried about their mental health. One is that the range of services offered means it is not obvious to others why a person is visiting a centre. Another is that a centre can often arrange counselling more quickly than if they had gone through their GP.


Familiarity with the service also makes young people more confident in asking for what they want. Wilson says: "People can access one bit of the service first - such as advice - and when they are comfortable with the environment and how things work they can approach the counselling side. Sometimes there's an immediate issue, such as homelessness, which they want to resolve before they feel able to look at their mental health. Others just go straight to it. A lot of young people said they didn't think counselling was stigmatising, and others said they just didn't know anything about it. But there is more fear and stigma attached to statutory mental health services."

For those who are too embarrassed or anxious to identify themselves, helplines can save lives. About 10 children a minute try to contact ChildLine, which has the advantage that it can be anonymous and is available 24 hours a day.

But many mental health professionals say that much can be done to reduce stigma before young people reach the stage of needing help. Even how problems are described makes a difference. Professionals suggest that simply talking about "stress" rather than mental health can help young people. Giving teenagers the chance to take part in stress management courses or lessons on anxiety or phobias are ways to introduce the concept of mental health without the emotive tag of "mental illness".

Teachers receive little training in child and adolescent mental health. Van Beinum says: "Most teachers are seen as helpful and supportive although there are a few out there who think people need to 'pull themselves together'. But teachers - and GPs and health workers - need training and supervision and back-up in youth mental health."

Additionally, children and young people could be given the tools to help deal with their own mental health problems. Van Beinum says: "I wish we were able to give classes in cognitive behavioural therapy to school students - it is a mainstay of treatment and it is entirely possible to train people how to use it."

Many professionals return to the same point when discussing stigma - that, rather than avoiding the issue of mental illness, schools and organisations working with young people ought to give mental health a higher profile. Whether you describe it as emotional literacy, stress management or mental health, simply raising the issue and making it normal is likely to remove the stigma in the long term. And there are signs that that may be happening. Some professionals suggest that the high-profile breakdowns and clinic attendances of celebrities, footballers and models may be doing more to destroy the stigma attached to mental illness than a government campaign ever could.

¹ Royal College of Psychiatrists. See www.rcpsych.ac.uk/press/preleases/pr/pr_368.htm

² C Wilson, Breaking Down the Barriers. Youth Access, £20. Tel: 020 8772 9900