Children face a mental health crisis, but they need more than antidepressants

<span>Photograph: Alamy Stock Photo</span>
Photograph: Alamy Stock Photo

I was still a child when I read Prozac Nation, the 1994 depression memoir by Elizabeth Wurtzel. It was probably inappropriate for a tweenager, but thankfully no one ever monitored what I checked out of the library. On its release, Prozac Nation had been hailed as capturing the zeitgeist in its depiction of the child and adolescent mental health crisis that then gripped the US.

“Very early in my life it was already too late,” Wurtzel wrote, likening the creep of her depression to Mike Campbell’s description of how he went bankrupt – “gradually, then suddenly” – in Hemingway’s The Sun Also Rises. “You won’t even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning 12 or turning 15, and then one day you realise that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.”

Almost three decades on, according to NHS figures children are being prescribed antidepressants in record numbers. In 2020, there were 231,791 prescriptions for the drugs issued to children aged between five and 16. A study last October by NHS Digital found that one in six children aged between five and 16 in England is “likely to have a mental disorder”, an increase of almost half since 2017. The children’s commissioner, Anne Longfield, has warned that services are unable to meet demand, with up to half of all children and teenagers referred to mental health, learning disability and autism services in the run-up to the pandemic left without proper support. This summer, referrals hit a record high. Parents, mostly mothers, report having to give up work to look after their mentally ill children. A recent Unicef survey ranked the UK in the bottom third of wealthy nations when it came to assessing the quality of children’s mental health.

It is a catastrophe. The rise in prescriptions, campaigners worry, is partly down to GPs feeling powerless to help in the face of long waiting lists and systematically underfunded services. It seems that rather than being a last resort for children, whose brains and bodies are still developing, medication is becoming a first resort, often without the complementary talking therapy that so many need. Drugs are not a substitute, and yet they are being used as a sticking plaster. Not funding child mental health services adequately is a false economy: those children will grow up, and, having not been treated properly in childhood, will likely need more support in adulthood.

Personally, I’ve cost the NHS quite a lot over the years, having first been diagnosed with PTSD in 2010. I was lucky to receive free trauma-focused therapy, after waiting for less than a month, and which was extended by the therapist. I happened to be in the right place (Camden and Islington NHS Foundation Trust) at the right time, but it could easily have gone another way. I don’t know where I would be now without that treatment. Dead, potentially.

I have spent many years reading and writing about trauma, and in doing so I have come to understand that its seeds germinate in childhood, because this is the time when we form our core beliefs. One of the things I remember thinking when I read Prozac Nation was that, in comparison, I wasn’t all that bad. I didn’t want to die. But I knew that something was wrong, and would undoubtedly have benefitted from counselling. I had a largely happy childhood and was surrounded by love, but there were also multiple stressors, I clearly had anxiety, and that anxiety potentially made me less resilient. Who knows whether, with early intervention, I would have become so ill later. But I suspect I may have coped better with what life threw at me.

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It’s heartbreaking to think of all the kids now who will end up needing treatment in adulthood, some of whom may never be able to live normal lives, when their suffering could so easily have been mitigated when they were small, just as the suffering of some of the adults in their lives could have been. Yet there continues to be little focus on the societal factors regarding why so many children, and the adults around them, are suffering from mental ill health. It’s rage-inducing, too. The government insists that it is “investing more than any government to transform mental health services” and that “early intervention and treatment is vital, and through our long-term plan an additional 345,000 children will be able to access NHS-funded support by 2024”. Assuming those promises are even kept, three years is a long time in the life of a child, and after more than 10 years of Conservative government, it is too little, too late. This crisis has been looming for years.

Mental health awareness has come on a lot since I was little, but even then people knew that children and adolescents could become anxious and depressed. We have known it for a long time. At school, we read about Holden Caulfield, in The Catcher in the Rye, smashing all the windows in the garage in his early teens (“They were going to have me psychoanalyzed and all”), and The Bell Jar’s Esther Greenwood swimming out and out and out in the hope of drowning. Years later, I saw a documentary in which a childhood friend of Sylvia Plath’s recalled the real-life swim she had based that scene on; how he had sensed that she had no intention of coming back to shore.

They knew the signs then, and we know them even better now. But what good is that when there is no proper treatment? When children and families are left to struggle on, with medication as their only option? Some of those unhappy children will grow up to have their own. That old misattributed line comes to mind, about insanity, and doing the same thing over and over but somehow still expecting different results.

  • Rhiannon Lucy Cosslett is a Guardian columnist and author