In December last year the government produced its Green Paper on children’s mental health. The opening paragraph begins with an optimistic note that the state can make a difference. ‘Children with a persistent mental health problem face unequal chances in life. This is one of the burning injustices of our time.’
Alas, it’s all downhill thereafter: the scale of the problem, the consequences of the problem, and the difficulty of treating the problem make depressing reading.
Treating the problem is one thing. But as the select committee on education, health and social care noted in its scathing review last month, although the role of families was acknowledged, there was no attempt to translate that into prevention, i.e. trying to control or reduce the demand for services.
To get an idea of the scale of children’s mental health problems, the Office for National Statistics (ONS) finds that one in eight 10-15-year-olds reports symptoms of mental ill-health. This has risen over time, as shown by the seven-yearly NHS Adult Psychiatric Morbidity Survey. This shows a rise in anxiety among 16-24-year-olds from 1993 onwards but especially between 2007 and 2014 for women.
As for causes, the select committee highlighted exam pressure, social media, school exclusion, parenting and what are called Adverse Childhood Experiences. The most recent rise coincides with the introduction of smartphones which really took off around 2008 and is certainly evidence – but by no means proof – that hours spent gazing at the fun everyone else appears to be having is not good for your mindset.
In the end, all these experts are arguing over ‘interventions’: things the state thinks it can do better, usually involving more money, services, and – as Laura Perrins pointed out – incursions into areas of life that could and should be done by families.
But there’s an optimistic way of looking at this. Families can do things better and children’s mental health outcomes can be a lot better as a result. How?
My colleague Professor Steve McKay at Lincoln University and I have been looking at a big national survey called the Millennium Cohort Study, which followed a large initial sample of 18,000 mothers who had children in the years 2000 and 2001. The parents were interviewed when the children were newborns and when they were aged three, five, seven, 11 and 14. They are now mostly 17-year-olds. From this sea of data, we can look at the prevalence of teenage mental health problems and also identify some of the factors present in families over the years that either increase or decrease the risk that children will face problems as teens.
The first paper we did on this last year found that the problem is much more widespread than the ONS reports.
Whereas ONS and others look at OVERALL level of problems (from the widely used Strengths and Difficulties Questionnaire), we looked at whether children faced ANY kind of problem. A child who plays up at school or who worries unduly might not have an OVERALL problem but each of these children certainly displays ANY kind of problem.
All in all, we found that 27 per cent of boys and girls have high levels of ANY problem – as reported by their parents – with boys tending to be more externalised and girls more internalised. This gender difference isn’t particularly new. Boys act out. Girls worry.
What was new was the sheer scale of the problem and our finding that family breakdown was the biggest risk factor for girls and equal first (alongside parent relationship happiness soon after the baby was born) for boys.
So family breakdown is as important, or more so, than either the parents’ relationship or various background factors such as mother’s age, education and ethnicity. Being married also makes a difference above and beyond all these other factors.
We are currently extending this research by looking only at the parents who have stayed together, adding in a lot more relationship factors, such as the use of physical force over time, the quality of the parents’ relationship over time, and the closeness between child and each parent. I hope to report these new findings before the end of the summer and expect they will be newsworthy.
Some of what we’ve already found could be really helpful in screening parents with newborns for risk through NHS post-natal clinics or Surestart centres. This would be a genuine early intervention, meaning specific families could be offered a parenting programme and follow-up before anything has gone wrong. If the state is going to stick its oar in, it’s far more cost-effective to do it this way than wait for problems to emerge and then play catch-up.
But in the end all of this is a bit like repairing sand castles on a beach. Without dealing with the underlying issue of family stability, it’s going to be a losing battle that will involve ever more taxpayer money and state resources.
In fact, children’s mental health problems have been on the increase since the 1970s, according to a Nuffield study. Yet the authors, as with so many enthusiasts for state intervention, go on to perform intellectual and verbal gymnastics to blame any aspect of social change except family structure.
I don’t doubt that mental health is a complex area. Anyone who is a parent with more than one child will be bemused by the variations in temperament and character between children brought up in the same household. So there is a lot more in play than simply how we bring up our kids.
But it defies the evidence we see with our own eyes as well as the empirical data to pretend that family structure doesn’t matter.
What is really needed is a concerted government policy to encourage parents to begin family life on a firm foundation. The inescapable conclusion is that this means formal commitment and marriage before having children.