In a special report, Irish Examiner journalists looks at teen mental health. A special Irish Examiner / ReachOut Ireland teen mental health survey was designed to capture the views of teenagers in Ireland in relation to youth mental health and the issues that affect them.
A body of work - three out of four teenagers worry about body shape
For teenage boys, it’s all about staying lean and aiming towards that athlete’s six pack.
For teenage girls, it’s being slim, if not thin and having a flawless face in social media posts. In the selfie and Instagram centred world that our teenagers spend so much of their time in, there is no room for flaws, according to Bodywhys, the eating disorders association.
In fact, there is little room for individuality or standing out from the crowd. The Irish Examiner/ ReachOut Ireland teen mental health survey shows that nearly three out of four teenagers worry about their body shape.
Girls worry more than boys but the male figures are still high. As teenagers mature, they don’t appear to become more confident about their bodies. Rather, they seem to self-berate and self-judge more. The survey results revealed that 72% of the 2,500 teenagers believed body image issues caused them difficulties.
In early teens just 61% of boys and girls said that body image was a cause of stress but by mid teens, that figure had risen to 74%. In turn, up to 81% of teenage girls named body image as a source of stress while that figure dropped to 52% amongst teenage boys.
Up to 43% of the young people described social media as causing them difficulties in their lives but in a later open ended question on mental health in Ireland, many referred to social media and ‘the need to have a perfect life’ as something that made them feel down.
There was no big change in attitudes to social media as the young people grew up with 42% of 13 and 14 years old citing it as a cause of stress and 42% of 18 and 19 year olds.
Barry Murphy, spokesman for the eating disorder association, Bodywhys said that teenagers live in a world where 10 million images are added every hour to Facebook and the average phone is unlocked 100 times a day: meaning body image is inextricably linked to how they compare to others online.
“We’ve held focus groups where young people have told us ‘I wish I was born before social media’. They are posting an image of themselves and then judging themselves on the reaction they get, how many likes. For many people, their self esteem and body image is all tied up in how they are treated on social media. Many can’t manage their expectations around social media,” he said.
Fiona Flynn is youth development officer with Bodywhys. She agrees that social media competition amongst friends is very real. As part her job, Fiona visits schools a lot to talk about body image and she holds focus groups with teenagers.
“What I hear all the time is that young people feel under a lot of pressure to look a certain way, to have the perfect life, to have a lot of likes when they post online and this pressure is not only coming from social media but also from from magazines, tv, movies. People will tell us ‘My selfie only got three likes, she got 100. Why?’,” she said.
“Also who hasn’t liked their posts preys on their mind a lot. They spend so much time thinking about this and about how to get more likes that they spend nowhere near enough time thinking about what they actually like or developing any sense of self which is one of the things that helps build self esteem”.
Barry Murphy says that as young people become more body conscious many of them, especially girls, often stop participating in sports.
“Again, these are the very activities that will help their build self esteem,” he said. Fiona Flynn says that in her school visits she talks to young people about “how the value in a person is not on the outside but in the inside, that it is who they are as a person, their personality, that is their real worth,” she said.
She advises parents to try to build a ‘strong sense of self’ in their children as they grow up to counter the culture of superficiality that predominates. Bodywhys did work on body image with Comhairle na nOg three years ago.
The resounding conclusion of the teenagers who took part was : “If you’re not feeling good about yourself, focussing on body image is the worst thing. Focus somewhere else, focus somewhere where you feel good, do what you like doing,” said Fiona.
Going online to find the answer
Teenagers are most likely to do a Google search if they are seeking help or information around mental health, writes Claire O’Sullivan.
The Irish Examiner/ ReachOut Ireland survey on teen mental health shows more than half (58%) of youngsters aged 13 to 19 are likely do an online search.
More than half (56%) said they would go to friends for help or information while 39% are likely to turn to family.
However, nearly just as many teens, or 36%, said they would be unlikely to seek help from family members.
Teenagers were most likely to seek support from family in early adolescence.
Mental health websites or apps are likely to be used by four in 10 of teenagers, according to the survey of 2,500 young people.
While friends are one of the most popular sources of help, another one in five young people said they would be unlikely to go to friends for help or information, a finding that could suggest fear of stigma amongst some teenagers.
Social media was largely rejected by the respondents as a way of finding support or information, with nearly two thirds or 62% of the teenagers saying that they would be unlikely to seek support or information from this channel.
There appears to be a strong rejection of guidance counsellors as a source of support with 65% saying they would be unlikely to go to the school counsellors while GPs and counsellors were rejected by 67% and 56% of the teenagers.
