Our Time CEO, Dympna writes about how the media portrayal of mental illness can reinforce the idea that mental illness is the cause and not the symptom of many issues we face in society.
We hear a lot about knife crime and violence among young people but we rarely ask what might be the underlying problem at a system level, rather than an individual level.
The violent acts of shooting in schools in the US or stabbings on the streets of London are often attributed to mental health issues and this may indeed be true but the mental health is not in itself the cause, but the symptom of something wrong in our society. The statistics do show an increase in mental health problems, or at least there is an increased awareness of how much mental distress there is in all sections of society, young and old. I would argue that mental illness is not the cause of violence but that a culture of violence is at the root of mental illness, thus the cycle continues. Violence in the home and in the media create a culture in which fear is a dominant factor.
Mental illness has many causes: genetic disposition, early childhood experience, family circumstances, traumatic life experiences and poverty. The social determinants of health are well known, the lower down you are on the socio-economic ladder, the more likely you are to suffer ill-health, both mental and physical. We know from ACE (adverse childhood experiences) research that stress in infancy and childhood takes a life-long toll on health. Toxic stress (sustained and systematic) has an effect on our brains, leading to problems with attachment, relationships, cognition, educational attainment and economic success. Many children live in extremely stressful environments and cope as best they can, sometimes in ways that are detrimental to themselves and to society. We are failing our children because we are not investing in creating safer environments in which all, or most, children can grow up without threat, can develop into adults who have the luxury of being able to explore, play, create, think and contribute to the society which nurtured them.
We seem to invest in illness rather than health, by waiting until a problem arises to provide help, which is usually too late as too much damage has been done by the time the symptoms show themselves. We need to invest in children and young people as a public health issue, preventing rather than treating mental illness. This will reduce the need for children to find bad ways of protecting themselves and it will create a safer society for everyone, adults and children.
Many areas of public policy and health provision are thinking about the family as the first and most influential environment in which people are shaped and this is absolutely right, however we are still reluctant to support families who are struggling, preferring to treat the problems that arise when things have gone wrong. Most therapeutic work is done at the individual level, not at the level of the system or the environment. We like to count individual actions, beneficiaries, patients and cost their care accordingly. This is flawed as it ignores the most important component of illness and distress, the places that we live – whether this is the family, the school, the street, or wider society.
One of the most hidden and stressful situations a child will have to cope with is parental mental illness and its consequences. The Children’s Society (Good Childhood Report, 2017) found that there are 1.65 million young people (aged 10-17 years) living with a parent/carer with depression/anxiety. Furthermore, they found that parental depression or anxiety, on average clustered with six other major challenges in the family. These challenges were most likely to be homelessness and exposure to domestic violence. Children in families with a parent with depression or anxiety were found to have demonstrably lower well-being. Most of these children are vulnerable to dangerous and negative experiences because they are less able to protect themselves and have less self-confidence which lends itself to social isolation and predators who target them. Childhood trauma is a feature of the majority of young people who fall foul of the authorities in different ways and as they go through life the trauma piles up. Exclusion from school may be a trigger which pushes these young people over the edge where they have nothing left to lose.
A WHO review stated: “Children with a parent who has a mental illness or substance use disorder are placed at high risk of experiencing family discord and psychiatric problems. The intergenerational transfer of mental disorder is the result of interactions between genetic, biological and social risk factors occurring as early as pregnancy and infancy. Rubovits work in this area has found that children and young people of parents with a mental illness have a 70% chance of developing mental health problems whilst young, with 40% requiring treatment by the age of 20. It also found that these children experience high levels of social isolation, stigmatisation, fear and shame.
This is not to say that parental mental illness is an excuse or reason for violent behaviour and in most cases these children are overly compliant rather than problematic, nevertheless they find themselves on the outside, struggling alone with the hidden trauma, which they do not understand, and which leads to many different kinds of self-destructive behaviours. When we feel ‘cast out,’ we lose one of the most important protections which we need for healthy psychological functioning — the feeling of belonging and being valued.
Children and young people mostly carry knives and join gangs for protection and because they feel that they don’t matter, that the rules are not made to protect them but to protect others who have more material wealth which they need to protect. When I did my clinical training in a psychiatric hospital I met a young man there who took it upon himself to tell me that the rules were not made for him, they were made to protect me from him! Why should he obey the rules when the whole system excludes him and his experience of life is one of being marginalised and even despised? He told me that ‘in here’ (the hospital) I was in charge but ‘out there’ (the street) he was in charge because he could intimidate me with guns and knives. The street belonged to him and he could own it with his threat and lack of interest in society or its rules. I learned a lot from him and it made perfect sense if I thought about things using his logic.