Adolescent mental illness - or familial distress?

Words like “shocking”, “staggering”, and “alarming” used to describe the “rise in mental ill health in children and young people” are designed to get our attention. And let’s face it, they do.

The question is: Who are the authors of those words? The short answer is the NHS, local and national newspapers, the Children’s Commissioner for England, the Scottish Children’s Services Coalition and a myriad of children’s charities, to name a few. All players with skin in the game. Anxiety sells and/or gets a bigger budget allocation.

Not for a minute am I suggesting that there isn’t a large swathe of young people and children actively and daily suffering with anxiety, low mood, intrusive and repetitive thoughts, compulsions and other behaviours that cause distress and discomfort. There is no doubt or question that there is a real and dire need to help those in distress.

What I am talking about and have certainly noticed from my time counselling in schools and within my private practice is that uncontrollable chronic stress and disconnection amongst young people and their family communities is such a large part of the distress young people experience, too.

The family environment is causing the issues, and the young person exhibits the symptoms of their life. It’s not spoken about in any real-world sense, as in 'let’s fix poverty, abusive and neglectful parenting behaviours and/or job insecurity etc.', but rather via restricted budgets promises offering “solutions” such as through yet more poorly renumerated work for counsellors offering in-school counselling rather than family counselling and, is this always the only way forward?

My experience of teachers in the school counselling settings has mainly been supportive, interested, kind and caring towards their young charges. However, they are also completely inundated with the workload, parental demands and at times unrealistic expectations from them, tighter than ever budgets, bigger class sizes and a more visibly distressed group of pupils since the Covid pandemic.

That, coupled with parents trying to do their best parentally and function optimally in the ever-demanding world of employment, or barely keeping it together (or not) themselves, is a lot to navigate. It’s no wonder children and young people are coming into the school environment overwrought, unhappy, distressed and disconnected before the day has even started.

As Gabor Mate says, “Children swim in the unconscious of their parents like fish swim in the sea.” Without blame attached, but rather a sense of curiosity and care when a child is offered counselling, shouldn’t we also be asking parents, “How are you all coping as a family?”.  

Asking for help is not always a comfortable state for some people and parents, which is why counselling is met with such a viscerally negative reaction from some. “Counselling? Rubbish, suck it up and get on with it. In my day…” Yet those same parents who won’t feel the need or want to address their fears and look at their “stuff” in therapy will almost instinctively (in the main but not always) want the best for their child and will agree to them seeing the school counsellor.

For clarity’s sake, I agree with and support school counselling. Children and young people need their own space to process their difficulties, emotions and behaviours. What feels disquieting about this for me as a counsellor?

Something like this scenario: “Now, so and so, make sure you bring your authentic self into the sessions and we’ll look at all of the negative areas influencing your life (out of your control, mind you) and then we’ll send you back out into that environment once again. However, please remember to practice those strategies we shared to manage your distress when your world is imploding around you in the interim. Here’s your appointment for next week to talk more about how helpless you are, and we can entrench the despair even more, as adults with caring responsibilities in your life continue unchallenged, distressing x, y and z behaviour yet again.”

I hasten to add that I am being facetious (i.e. not to be taken literally or seriously), before I get all of the good school counsellors out there telling me that’s not how they work. Of course it isn’t. Equally, not all parents of children in counselling will benefit from or require family counselling. But isn’t there a grain of truth when we only offer counselling to one person in the struggling family dynamic?

Offering a very short-term block of counselling sessions to a young person in familial distress and knowing that nothing can or will change for them in the short term because of systemic disadvantages and adults in their life making other incompatible decisions for the whole family is one of the uncomfortable truths of school counselling. Teachers are aware of this too, and like them, we as counsellors also try to do our best for young people.

Yet if a child is offered school counselling, surely, counselling for the family should also be offered. Parents could explore some of their parenting blind spots and hear how their young person is feeling and suffering within that family and school environment. If parents have the only power in the home to make decisions, then surely distress for some young people is inevitable. A good enough but preoccupied, stressed parent might find it difficult to attune to their child’s demands and/or “bad behaviour”.

In other households where there isn’t even good enough parenting, the distress experienced is usually hidden/buried/repressed by the young person. Some may well re-enact this within the safe space of schools, and some schools just aren’t equipped to handle this. Often, the counsellor can be the space for the behaviour to be sent to, and yet it sends the message that there’s something wrong with the child and they need to “work on themselves”.  The family are exempt from this explorative work.

While many supportive charities are trying to help parents, such as Home-Start, Action for Children, Family Action, etc. in the middle of a crisis the motivation and ability to search online and read the articles or fill in the online registration forms might not the first thing that springs to mind for the overwrought parent. Therefore, enlisting the school’s help to offer the child counselling to take the immediate pressure off the family pressure cooker situation is a good strategy. But with only one “ingredient” in the mix getting attention and support, then surely this can only ever be a “sticking plaster” solution.

Caring teachers work hard under enormous pressure to understand the distressed child’s viewpoint and to offer accommodations once they know what the child needs and would be best supported by implementing them. This is where counsellors can help the different players to coordinate the best plan of action for the school environment. It would be kinder to all if struggling parents were offered the same opportunity to be supported and to support their children in family counselling sessions.

I get it that this will cost the government, councils and individuals money and incorporates a lot of logistical issues 'by whom and where would it be delivered?', of course it would. But there are already school counselling programmes that use health centres out of school hours for counselling, so could this be one area opened up more widely? The resistance from parents may be the biggest hurdle, though.

Yet the potential benefits to society and the connection that could grow from this opportunity don’t seem to be factored into the school counselling equation or budgets by the powers that be. What is the point of siloed counselling when the problems can also be systemic and familial?

It’s not solely the responsibility of the child and young person to change their attitude or their way of thinking to appease the world, but rather to feel that they have a place, a voice and a sense of validation about their own experiences and feelings about their world. We as adults and parents would do well to be curious, humble and open to other viewpoints rather than our own way of thinking as the only right way to operate in the world.  

I have seen transformative changes within a family counselling dynamic as each family member hears different opinions and viewpoints that have surprised and encouraged them to see their young person as a capable, feeling human in their own right and not just as the young, surly, misbehaving “other”. It also allows the young person the opportunity to see the parents’ viewpoints and their own struggles and fears, and to work together in a more collaborative and connected way.

As schools experience the lion’s share of children and young people’s distress, supported family counselling alongside school counselling might be the next area our governance bodies, and we as a society, want to lobby parliamentary and local budgets for.

References:

Articles about the rise in mental health for children and young people:

• Coalition calls on Scottish Government to up its game over children’s mental health
•  Alarming’ surge in mental ill health among young people in the face of ‘unprecedented’ challenges, experts warn
• Over a quarter of a million children are still waiting for mental health support, the Children’s Commissioner warns

Family support group resources:

• Family Lives
• Family Action
• Home Start

Book: 

• Gabor Mate and Dr Gordon Neufeld – Hold on to your kids – why parents need to matter more than peers – Vermillion Books (2019)