There also seems to be a clear reticence amongst teenagers around using telephone helplines for mental health support with nearly four in five of the teenagers saying they were unlikely to use a telephone helpline.
Two thirds or 67% of the respondents said they would be unlikely to turn to HSE mental health services for support.
Derek Chambers, CEO of ReachOut Ireland, which provides online mental health information to teenagers, said the use of online searches reflects changes in modern help seeking. “Help seeking has changed with international research showing that people use reliable online resources to find out about the issue that is troubling them and then when they feel more confident, they open up to somebody else and possibly, together they will seek supports and services.
“In some cases, people will feel sufficiently reassured by just the online research, they’ll have their worries addressed by learning that they are not the only one feeling anxious in social settings, feeling depressed on Mondays or constantly arguing with a partner,” he said.
A third of the respondents answered outlined mental health supports that they had actually used in the past.
Just over one third has spoken to a friend, including a boyfriend or girlfriend, when they needed support around mental health issues.
Just over one quarter had spoken to a family member. One fifth had used school or college based supports and 14% had used online supports. Nearly a quarter or 23.5% had attended a counsellor. Another 8.6% had used mental health websites.
Some 15% had attended HSE services and nearly 13% had attended a GP.
Are we asking the wrong questions?
We may just be getting something wrong. Parents and the media fixate on social media and cyberbullying when it comes to young people’s lives, writes Claire O’Sullivan.
However, the Irish Examiner/ReachOut Ireland survey on teen mental health suggests a wider conversation needs to take place around the education system and the cultural environment in which children move from childhood to adulthood; an environment where teenagers strive for “perfection”, often to their detriment.
When asked to make a general statement around teenage mental health, the opportunity was seized upon by nearly half of the 2,500 teenagers who took part in the research.
Comments centred around school life, feeling “under pressure”, mental health in this country, how mental health concerns are perceived, mental health supports, social media, and suicide.
ReachOut Ireland CEO Derek Chambers, who analysed these comments, said “a real depth of negative feeling was communicated” around school.
One teenager said: “It is not okay for 70/ 80 % of students to be hating getting up in the morning going to school because they know how bad it makes them feel.”
Another expressed similar frustration: “I think teachers especially need to be easier on kids and give them confidence… I feel like teachers and school cause me the most stress and anxiety. there is too much pressure put on our shoulders from teachers.”
Many respondents spoke about an inner struggle as they compare their lives to those around them and to others on social media.
One female respondent said: “I feel like I’m always being compared to someone else in anything I do, making me feel like if I don’t reach a high standard, I’m stupid.”
According to ReachOut Ireland, a number of the young people who spoke of “living under pressure” went through a typical school day and added up the hours that school, homework, study, chores and sports take up. They felt they had no time to relax.”
Mr Chambers said: “There might be practical solutions to some of the pressure that teenagers are feeling by addressing the issue of time pressure and exploring the relative productivity of extended homework or study time.”
Many spoke about anxiety and depression amongst friends.
“I’ve noticed anxiety is a huge issue amongst teens nowadays in Ireland, said one respondent. “A lot of my friends struggle with not average levels of anxiety as well as my cousins and I.”
Just 39% of the teenagers who took part in the nationwide survey said they would turn to family if they were having emotional problems and this reluctance was expanded upon in their general comments on mental health.
In its report, ReachOut Ireland noted “that there was a sense that young people feel that their mental health isn’t taken seriously by the adults in their lives”.
“I feel like mental health in teenagers is not is not really paid attention to we’re always just been looked at as moody,” said one teenager, while another said: “Sometimes older generations can brush off our anxiety or depression because sometimes they feel we’re making a mountain out of a molehill, when in reality we’re struggling.”
There also appears to be a be silent but dangerous debate amongst teenagers around mental health, attention-seeking, and “faking it”.
According to ReachOut Ireland, the belief that some people who speak out about mental health problems are “faking it” is “an important theme [in this survey] because those who expressed this view generally reported serious personal difficulties”.
One 17-year-old girl said: “Some people are faking mental health issues to get attention. So then when someone has a genuine issue, they are told they are attention-seeking, and this only makes the problem worse.”
Another girl said “it’s a bit overdone. Loads of people are saying ‘oh I’ve mental health problems’ and that’s great but other generations, especially my parents, say ‘ugh, they can’t all have mental health problems, and people only say they have for attention’.
“That makes it really hard for me to say that I’m struggling and I’m not coping.”
