The Kusnacht Practice Podcast #011 Interview with Melissa Nobile, psychologist at The Kusnacht Practice on the increasing strain on young people’s mental health

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“There’s a link between experiencing stressors and having difficulties with mental health.” – Melissa Nobile, psychologist MSc.

With the global pandemic far from over, the dramatic adjustment to the ‘new normal’ is placing an additional strain on the mental health of our youth.

In the eleventh episode of The Kusnacht Practice’s podcast series, we are talking with Melissa Nobile – psychologist MSc about the rising cases of mental health disorders among young people.

Melissa explores the many circumstances that have led to the increase. The stressors created by the lockdown and its related effects on children through ‘social referencing’, as well as the developmental stunting experienced by teens.

She addresses the alarming escalation in eating disorders and incidences of self-harming, identifying the warning signs and providing advice to parents and loved ones’ on the steps to seeking help.

Presenter: Hello. We’re here today with Melissa Nobile. Melissa Nobile is a qualified psychologist and she’s the project manager and operation coordinator.

Melissa Nobile: Hello. Thank you for having me.

Presenter: Probable rates of mental disorders among children and young people have increased by almost half since 2017, England’s official survey into mental health has found- with COVID-19 and lockdown identified as aggravating factors. One in six children, aged five to sixteen, was identified as having a probable mental disorder- five children in a class of thirty students. This was an increase from one in nine children in 2017. Melissa, how alarming are these figures to you?

MN: Well, I haven’t looked at how this data was collected, but if these numbers are accurate it’s definitely alarming. And if we think in terms of the pandemic and how it may have impacted youth, it’s worth separating under the umbrella of what we call youth: teenagers and children, because they were probably impacted for different reasons, in some situations.

I can give you a few examples. For example, with children, and again it’s one example amongst many that could explain the pathway that may have led to mental health difficulties. Children, they do, what we psychologists call, social referencing. So they’re going to look a lot at the emotional display that adults give them to interpret the world, to regulate their behaviour, to regulate their emotions.

So, in this pandemic we have to look at what the parents of these children were at times doing. So if you had a parent that was quite anxious about the situation, if you had a parent who maybe lost a job due to the pandemic and was a little bit overwhelmed or stressed at home. Kids, children, they’re going to be antennas, they’re really going to pick up on all the signals to adjust their own behaviours and emotions.

And this happens in day to day life. For humans, it’s part of the human experience. But in some of these children, over the course of day after day, maybe being in one of these situations, it could have led to, amongst many other factors, deterioration in mental health.

And that would be noticed, for example, with children who suddenly become a lot more clingy than usual; children who were maybe potty trained and suddenly start having reversed behaviours. That’s been observed a lot, or children who are a little bit more anxious.

So again, this is just an example amongst many. Another one I could think of would be the families. Suddenly you had parents who had to work from home, except that they had nowhere to put the children during the day anymore. So you had parents who had this double duty of having to be an employee, and at the same time, to care for the children.

And the easy solution, and a great and functional solution in a crisis in the short term, was to put kids behind screens a lot. And again, for loads of kids, that was not a problem in the mid to long term, and it was again a great solution. And for a subset of children, interacting with loads of other factors it could have led to technology use or addiction problems in that area.

So that’s for children. And then for teenagers, because again, they’re different groups, so they probably were impacted quite differently. Teenagers, they’re really going through a developmental stage in their life where they have loads of tasks they need to achieve; one of them is becoming independent from the family.

And the other one, amongst many again, would be that they need to create a new identity that’s usually led by their peer groups. And in the pandemic, schools were shut down, they were back at home, cut off from peers, they could only interact through social media, which boomed during the pandemic.

And they were forced to be closer to the parents at a time in life where you really want to be separating, which is a normal developmental need again. So based on all that I’m not surprised that teenagers as well went through a challenging time in this pandemic.

Presenter: The NHS survey found that although the increase was fastest in primary age children, the likelihood that mental health issues would be identified as a probable disorder increased with age, with young women aged 17 to 22 being most at risk.

Researchers identified 27.2% of young women and 13.3% of young men as having a probable mental disorder. This is evidence of the coronavirus mental health time bomb and the need for “Psychological PPE” provision for the young, isn’t it? How do you see that Melissa?

MN: Again, because I haven’t read this survey in detail on how it was conducted. Sometimes when we see such discrepancies in numbers between genders, like young women and young men, it can represent that it’s more difficult for boys or men to express emotions and to report mental health difficulties. So for these numbers, that’s just a small parenthesis I wanted to make.

And on the other hand, young women and girls, they do go through certain stresses that men don’t necessarily go through. For example, young women are more likely to feel afraid, walking home at night, etc. So it’s difficult to conclude in terms of those numbers specifically.

But regardless of that, I can say that, yes, definitely. Early interventions or intervening when a child or teenager is starting to display symptoms or difficulties is definitely going to prevent the suffering from potentially going on for too long. And it’s going to prevent some conditions from becoming more chronic.

Presenter: And that same survey found that 63.8% of girls, aged eleven to sixteen, with a probable mental disorder had seen or heard an argument amongst adults in the household. Compared with 46.8% of those unlikely to have a mental disorder.

It also found that children, aged five to sixteen, with a probable mental disorder were more than twice as likely to live in a household that had fallen behind with payments, that was about 16.3% that was reported. And that children that were unlikely to have a mental disorder 6.4%. So the lockdown has meant families have been shut in together. And this has also fed into a surge in mental health issues, hasn’t it?

MN: Yes, definitely. One of the things that happened during this pandemic, but specifically the lockdown, is that families on a day-to-day basis were going on with their lives without having to think too much about the internal organisation of the family. And then suddenly, you have this lockdown, where the focus is coming back internally on the family.

