What’s really going on with mental health?

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One of the biggest stories of the past decade has been worsening mental health among young adults. Countries across the globe have seen a marked rise in reports and diagnoses of conditions such as anxiety, autism and ADHD and a steep rise in the share who report a disability.

I want to be clear that this is a phenomenon I take very seriously. The rise in young people’s psychological distress is certainly real — it shows up most unambiguously and alarmingly in sharply rising rates of hospitalisation for self-harm among teenage girls and young women.

But this acute and narrow signal — self-harm is the extreme end of the spectrum — is where the high-quality data ends.

Over several months I’ve been digging into what different measures of mental health tell us about the picture in different countries, contexts and communities. It is anything but clear, hampering the ability of policymakers and society more broadly to fully understand, let alone respond to, these shifts.

In some countries the share of young people who report a long-term illness has risen, while their self-reported health overall has remained unchanged; in others we see the opposite. A study published last week finds similarly conflicting patterns: it depends on the question asked. Christoph Henking and Ben Baumberg Geiger found that while there has been a steep rise in the share of young Britons reporting a mental illness, the share of people who say a mental health problem limits their day-to-day functioning has barely budged.

They propose a range of hypotheses for what’s going on. One I find particularly interesting is “systems medicalisation” — the idea that outdated and inflexible frameworks in workplaces and the education and welfare systems force those with any level of need, whether debilitating or distracting, permanent or fluctuating, into a binary of “disabled” or “not disabled”.

More broadly, the idea that societies are struggling to interpret the results of reduced stigma and increased openness about mental health conditions finds strong support in the data.

One of the most striking patterns — which shows up in multiple countries — is that different groups of people label the same behaviour or symptoms very differently, and this has seen a rapid change over the past decade. In both the UK and the US, the rise in reports of mental health problems has been much higher in young people than old, and in those on the political left than the right, but subtle variations in how questions are worded cause those gaps to disappear.

Perhaps the most informative piece of evidence here is that when asked if they would consider someone experiencing typical fluctuations in mood (described as broad happiness but occasional moments of worry, frustration or loss of confidence) as having a mental illness, more than half of young Americans say yes, up from just a fifth 15 years ago. Older people’s views show no such change.

This shift in how people conceptualise mental health could be seen as a positive — the hard-won result of years of campaigning to reduce stigma and raise awareness and inclusivity — but if it is happening more among some groups than others, it will distort our sense of what is really getting worse and for whom.

It’s important to note, too, that this doesn’t mean the rise in reported mental health problems is a mirage. In addition to concrete evidence of self-harm, another defensible reading of the data is that older and more ideologically conservative groups are also struggling — they’re just disinclined to label these struggles as mental health problems. Perhaps mental health has worsened only for the young and progressive; perhaps it has worsened for everyone but only some label it in these terms; perhaps it has not changed much at all for most, but the way we talk about it has; or perhaps the shifts in how we conceptualise our mental health even cause it to change.

The point is that inconsistent measures and a change in how some but not all people interpret the concept mean the state of young people’s mental health is far less clear than we think. For the sake of everyone — from the individuals in most critical need to worried parents and policymakers — we need a push for much better and more precise measures of psychological difficulties.

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