On Tuesday afternoon, 28 June, a small portion of Blackwells’ Bookshop in Oxford was annexed for the sake of science…
As part of the Oxfordshire Science Festival activities, Blackwells were hosting a week of 30-minute lunchtime talks on mental health with authors from the “A very short introduction” series.
We went along to see our Deputy Director and Theme 1 leader, Professor Belinda Lennox and Peter Smith, Emeritus Professor of Psychology at Goldsmiths University of London, talk about adolescence and mental health.
We’ve tried to capture and write-up some of what they spoke about below – any errors are ours, not theirs! So, with that disclaimer out of the way, please read on…
Peter Smith kicked off the talk, giving us a quick overview of what adolescence is and some of the science and psychology behind it.
Adolescence is classifed as the ages between about 10 and 18, the period between being a child and becoming an adult. Peter noted that 10 might seem a bit young to some – still a child really – but people are entering puberty younger and younger in recent times.
Adolescence is a period of transition and change through many aspects of life, including physical, psychological, social and even cultural. This is especially true through puberty.
While there are definitely differences in how adolescence evolves between different cultures, some features of this transition remain universal. Chief among them is that throughout adolescence there is a search for identity and shift from parent-oriented relationships to peer-oriented relationships.
The closeness of a child to their parents begins to decrease, while the closeness to their peers increases. From this, conflicts, particularly with parents, often begin to arise.
There is, of course, variation between individuals, Peter said. For some, this is not such a stark shift, but generally, after adolescence people are not as close to their parents as when they were 5–6 years old, for example.
Throughout adolescence, the influence of a child’s peers intensifies, especially with regard to concerns about rejection by peers. This is especially true at around the age of 14.
Many points of conflict can arise from the physical changes going on through adolescence. For example, sleep – adolescents tend to go to bed later, therefore are often sleepy in the morning. A cause of frustration and conflicts for parents who want them out of bed and at school on time.
Adolescence is also typically marked by an increasing interest in sport or other leisure activities. Now, with the advent of the internet, computers and smartphones, social networking has become increasingly prominent.
This has both positive and negative aspects, Peter says. For the majority of young people, this is mainly positive, a means for communication between friends and self-expression, especially for those who may otherwise be more shy.
But it is definitely not without its negatives.
Around 9% of young people have experienced cyberbullying more than once. Then there is the more recent phenomena of ‘sexting’. While this is seen by many young people as a way of sharing intimacy, at that age relationships tend not to last long, and feelings can be hurt, sometimes leading to ‘revenge porn’.
Which ties in with another distinguishing feature of Adolescence: puberty. The advent of puberty in adolescence signals greater interest in sexual and romantic relationships, again, drawing young people more toward their peers, away from their parents.
It’s not just hormones that alter behaviour though, as people often assume.
There are physical changes during adolescence, not just in the development of young people’s bodies, but also in how their brains continue to develop into adulthood. Peter spoke about how neuroscience is helping to inform our understanding of this.
Brain development during adolescence is thought to influence the balance of the ‘dual system model’. This model pits two systems against one another to help explain behaviour and reasoning; the quick, automatic non-conscious ‘system 1’ against the more controlled, slower and conscious ‘system 2’.
System 1 is influenced by the rewards centres of the brain, the area’s leading to actions that are more immediately gratifying.
System 2 is influenced by the pre-frontal cortex, boosting our ‘cognitive control’, our ability to override our immediate desires. Think self-restraint – the ability to stop yourself snatching the sandwich off your colleague’s desk when you’re hungry.
During adolescence, Peter says, neuroscience is telling us that the balance between the parts of the brain influencing systems 1 and 2 may shift in favour of system 1 – immediate rewards.
This may erode, to some extent, an adolescent’s ability to override impulsive behaviour or emotional responses, making behaviours which give short-term payoffs more likely. Even when there are longer-term negatives to these behaviours.
This can lead to a boost in risky behaviour as the rewards (e.g. acknowledgement or status), especially those given by peers, may become a far bigger motivator. Drug taking or unprotected sex, for example, may all be seen as worthwhile risks if they provide immediate rewards or enhance an adolescent’s status among their peers.
These behaviours or emotional responses tend to manifest as either externalised or internalised, peaking at around 14 or 15 years old. Generally, externalised behaviour is more common in boys, while internalised behaviour is more common in girls.
