Patchwork won’t do

Adolescence is in the news. In recent months, a spate of books,
television and radio programmes have been giving advice to parents
and teenagers alike on the perils and pleasures of growing up. Last
week, one of the largest ever surveys of adolescent attitudes was
published, which showed that a majority of young people have a
positive and trusting approach to life ahead.

But for some young people, things seem to be going more
seriously wrong. An astonishing one in five children and
adolescents now has some kind of mental health problem. One in 17
adolescents injure themselves in some way. Suicide rates among
young men are also on the rise.

It can be hard to separate the social, economic and
psychological. Mental health professionals who work with young
people report cases in which poverty or political upheaval play a
crucial but not always a central role in a child or young person’s
poor sense of self. Having a vision of a meaningful future is
obviously helped by a sense of a worthwhile past: if your family
has long struggled to make a good life for itself, it is likely
that you, the child, will inherit that sense of difficulty and
damage. If you look around and see few adults in interesting or
well-paid work, what hope are you likely to feel? Many young men,
in particular, sense they have no place in the economy or public
world.

For the children of the relatively well off, there is more
access to expert attention. Private hospital care, long-term
psychotherapy and expensive treatments may be purchased to guide a
child through a difficult time and prevent him or her from a
complete breakdown, possibly with lifelong consequences.

Others are not so lucky. A large number of disturbed children
and adolescents rely on public provision for help. Yet child and
adolescent mental health is one of the most underfunded areas of
the health service. Compared with the adult sector, investment in
children and young people’s services is tiny.

The case for more investment can, as always, be quickly made and
is largely unarguable. But perhaps the real debate, here, is about
what kind of service should be on offer. Among child mental health
professionals there is a strong feeling that the government may
have invested too much in quick fixes while neglecting core
services. Under the heading of quick fixes, we can include
initiatives such as Sure Start, Connexions and the Children’s Fund,
each of which are aimed at patching the holes in children’s lives
and existing statutory services alike.

As one experienced child psychotherapist said to me:”Throwing
lots of money into voluntary services isn’t really the answer,
especially if there is a chronic shortage of well-trained
professionals such as child psychotherapists and psychiatrists.”
There are currently about 500 trained child psychotherapists in
this country: the majority of these work in and around London. But
this is is a tiny ratio of professionals to children compared with
some north European countries.

There are other versions of the quick fix, too. A variety of
brief therapies have become popular in recent years. So has the use
of medication, such as Ritalin, for the treatment of certain
attention disorders. Mental health professionals may give a
qualified welcome to these short-term measures while warning
against a neglect of longer-term therapy.

There are also surprising economic benefits to supporting the
long-term approach. As one manager of a borough service for
children and teenagers observes: “We can offer up to 40 or more
places in long-term therapy for the same cost per week as an
in-patient unit that might help a dozen young people at most.”

The same message comes out over and over again: don’t neglect
the slow-working, less glamorous slog of long-term help in favour
of the headline-grabbing service or slogan. For many children and
young people, some fundamental relationships have gone askew in the
very early years. To put it at its crudest, no one was there for
them: to gaze, to hold, to listen, to contain their most
frightening and sad feelings. If, in a time of crisis or
instability, they should turn to public provision, which is so
woefully inadequate at the moment, they should rightfully expect to
be helped by someone skilful and knowledgeable with the time and
patience to help them through. That sort of help comes neither
quick nor cheap.

Melissa Benn is a journalist and novelist.