The enemy within

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

“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

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

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

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