In May 2024 the ‘Beyond Pills’ All-Parliamentary Party Group (APPG) published a report on mental health, entitled ‘Shifting the Balance Towards Social Interventions: A Call for an Overhaul of the Mental Health System. Myself, and many others it seems, in the youth work field were unaware this government inquiry was taking place, and those involved in the production of the report have not given much thought as to the possibility, nor the importance, of youth work interventions around issues of mental health. The important recommendations in the report do, however, cohere with a youth work approach to supporting, ameliorating and preventing young people’s mental health problems. This article reflects on the current mental health ‘crisis’, discussing recent research on some of young people’s mental health problems. It then discusses the reframing of mental health and assesses the role of youth work within this. It concludes that whilst it is frustrating that the report does not highlight youth work, the new approach recommended within it provides an opportunity for youth work to grasp, in creating supportive developmental opportunities for young people ‘beyond pills’.

Mental Health ‘Crisis’?

The phrase ‘mental health crisis’ is often used uncritically, and we should always be a little sceptical about any such claims about crises and any ensuing ‘moral panics’ about young people (Cohen, 2011). Indeed, Foulkes and Andrews (2023) suggest that whilst the current focus on mental health awareness has the beneficial effect of leading to more accurate reporting of previously under-recognised symptoms, it is possible that there are also negative consequences, such as the ‘Inflation Prevalence Hypothesis’. Put simply, the more mindful people are of something and the more attention they pay it, the more prevalent it becomes. Problematically, Foulkes and Andrews (2023) suggest mental health awareness efforts are in some cases leading individuals to interpret and report milder forms of distress as mental health problems. For example, young people no longer ‘feel down’, but are depressed. They no longer ‘feel worried’, but have anxiety. More worryingly still, Foulkes and Andrews’ hypothesis suggests some individuals experience a genuine increase in symptoms ‘because labelling distress as a mental health problem can affect an individual’s self-concept and behaviour in a way that is ultimately self-fulfilling’ (Foulkes & Andrews 2023: 1).

Despite these concerns, there is a growing body of evidence which demonstrates that the mental health of young people is deteriorating. Much of this evidence comes from the US. For example, the Centre for Disease Control and Prevention’s comprehensive biannual Youth Risk Behaviour Survey from 2011 – 2021 (CDCP,  2022) demonstrates that 57 per cent of teenage girls now say they experience persistent sadness or hopelessness (up from 36 per cent in 2011), and 30 per cent of teenage girls say that they have seriously considered suicide (up from 19 per cent in 2011). Boys are doing badly too, but their reported rates of depression and anxiety are not as high as girls, and their increases are not as significant. Data from the UK is comparable with the figures from the NHS Mental Health of Children and Young People Survey (NHS, 2017) showing 19.6% of 16-19 year olds were identified as having a mental health condition, the most commonly identified of which were emotional disorders. The Association of Young People’s Mental Health also noted the teenage years are crucial in identifying mental health problems and providing support, as 14.5 is the age for the peak onset of problems (AYPMH 2023).

A key factor in this rise of poor mental health for young people is the use of smart phones and social media. Evidence from over a million young research participants was collated by Jean Twenge and her colleagues in America (Twenge et al., 2018, Twenge et al., 2017). They consistently found in their studies that adolescents who spent more time on smart phones and social media were more likely to report mental health issues, than young people who spent more time on non-screen activities (such as in-person social interaction, sports/exercise, homework, print media, and attending religious services). Haidt (2023) also clearly shows girls are particularly prone to the negative impact of social media use. The research suggests little or no social media usage is associated with around 10% chance of having mental health problems whereas five hours or more is associated with close to a 40% chance.

Reframing Mental Health

Conceptualisation of mental health problems as psychological disorders was first formalised in 1952 with the first publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is now in its fifth edition, published in 2021 (APA, 2021). Mental ‘disorders’ are defined as a significant behavioural or psychological pattern associated with distress, suffering, or a loss of freedom. However, there are flaws in such a ‘diagnostic and statistical’ approach which reveals how cultural and social norms are strongly associated with such judgments. For example, it was only in 1974 that homosexuality was removed from the categories of mental disorders where it has been defined as a ‘sociopathic personality disturbance’ (APA,1952).

A growing group of critical psychiatrists are questioning the basis of the DSM and the dominance of the bio-medical model of mental health difficulties. They draw on philosophy, history, anthropology, social science and mental health service users’ experiences to mount a scientific challenge to claims about the nature and causes of mental disorders and the effects of psychiatric interventions (Critical Psychiatry, 2024). It advocates a more reflective, sceptical and patient-centered approach to the theory and practice of psychiatry (ibid). An example of which includes an approach to the experience of auditory hallucinations referred to as the ‘Hearing Voices Project’ which brings people together who experience this phenomenon without pathologization, instead providing peer support and coping strategies without medical intervention (Pini, 2024).

