Today is World Mental Health Day and this year’s theme could not be more important – “Young People and Mental Health in a Changing World”. The pressures on children and young people today are immense. The World Federation for Mental Health identify internet usage, bullying, cyber crimes, violent video games, gender and sexuality issues and trauma as some of the key issues in the lives of young people.
These issues can trigger or worsen mental illness. But what if you develop a co-existing addictive disorder? In this blog, we look at the double bind of a dual diagnosis – how one illness can become entangled with the other – and why early intervention is so critical.
Dual Diagnosis and Young People – How It Starts
Imagine you’re a 15 year old girl. You feel awkward and uncomfortable when you hang out with friends. The most popular girl in your group makes fun of you – she pretends it’s all a joke but her comments do hurt and make you feel very self-conscious. When you meet up with your friends at the weekend, you try some cider. It makes you feel more outgoing and you chat to a boy from school.
Or you’re an 18 year old boy. You’re in your first term at Newcastle University, over 100 miles from home. You haven’t told anyone how lonely you feel. You go out with some new friends to a nightclub and take ecstasy for the first time. You dance and laugh and you forget your worries for the night. You can’t wait to do it again.
Perhaps you’re even younger – just 11 or 12 – your mum moved out last month. She’s gone to live in another town. You live with your dad in the week and you stay with your mum at weekends. The happiest you feel is when you’re playing Fortnite. It’s exciting and you’re getting really good at it. It’s when you’re not playing the game that you don’t feel quite right.
Maybe you’re a young person in care – you don’t feel you’ll ever match up to the images you see on Instagram. There are so many people who look beautiful and confident and happy and thin – they post everyday about the amazing things they’re doing in their life. You skip breakfast one day and it makes you feel more in control. A few months later, an older friend tells you about a pill that takes away the hunger. You look up to her, so you try it. That day, you skip breakfast and lunch.
You’re 17 and you’re gay – but you haven’t told anyone yet. You’re certain your parents won’t understand, as they’ve often made jokes about gay people on TV. You’ve cut yourself recently to take away the pain. To sleep at night, you’ve been taking a strong painkiller. You’re not sure exactly what’s in them but you only need one tablet to switch off all your troubling thoughts.
You could be a boy, just 7 years old. You think that if you keep your bedroom really tidy and you don’t make too much noise, then your dad won’t be so cross with you when he comes home. He might even be pleased with you. He doesn’t notice you that night – but still, it’s better than when he’s angry. You stay really quiet by messaging friends on Whatsapp with the sound turned down. It takes some of your worry away.
Dual Diagnosis and Young People – How It Progresses
It’s three years later and you’re an 18-year-old girl. You’ve done okay in your A-Levels but you have no idea what you want to do next. You get a job in a local pub to earn some money. You ask for as many shifts as possible. The locals often buy you drinks at work and the pub landlord is relaxed about you drinking behind the bar. They drink too and alcohol always makes your shifts more fun.
After work on Fridays and Saturdays, you carry on drinking with the other bar staff – sometimes you have shots after work in the pub or you go on to a party. You’re sick sometimes after drinking too much. And you can’t remember everything you’ve done. Always the next morning, you feel very anxious, trying to remember what happened the night before.
It’s the third year of university now. You’re a 20 year old man. The pressure to deliver coursework and do well in your exams feels crushing. You’ve made some great friends at university now. You don’t go out to nightclubs much anymore. You spend most of your free time in each other’s houses, drinking and taking drugs.
Your first deadline comes along for an important assignment but you miss it. You bargain some extra time from your lecturer, saying you’ve been dealing with a family problem. You’re given a week’s extension and you decide you’ll work on the assignment tomorrow, after having a relaxing session with your friends.
Two years on and your mum and dad have got back together. They still row and they often involve you in their arguments. You think maybe it was better when they lived apart. At 14, you’re now gaming everyday. You’re finding it hard to concentrate on anything else when you’re not playing – homework is boring and you don’t want to meet up with friends. In the school holidays, your parents take you away for a week to Cornwall.