And the members of these families had to learn to renegotiate boundaries, renegotiate the roles in the family, renegotiate the space, renegotiate proximity, loads of different contributing factors. And some families were more successful than others at doing that, for various reasons. So that’s something that the lockdown definitely did naturally on families.

And then we know that there’s a link between experiencing stressors and having difficulties with mental health, which we’ve all experienced, as humans. If you’re having a difficult relationship with your spouse you’re more likely to feel a little unsettled than if you had a harmonious evening. So tension in the household, regular arguments, even violence are going to be considered as of course stressors.

A difficult economic situation for some families is going to be a stressor. And this in a lot of different ways; It can be the parents, maybe during this lockdown. If they were stressed about their own economic situation they’re going to be, maybe, a little bit less patient, which is completely human, and less present for the loved ones, which could create tension.

If you’re from a low income family, you might live in a smaller apartment. Therefore, there’s going to be more proximity between family members and it’s going to be harder to access privacy during the lockdown. So to answer your question, I could go on for a long time, but yes. The lockdown definitely magnified difficulties that some families were having and created new difficulties for some of them.

PR: It certainly has. So members of SAGE, as known as the scientific advisory group for emergencies which feed directly into the UK Government decision making. That SAGE group has warned that young people are at risk of becoming a lost generation because of the pandemic policies.

MN: The first thing I want to say is, while the situation is concerning currently, especially now with the second wave that’s begun, it’s too early in my professional opinion, to conclude that youth is a lost generation. There’ll be data collected in a year, two years, three years time, and we’ll have a better insight as to what the consequences of this pandemic were. Even though again, the reality is definitely concerning.

PR: And now one of the largest private eating disorder services reported a 71% rise in admission in September compared with the same period a year ago. What can families and loved ones do to spot these signs? And what advice would you give to those who fear they are developing such disorders? What kind of advice would you give?

MN: Sure, so with clients, I choose to use the term disordered eating patterns more than eating disorder. And the reason for that is that we’re all humans, we’re all feeding ourselves daily, we all need food. And we’re all somewhere in that continuum with more or less of a disordered eating pattern around food. And more or less have a healthy relationship to food, therefore.

The signs to look out for that will indicate disordered eating patterns. There’s loads, there are emotional ones, there’s physical ones, and there’s behavioural ones. Family members cannot see all of them. But I’d say that the main ones they could notice are going to be behaviours that indicate weight loss, dieting, control over food – being one of the main concerns of the family member or their loved one.

Preoccupations with calories, calorie counting is very common. Restricting certain food groups. Someone who appears uncomfortable suddenly eating with others, someone who’s suddenly skipping meals. And usually there’s this secrecy component around food that family members report noticing as an early sign.

Those are the main signs that would indicate someone struggling, and overall keep your eyes open and think of the relationship that the person is having with food. Is it an easy relationship, or is it just looking quite complicated? And if it’s looking complicated, it likely is.

And my advice to those who would like to improve their relationship with food would be to actually seek professional help. As it’s one of those difficulties where it’s harder to get out of it alone, than for some other difficulties. It’s not impossible, but if you’ve already tried different things, and you see nothing’s working for you, I’d definitely seek help. Because there’s a way out, you don’t have to be alone with it, and there’s a way to make peace with food, with a little support.

PR: And shifting to safeguarding now. A charity that offers counselling, say reports of safeguarding issues went up 77% amongst a sample of secondary school children, particularly in self-harming. Again, how can family look out for the forthcoming signs and how can they act?

MN: The first thing I’ll say is that there’s a lot of misconceptions around why a teenager is self-harming. It’s quite largely misunderstood by the community. I’ll give you a few different reasons why someone might be self-harming.

And again, there’s as many reasons as you could possibly think of, but it can be for some teenagers a way to gain control over a body that’s drastically changing. At that age, there’s hormonal changes, they’re going to grow hair – if you’re a man. You’re going to grow different body parts if you’re a man or a woman. You’re going to have some sexual changes happening.

And for some teenagers, that loss of control of their own body can be so overwhelming that self-harming is a way to feel that the body is theirs again; like I can control this, therefore, you’re still mine.

For other teenagers, it can be a way to externalise emotions that they just can’t put into words, it’s really a sign that, you know, I’m having a hard time. For some teenagers it can be following potentially traumatic events. I’ve seen young women that were, for example, sexually assaulted, or even young men. And it’s a way to punish their body, feeling that it’s the body that’s to blame, and it’s their way of coping with that, with punishing themselves.

It can be a way to calm themselves down, because for some people it feels good to be doing that. It can be for so many different reasons. That’s the first thing I’d want to say. And in the majority of cases, to answer your question in terms of what parents can look out for, it’s quite a secret behaviour. So it’s difficult to see signs.

But, if you were to see something, what you’d likely be seeing would be unexplained cuts or scratches, especially if they’re going to be recurrent. So if you see that, it’s likely that could be what’s going on.

And then my advice of what to do about it as a parent would be that, if you have a relationship that allows you to do so, when you feel comfortable doing so, to talk to your child. Tell them you’re worried about them. You notice that they’ve been self-harming. Are they okay? Would they like to talk about it? That would be the first step, again, depending on your relationship with your child.

And obviously, I would also encourage you to reach out for professional help to guide you for your specific situation, as it can mean many different things for different youth. But again, there’s help available if you’re in that situation.

Presenter: Thank you very, very much Melissa, for sharing this with us today. We were discussing the increasing mental health toll on young people during the global pandemic. Thank you very much Melissa.

MN: Thank you for having me.

Presenter: Talk to you soon then.