Mental health care crucial for young people

There has been a rise in mental health distress in our society, especially in the youth population.

Research psychologist Jean Twenge provided some statistics on the Ezra Klein Show, New York Times podcast in May 2023: “Between 2011 and 2021, the number of teens and young adults with clinical depression more than doubled...between 2007 and 2019, the suicide rate for those in their early 20s rose by 41 percent. And the suicide rate for 10 to 14-year-olds...tripled and it nearly quadrupled for girls.”

To comment on this alarming trend, we spoke to psychiatrist Dr. Julian Z. Xue, lecturer at McGill University, owner and director of Libera Clinic, and consulting psychiatrist at the English Montreal School Board.

According to Dr. Xue, clinics in both the private and public sectors are overwhelmed with patients requiring mental health support. Traditionally child psychiatry training is a family-centric practice focussing on therapy for children and their families; however, the current practice is trying to keep up with the volume of needs, thus focussing more on diagnoses and initializing medication. As a result, the therapy portion moves onto the shoulders of social workers, who in turn have a higher volume of clients.

 Why such a rise? Has the stress always been there? Is a shift in our social-political environment making people more fragile? Is social media a problem? It is unclear what precise factors are making clinical pressures so huge.

Previously it was rare for a 12-year-old to show signs of mental health stress yet now children as young as 8 are starting to display self-injurious behaviours such as cutting. “It is a very different world. The culture and practice of psychiatry has really changed, and psychiatrists are feeling the pressure,” explains Dr. Xue.

One hypothesis based on his clinical experience is perhaps that, as a society, people are more encouraged to talk about their distress in a way they did not in the past. For example, mental health is discussed on social media, blogs and ad campaigns. However, the medical services are not prepared to address this increase in demand that this openness is bringing forward.

Dr. Xue further explains that in the history of psychiatry and mental health, the distribution of disorders has changed over time. Previously, people with a cluster C personality type of disorders, those defined as more repressed pathologies, often did not seek out help. Such conditions include obsessive compulsive disorders (OCD), some types of attention deficit hyperactivity disorders (ADHD) and a variety of personality disorders. “Today the epidemiology is different, more expressionist. It is the same level of pathology but more externalized onto society, which may affect our rates.”

Neurodiversity has many forms. Some neurodivergent people can lead fulfilling lives by developing adaptive coping strategies in a society that may not be accepting of their needs. However, this does not correspond to Dr. Xue’s clinical reality with people in great distress and who are struggling to function in society due to diagnoses such as OCD, anxiety or depression.

When asked about the rise of ADHD, Dr. Xue explains that cognitive behaviour therapy (CBT), family therapy, changing the milieu and adding supports can be very helpful for youth. It can get more difficult as patients get older, however, and medication can help. He does not typically prescribe medication to patients younger than 14 years old but says stimulants can be transformative for young adults. Thus, treatment and medication work - the only obstacle is getting a proper diagnosis.

“It truly takes a village to raise a child,” he said, “More specifically, we need a highly functioning society to have flourishing human beings in it because psychiatry and mental health is not the only answer. The epidemiology of all of it is a question for every citizen, in terms of being invested in civil society and politics so that everyone has a say in what is going on. Families who have extended family support, access to social services and therapies, and school support do better in society. So, we must re-examine our social-political structure as citizens. It is this generation of young people we are helping that will need to create solutions to see us out of this.”

For individuals wanting to seek mental health help, consult mental health organizations, social workers in the public sector (CLSCs), family doctors or private sector therapists such as psychologists and psychiatrists. In most schools, students can seek help from school psychologists at the elementary level and guidance counsellors at the high school level.

Tania Piperni is an autism spectrum disorder consultant at the English Montreal School Board. She has a Master of Education in Educational Psychology from McGill University.