There were complaints that access to CAMHS (Child and Adolescent Mental Health Services) was too limited and that a teenager had to be suicidal to gain access.
“There isn’t enough help for teenagers unless they’re in deep, deep distress,” said one respondent. “I have been turned away from help more than I can count, mostly because I’m deemed not bad enough.”
MANY of the teenagers wanted more education around mental health, in some cases so they could support others. One person said: “We aren’t taught anything at all of how to deal with problems that we ourselves, or other people may be dealing with.”
Another stated: “I would like to learn how to help my friends/ family when they have a panic attach or something similar. I want to be able to help.”
Many of the views around social media were negative and linked to body image.
One person wrote: “I think there’s too much pressure put on teenagers these days, social media has created a false sense of what is right and what is wrong.
“I feel like teenagers are forced to alter themselves and reach unrealistic expectations because they’re only seeing good things someone’s posting about their lives on Facebook or Instagram, when if there was an app to post what’s going on in your mind, you’d realise we’re all the same, facing the same struggles and battling the same demons everyday.”
Suicide was mentioned more than 80 times in teenagers’ comments on mental health. Many mentioned recent suicides in their community and not one of them described a positive response from their local community or school.
One young person mentioned that there had been two recent suicides in their school “and three months later there still has not been any sort of help or advice or anything made available to students”.
According to Mr Chambers, suicide prevention is a challenging area but there are some tangible things that can be done.
“For one thing, ensuring a response in school settings if a student takes their own life is important for students and this was clearly expressed,” he said.
“The exact nature of the response is not the most important thing, but a response that allows time for reflection, the opportunity to ask questions and to collectively acknowledge the loss would seem to be a basic, important strategy.”
Phones a source of tension with parents
Observing a generation growing up who’ve never known life without the internet comes with a lot of concern and confusion about the implications for their wellbeing and development, writes Naoise Kavanagh.
Social media and smartphone technology are both really in their adolescent years themselves, and as such we’re all fumbling around working out our own relationship with being connected like never before.
Frequently, concerns about this state of constant connectivity, especially for young people, centre on cyberbullying. There is a feeling the two go hand and hand and are more relentless given the 24/7 nature of mobile technology.
But, in our survey of 2,500 teenagers, bullying, online, or otherwise, wasn’t high on the list of stressors experienced.
Body image (72%) was the third greatest cause of stress after school and exams, followed by friends (69%). Over 4 in 5 girls selected body image as a source of stress (81%) compared with 52% for boys.
Phones and social media were mentioned as a cause of tension between parents and teenagers, with 43% of respondents labelling them as stressors and a source of pressure.
“Smartphones and social media are a huge cause of bad mental health” and “it’s just non-stop pressure and nobody seems to truly grasp that”, were just some of the comments from the students themselves.
Reading the results of the survey and the opinions of teenagers themselves, it would seem the pressure linked to social media they talk about focusses on the “always on” nature and internalised pressure making them feel inadequate; to look a certain way; be a certain way and putting your best self forward, whatever that may be.
Reading the comments of the teenagers, you get a flavour of how social media influences them and their mental health:
“Social media is setting standards too high for people, both body wise and expectations wise”;
“Body image and the pressure of living up to everyone’s expectations”;
“Everything is online, the pressure to get ‘likes’ is massive”;
“School, social media etc. put pressure on teenagers and stress to make them think they’re not good enough.”
Today, young people are dancing like everyone’s watching, growing up in a very public way, with no privacy.
The benefits of failure and learning from mistakes is spoken about but those messages are mixed in with punishing judgment and cautionary tales like “the internet never forgets”.
But, it’s not all bad. Groups of young people, in both rural or urban settings, have told us before that weekends and school/college holidays can be lonely periods, away from their friends, with no access to transport.
Social media has become their lifeline for staying in touch, as well enabling them to support each other.
Again one respondent said: “I feel like social media has become a huge help for people to express their feelings, talk to people and get help.”
Yet, some are tired of it. “Social media plays a big part in making teens feel unwelcome and insecure about their body types.”
While providing a lifeline, it can also reinforce feelings of isolation, with one respondent claiming it “excludes people and rubs their face in it”. So, social media is a double-edged sword and no one is more aware of it than young people.
We know that ‘always on’ culture and excessive screen time interferes with sleep, which is crucial for a good sense of wellbeing.
Again you only have to read the comments of the students themselves:
“I feel drained if I’m on my phone too much and I get tired.”
“So much to do with social media. People spending too much time on their phones, not getting enough exercise and sleep”.