For the whole of the car journey, your mum and dad aren’t talking to each other. When you get to the campsite, the internet connection is terrible, so you can’t play your game. You get really angry and say you wish they’d left you at home. Your mum shouts at you before bed. In the bathroom at the campsite, you cut yourself in a place they won’t see.
You’re living with foster parents now. You’re posting daily pictures to your own Instagram account now. You get a lot of comments about how good you look but still some people are mean. One horrible comment seems to outweigh 20 positive ones. Your foster parents are concerned about your weight. They take you to see the doctor and they decide that you need counselling. The counsellor you see is too nice to you – it makes you feel under pressure and the silences make you feel uncomfortable. A few months later, your GP suggests taking antidepressants – to help improve your mood. You bite down on your lip because they just don’t get how you feel at all – but you agree to the medication, to get everyone off your back.
You’re 20 now. You’ve moved out of home and you’re in your first gay relationship. Your mum knows you’re gay and she seems okay about it – but she says it’s best if your dad doesn’t find out. Fair enough, you think – it feels easier that way for you too. You haven’t self-harmed for over a year now but you take painkillers whenever you need them. You also feel a lot of fear and jealousy when your boyfriend goes out by himself. You send him messages, asking what he’s doing. When he doesn’t answer straight away, it feels agonising. You’re convinced he’s flirting with other guys. Sometimes you check his phone when he gets home, when he’s in the bathroom.
It’s eight years later and you’re 15. You’re not so scared of your dad now because you’re taller than him and it’s easier to go out when he’s in a bad mood. You’ve been smoking cannabis for two years in secret but your mum suspects you’re using it. She’s challenged you a few times. You’ve got angry with her and denied it each time. It none of her business, you think.
But there’s one thing that’s quietly troubling you –the feelings you sometimes get when you smoke skunk. It’s funny at first, unpredictable and thrilling – but often you end up feeling paranoid, even with your best mates.
Dual Diagnosis and Young People – How It Ends
There are so many possible endings for these stories. Perhaps one or two of these young people will find their way through their difficulties. They’ll come out the other side with a few scrapes but no long-lasting damage. Others won’t be so lucky, however – the symptoms of their mental illness and co-existing addiction(s) will progress.
They will attempt to self-medicate even more, further exacerbating symptoms. They might try to access help but find their local services have been cut back. They might be medicated more than they need to be, when therapeutic rehabilitation would help them more. They might have accidents, injure themselves or suffer terrible consequences resulting from their mental illness or addiction. And some might not make it.
Perhaps these young people’s stories seem unusual or very sad. In fact, all these examples of young people in today’s changing world are fairly commonplace.
According to the World Health Organisation, 1 in 5 young people suffer from a mental health illness. Suicide is the second leading cause of death among 15-29 year olds.
In terms of addictive disorders, young people are particularly susceptible to and harmed by digital addictions, cannabis abuse and food addiction. Eating disorders, which are variously classified as an addiction and/or a mental illness, have a devastating effect on young people. According to the Joint Commissioning Panel for Mental Health, anorexia nervosa is the leading cause of death amongst all psychiatric disorders.
Dual Diagnosis and Young People – How It Should Always Be
All of our young people in these stories would benefit greatly from early interventions. Specialist treatment and support needs to be available when young people need it most. Talking therapies, medication where absolutely necessary, abstinence-based rehabilitation programmes, peer support, local high quality services, GPs who are willing to take the time to understand their needs. Our young people deserve nothing less than this.
At UKAT, it’s our wish on World Mental Health Day 2018 that all young people who are suffering with a dual diagnosis find someone who listens. It’s not always a straightforward pathway to effective treatment and support – but compassion, and open-mindedness are great places to start. It’s about being willing to treat young people as experts, when it comes to their life experiences and healthcare.