Externalised behaviour directs emotional responses away from the individual, leading to a tendency to aggression and delinquent or rule breaking behaviour. More extreme examples include drug taking or minor crimes like shoplifting.
Internalised behaviour, by contrast, shifts the focus to the self, affecting the young person’s psychological environment. In more serious instances this manifests as problems such as anxiety and depression, obsessive/controlling behaviours or self-harm.
At which point, Peter handed over to Belinda Lennox to talk about mental health and adolescence.
Adolescence and mental health
Most mental health disorders start in adolescence.
For example, if you ask adults with depression, around 60% will say they have had experience of depression in childhood. And the longer a mental health problem goes on without treatment, the bigger a problem it becomes.
Adolescence is a period of change anyway, so the real difficulty is working out what's normal for that period and what isn't.
There’s evidence that almost all adolescents experience some degree of depression or anxiety. 1 in 6 may have experienced symptoms of psychosis, such as hearing voices or feelings of paranoia, which makes these symptoms reasonably common too.
Such symptoms often pass without lasting effect and are rarely at a level that actually ‘impairs functioning’ – a level where people begin to withdraw socially, no longer going out or spending time with friends, not doing as well at school – and requires professional help.
However, if these symptoms do get to a point where they begin to impair functioning, then it is time to intervene and get professional help.
As many as 1 in 10 adolescents will have some form of mental disorder requiring treatment. And this number has increased greatly over the last 10 years – a 68% increase in self-harm, for example. Depression among adolescents has doubled in the same time. Why?
The problem with answering that is, as with many things, there is no simple root cause to fix. Instead, the reasons are multiple and complex, driven by social, cultural, technological and personal factors.
What we do know is that in cases where things have gone badly wrong, such as suicide attempts, the most common causes mentioned seem to be bullying, exam stress, and family breakdown.
Another difficulty is, in contrast to middle-aged people who are pretty good noticing when something’s not right and asking for help, young people (<24 y/o) often don't actually access help.
So, what’s holding them back?
There are two main issues Belinda mentioned. Firstly, stigma and prejudice. Some young people report that they don’t want to ‘be seen as a psycho’. Secondly, young people just lack the information or access to help that they need.
As an example, Belinda said that some young people have reported that they ‘didn't even think of it as an illness’. They didn’t recognise the symptoms as being indicative of a problem, or that it was a problem for which they could get help, so didn’t even try to seek it.
Another problem is that, structurally, our mental health services have developed to treat children separately from adults. Child mental health services typically go up to age 18. After that, it’s adult mental health services. When you cross that boundary, the system can become very hard to navigate and adolescents are often lost to this system in this transition.
For example, one study, published in 2010, followed the journey between 'child and adolescent mental health services' (CAMHS) and 'adult mental health services' (AMHS) of 154 seventeen-year-olds. Of the 154, only 90 were actually referred to the adult service, and only 4 met all the criteria for an optimal transition, including continuity of care.
The paper concluded that “For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced."
Rounding off the talk, Belinda reminded us it’s not all gloom, though. Things are looking up, despite there still being some way to go.
The fight to raise awareness of mental health problems and to break the stigma around mental ill health is ongoing, and making headway.
There are many people researching adolescent mental health, and developing and piloting new types of services to help improve treatment for young people.
In Oxfordshire, as of the first of April this year, young people experiencing a first case of psychosis can access the Oxfordshire Early Intervention in Psychosis (EIP) service.
The EIP service works with young people who are experiencing their first episode of psychosis. Rather than a tricky to navigate set of checklists, referrals and waiting lists, EIP makes use of specialist community treatment teams to try to get people well and functioning normally as quickly as possible, working with the needs of individuals and families.
Anyone can refer a young person to the EIP service, including the person themselves, teachers, parents or doctors.
Referring to a CLAHRC Oxford project, Belinda noted that EIP services have been shown to reduce inpatient bed use, improve clinical outcomes, increase the number of young people in employment or education, and reduce costs to the NHS.
(For more information on this project you can download our BITE, a short summary of the evidence, here)
All written content on the blog section of this site, unless otherwise stated, is free to reuse, licensed under a Creative Commons Attribution 4.0 International Licence (CC by 4.0).
Further general reading:
MQ: Transforming Mental Health Through Research blog:
Adolescence: A very short introduction, by Peter Smith
For the patients and the public:
Oxford Health NHS Trust Mental Young Peoples’ health services:
This talk was developed through a partnership between Oxford AHSN, Oxford University Press and Blackwells Bookshop.