Only this week, it was reported SimSimi, an anonymous chat app linked to cyberbullying, was forced to block access to users in Ireland after a flood of complaints.
The app allows users to view anonymous, and often insulting, messages left about them by typing in their name.
There have been cases like this before and there will again, demonstrating when accountability is absent, negative behaviour will not be far behind it.
It’s not to throw our hands in the air, muttering we’ll always be on the backfoot when it comes to technology but it’s another reminder we need to take human measures to control it and real world rules apply.
Obviously at ReachOut.com we’re advocates of technology, using online tools to let young people build their own resilience, connect with others, develop coping mechanisms and access support in ways they’re comfortable with, but we know that breaks are needed.
The most important message to young people and parents about social media and phones is set some boundaries about screen time and stick to them, take breaks and remember, you’re allowed to take control of your own social media use and you should avoid the things that make you feel bad.
Naoise Kavanagh is online communications manager, ReachOut Ireland.
Progress proving painfully slow
Because of reduced stigma and increased public awareness, more young people are talking about their mental health, writes Ian Power.
Too often, young people who do reach out don’t get the immediate care they need before they get worse.
In the last five years, mental health has been prioritised by young people as the top issue preventing them from flourishing and from being the happy children and young adults we want them to be.
Parents watch their children suffer without support. Our communities have lost too many young people to suicide.
Despite asking for our help, progress is painfully slow. Mental health is incredibly complex and the list of issues affecting young people in Ireland is long.
Our ability to address the flaws in our mental health system will determine our success in creating a supportive environment that protects young people from preventable harm.
About 75% of all serious mental health difficulties first emerge between the ages of 15 and 25, and four in every 10 young people in Ireland have reported, at some point, that their life is not worth living.
Ireland has the fourth-highest suicide rate in the EU among 15 to 24-year-olds.
To prevent difficulties emerging or worsening, we have to act early and quickly.
We have to do more to support infant mental health and we have to equip children with mental health literacy, coping strategies, optimism, self-esteem, and resilience as early in their lives as possible.
Children and young people equipped with these skills navigate life’s major transitions, like moving to secondary school or college, in ways that are less likely to negatively impact their mental health.
The list of things that hurt the mental health of young people is considerable and growing.
Perennial challenges like alcohol abuse, drug abuse, and bullying have been joined by sexual violence, body image pressures, gambling, and growing economic inequality.
Systemic economic inequality, which has been building over the last decade, is creating an environment that doesn’t support young people when they need it most.
The recession has affected their economic power and they have reduced access to secure employment, income support, and housing. Young people can face years of temporary, low-paid employment after college, with poor conditions and pay.
All of this matters, not just because of the injustice, but because one of the most important protective factors for mental health is economic security.
Then, there are groups of young people prevented from flourishing by societal discrimination.
LGBT young people in Ireland are three times more likely to attempt suicide, while the suicide rate within the Traveller community is six times higher than in the general population. Today, in Ireland, 10% of the young adults admitted to psychiatric units are homeless.
Direct provision has been described by clinicians as ‘toxic’ to the mental health of those forced to live there.
Too many of our young people are needlessly suffering, when we should be reversing inequality and providing people with the support they need to recover.
As a result of the growing public demand to improve our response to the mental health needs of young people, the system is changing, albeit slowly and starting from a low base.
The Department of Education is introducing a new wellbeing curriculum this autumn. This will, hopefully, be comprehensively and enthusiastically implemented by schools, and equip our children and young people with the skills needed to be happy and healthy.
The mental health division in the HSE has a number of service-improvement projects in train, including the appointment of new clinical leads for self-harm and dual diagnosis, and significant efforts to reform the Child and Adolescent Mental Health Service (CAMHS).
It is also currently implementing Connecting for Life, a new strategy to reduce suicide and self-harm.
One of the biggest challenges facing the mental health system is a gaping hole in the national availability of free, accessible early intervention and primary care psychotherapeutic services for young people.
Demand for these types of services massively outstrips supply and is placing pressure on our acute system, including CAMHS.
Three new brief intervention Jigsaw centres for youth mental health will open in Dublin, Cork, and Limerick this year, bringing the total to 13.
A plan to recruit 100 assistant psychologists to staff primary-care psychology services around the country is also currently awaiting approval from the Department of Public Expenditure and Reform.
All of these are welcome developments, but for those relying on these improvements to make a difference to their lives, you can understand their impatience and frustration at the pace of change.
Ultimately, Government needs to invest significantly more money in the system if it is to provide 24/7 access to appropriate care and therapy.