This approach has until recently been far from the dominant perspective, and medicalisation is still the most common intervention for young people. For example, between 2005 and 2017 antidepressant use in the UK more than doubled for young people between the ages of 12 and 17 (NIHR, 2024). Furthermore, despite guidelines recommending that young people are assessed by a psychiatrist before being subscribed mediation, a study of 21,000 young people found only 1 in 4 of them visited a child and adolescent psychiatrist (ibid).

All Parliamentary Party Group ‘Beyond Pills’

A change is afoot however, as the new report on mental health by the Beyond Pills All-Parliamentary Party Group (APPG) entitled ‘Shifting the Balance Towards Social interventions: A Call for an Overhaul of the Mental Health System’ – advocates a fundamental shift. The report is highly critical of mainstream approaches to mental health and its reliance on medicalisation. It points out that: ‘the dominant biomedical model of mental health care has led to over-reliance on psychiatric drugs’ (APPG, 2024: 5).  The report draws attention to social and community approaches which focus on establishing supportive relationships and networks to enable people with mental health difficulties to better manage and ultimately overcome their problems. This alternative approach echoes both the World Health Organisation and the United Nations who urge us to:  ‘pay greater attention to the social determinants of mental distress’ (APPG, 2024: 10). The APPG report sets out a set of six principles which should underpin a radical overhaul of mental health services:

APPG – Six Principles for Mental Health Reform

1. Mental health problems are mostly about our circumstances and relationships
2. Mental health problems arise within our social environments
3. Mental health problems are exacerbated by societal messages
4. Positive narratives and language are needed for recovery
5. Psychiatric drugs should be used with caution and over-prescribing must be reduced
6. Research should focus on better psychosocial provision

(APPG, 2024: 13).

The Youth Work Role

First amongst the APPG’s calls for action is to boost provision for social interventions, including social prescribing and community-based resources (APPG, 2024: 16). Although well intentioned, this section is weak and doesn’t explicate in any detail how this would best work. Whilst it acknowledges some of the community-based support services which the authors are aware of, such as mental health hubs, it appears to have no knowledge of youth (and community) work approaches. The report also mentions the need for social prescribing but fails to specify in detail how such an approach could and should work.

Youth work has demonstrated that it is a powerful social intervention and makes a significant difference to the mental health of young people. Research shows that delivery of specialist youth work projects which provide spaces for young people experiencing mental health difficulties can, through a non-judgemental and strengths-based approach, bring about significant changes in young people who had previously experienced severe mental health difficulties (Davies, 2000; Wright & Ord, 2015). My recent research has also demonstrated that such specialist youth work projects is successful, because they are based on trusting supportive relationships and provide an activity programme designed to enable transformative experiences through which young people develop and grow, rather than be diagnosed and treated. As one young person attested, reporting their experience of being a part of this developmental group environment: ‘I don’t want to die anymore’ (Elsen & Ord 223: 1436).

Youth work interventions around the issue of mental health have been developed within both targeted and open access youth work. Targeted, or 1-1 youth work, has demonstrated benefits, where youth workers focus exclusively on the needs of individual young people exploring their issues, offering support, advice and guidance, and building self-esteem (Välimäki & Husu, 2023). Open access youth work has also been shown to provide the safe spaces and secure trusting relationships necessary for young people to both explore their concerns and develop (IDYW, 2011; Ord et el, 2018; de St Croix, T., & Doherty, L. (2023). Interestingly the open access spaces are successful in part because the focus is not exclusively or indeed primarily on mental health but on promoting growth and development holistically. Such outcomes are incidental (Smith, 1988) and emerge out of a process of engagement over time. All three of these approaches incorporate an asset or strength-based approach and are consistent with the recommendations of the APPG ‘Beyond Pills’ report.

It is also incumbent on youth workers as informal educators (Jeffs and Smith, 2005) in whatever settings they work in to engage in conversations with young people about mental health. Firstly, they may be able to help prevent ‘prevalence inflation’ and avoid the exacerbation of life’s every day difficulties spiralling into mental health problems. However, more importantly given the stark findings of Haidt (2023; 2024) and Twenge’s (2017; 2018) research, youth workers must engage in conversations about smart phone and social media use. Every opportunity must be grasped to discuss their addictive nature. Can youth workers encourage young people to ‘come off their phones’? Can Youth workers engage in debates about and encourage young people to reflect on  the impacts of this on self-esteem and wellbeing? Can youth workers also engage in discussion about the impact of the affirmation culture associated with social media – the need for ‘likes’ and its effects on self-esteem and mental health? Smart phones open up endless possibilities for young people, but they are not neutral and avoiding the negative impact of their use is one of the most important challenges currently facing youth workers, as well as wider society.

Conclusion

It is of enormous significance that a government report has identified a significant positive shift in approaches to mental health to relational, social and communal determinants of (ill)health. This now opens up a significant opportunity for the youth work profession to call for investment and support for its approaches which dovetail with this alternative, and arguably more effective, approach to mental health support. In short, if the causes of mental health difficulties are primarily relational and social then the solutions must well be relational and social as well. The relational practice of youth work is uniquely placed to provide the spaces and places for youth workers to enable young people to develop and grow and not be medicalised. The field must now take advantage of this opportunity.