Progress is being made, but if we’re serious about making a difference, we need to work harder.
Ian Power is executive director of youth information website, SpunOut.ie, and a member of the National Taskforce on Youth Mental Health.
A lot of noise on the subject but a strategy is lacking
Everyone has an opinion on mental health these days, and so we should, writes Derek Chambers.
Mental health is a fundamental part of being human, a part of our everyday lives. In the conversations we are having about mental health, the wellbeing of teenagers is a priority, especially as it relates to our relatively high rates of self-harm and youth suicide.
When we asked teenagers themselves about the issue, they had plenty to say and much of it was contradictory, reflecting the lack of a shared understanding amid increasing talk, campaigning and concern.
The aim of our survey was to give a voice to teenagers on mental health and many who answered the final open question in our survey were happy to share their thoughts.
Some were frustrated about the amount of talk there is. “To me, it seems as if there’s too much awareness for mental health sometimes. You need an escape from negativity and sometimes that’s not possible because depression/suicide is practically everywhere” was one of the many related comments in the survey.
Other young people spoke about the glamourising of mental health and the idea that it can be too easy to say you have depression or another mental health problem.
As one 17-year-old female put it: “Some people are faking mental health issues to get attention. So then when someone has a genuine issue, they are told they are attention-seeking, and this only makes the problem worse.”
This idea of “faking it” matters because it was expressed by teenagers who were themselves experiencing mental health problems and were finding it hard to ask for help.
As another young person put it: “It’s a bit overdone. Loads of people are saying oh I’ve mental health problems and that’s great but other generations especially my parents say ugh they can’t all have mental health problems, and people only say they have for attention. That makes it really hard for me to say that I’m struggling and I’m not coping.”
Maybe the framing of mental health has become too negative in the context of a medical and diagnostic approach to the issue. One teenager suggested that “a lot of teens misinterpret sadness as depression and self-diagnose which leaves them believing they are worse. This is very negative”.
However, the experience of mental health, for better or worse, is very personal and subjective. The state of our mental health captures both who and how we are.
The fact that we cannot physically measure or view another person’s feelings means the area of mental health relies on human beings communicating in a spirit of openness, honesty and acceptance. So, when a teenager says “people need to stop romanticising weak mental health”, others are likely to be upset by the notion that we do.
For every teenager in our survey who suggested there is too much talk about mental health, there were more who said not enough is being done, or “it’s being covered up and not enough people are speaking about it”, “it needs to be discussed more” and “it isn’t openly talked about”.
The importance for many teenagers of increased awareness was reflected in one response pointing out that “it is important for teenagers to realise that no matter how many people seem like they don’t care, there always a few people who would do almost anything for you.”
This mix of views should make us stop and reflect on the ways in which mental health is spoken about in Ireland. For a while, there has been this notion that it is great that mental health and suicide are finally being discussed — the idea that these subjects are no longer “brushed under the carpet”.
This in itself is not necessarily a good thing or the whole story. What is fundamentally important is the way in which these issues are spoken about. These issues should be spoken about in the context of the supports that exist and in the spirit of empathy and shared humanity.
Many positive suggestions to improve help-seeking and understanding of mental health were made by survey respondents, often with a view to supporting family and friends.
A common sentiment was expressed by one girl who said: “I would like to learn how to help my friends / family when they have a panic attack or something similar. I want to be able to help.”
Young people are telling us that we need to move the national conversation on mental health forward. For now, there is a lot of noise on the subject but a clear and robust strategy is lacking.
Reflecting on the sentiment expressed by one 19-year-old that “mental health is complex and messy and deserves more measured and compassioned attention” — it is time to take a deep breath, listen to our teenagers and begin to change the way we talk about mental health for the better.
Derek Chambers is Acting CEO of ReachOut Ireland.
In tomorrow’s Irish Examiner, we look at one school’s hands-on approach to mental health and offer advice to parents and young people about how to cope with down days and build resilience.
The Irish Examiner / ReachOut Ireland teen mental health survey was designed to capture the views of teenagers in Ireland in relation to youth mental health and the issues that affect them. The survey involved 2,500 interviews with teenagers between the ages of 13 and 19 in the Republic of Ireland. Promotion of, and recruitment for, the survey was conducted solely through social media (Twitter, Facebook and Instagram). Data collection took place from 28 February to 3 March 2017. Personal consent was sought from all participants and parental/guardian consent was sought for those under 18 years-old. All data is copyrighted by the Irish Examiner / ReachOut Ireland and should be attributed to this source where quoted.
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