There was much discussion of a mental health crisis possibly existing in some of the richest western countries even before the pandemic, particularly in the context of the younger part of the population. This certainly increased during the pandemic and has remained generally at higher than pre-pandemic levels since then.
However there is considerable difference of opinion and much debate regarding the interpretation of the available data. In fact the data tends to be presented by different scholars in various ways, depending on whether they want to draw attention to the seriousness of mental health problems, or whether their objective is to downplay some of the more disturbing statistics and studies. In the context of some countries, there is a big difference in the situation conveyed by the more routine official reporting, and some studies based on smaller samples which could investigate issues in greater detail or more closely.
However the issues involved are certainly much more important than a merely academic debate. While a proper understanding of the prevailing situation will certainly help to provide relief to a large number of people, reducing their stress and distress on the basis of an evidence-based rational approach, at the same time this can also lead us to a better understanding of society and important social trends. This understanding in turn has a much wider significance in the larger task of creating a safer and more peaceful world.
To give an example of this wider significance, if it can be shown in credible ways that some of the richest countries have abnormally high rates of mental stress and distress, then this can be an important point for mobilizing public attention on some important but neglected areas of social and even political reform. This is in itself an important step forward, for some establishment leaders do not even want to acknowledge several serious and persisting problems in their proper context.
Another aspect that should be highlighted relates to how the more sensitive minds of the society are affected by the prevailing serious problems and distortions of society. The sensitive minds and noble thinking of many people, particularly younger people, may not be able to adjust to these distortions or the injustices behind them, and hence may show signs of withdrawing from such a society, or getting overwhelmed by them.
One response of society may be to refer to these sensitive and noble persons as being affected by mental disorders, as they are unable to adjust to the dominant social trends. Hence those who are possibly most capable of reforming and leading society may instead be condemned to various long-term treatments, including placement in asylums, till they are believed to be cured of their maladjustment or lack of adjustment to dominant social norms. The possibility that it is not these sensitive minds that need treatment, but instead it is the dominant social norms which may be wrong and unjust, is not even explored.
Hence a proper analysis of the mental health situation has the potential for gaining a much better understanding of the kind of social reform that is most needed. Given the importance of western countries and particularly the USA at world level, anything that contributes to a more just and stable western society should be helpful for the entire world.
It is with this perspective that certain questions are explored here. Does a mental health crisis exist in western countries, particularly among the younger people? If this is a reality, then how is it to be understood in better ways that can also show the path forward for reducing the associated distress and stress as well as wider social reform?
One of the more obvious responses to increasing mental stress has been to ask for a higher budget for treatment facilities, so it may be stated at the outset that mental health problems have been rising despite a significant rise in budgets for this in several western countries. According to the available data on the expenditure on mental health services in the USA, for instance, this increased rapidly from 147 billion dollars in 2009 to 238 billion dollars in 2020. A recent White House document (Reducing the Economic Burden of Unmet Mental Health Needs, May 31, 2022, hereafter referred to as the White House document) noted—“The federal government covers some of the costs of treating mental health disorders. Around $280 billion were spent on mental health services in 2020, about a quarter of which came from the US Medicaid program.”
The Health Care Cost Institute’s 2018 Report disclosed that per person spending on mental health admissions in the USA increased by 33% between 2014-18 while spending on outpatient psychiatry increased by 43%. Between 2007 and 2017 the percentage of medical claims associated with behavioral health more than doubled.
According to a report of the National Center for Health Statistics, USA, in the age group over 12 years, from 1988-94 to 2005-08, the use of anti-depressants increased by an astonishing 400%, with nearly 10% Americans using these medicines and as many as 23% of women in their 40s and 50s using these medicines. This trend continued to increase. In 2018 13.2% of US population over 12 years of age said that they had taken anti-depressants during the previous month.
Despite all these important trends of increase of mental health expenditure and increasing use of mental health medicines, however, mental health problems and disorders were being reported on an increasing scale, with the result that on the one hand expenditure on mental health increased but number of people not able to access treatment for mental health orders also increased. In the USA for instance, among the persons who need treatment for mental health orders about half are unable to access/afford this, according to official data. A study of 36,000 people stated that 62% of people who suffered from mood disorders, 76% of people who suffered from anxiety disorders and 81% of people who suffered from substance use disorders were not accessing treatment.
The number of people suffering from mental health disorders has gone on increasing over the years despite there being more medicines, increasing number of hospitals and related infra-structure. This increase is perhaps the most marked for the younger age groups.
The latest official statistics of ‘Youth Risk Behavior Survey’ (YRBS), USA, 2011-2021 released recently by the Centers for Disease Control and Prevention, (CDC) tell us that in year 2021 42% of US high school students “experienced persistent feelings of sadness or hopelessness”, up from 28% in 2011. In the case of female students, this percentage is even higher—in 2021 as many as 57% of female high school students experienced persistent feelings of sadness and hopelessness. Further, as many as 22% high school students in the USA “seriously considered attempting suicide”. Here also we see an overall increasing trend from 16% in 2011 to 22% in 2021. In the case of female students this number was as high as 30% in year 2021. In other words, almost one-third of female high school students in the USA were so distressed as to “seriously consider attempting suicide” during this year.
There have been several other indications of such disturbing trends, including the call given twice in recent times by top child health organizations in the country for declaring a mental health emergency for children, given the scale of these problems.
According to the White House document quoted above, “there are several indications that Americans were experiencing a mental health crisis prior to the pandemic”. Between 2008 and 2019, the percentage of adolescents ( age 12-17) that reported having experienced at least one major depressive episode in the past year increased by 90%, in the age-group 18-25 this increased by 81%. Suicide death rate in the age-group 10-24 increased by 47%. Disturbing trends have been starting very early in childhood. As the White House document tells us, approximately one in six US children aged as little as 2-8 years have a diagnosed mental, behavioral and development disorder. What is more, this document informed, one half of all lifetime cases of mental disorders are estimated to start before age 14.
According to the National Institute of Mental Health, USA, in 2021 in the age-group 18-25 years, 33.7 per cent of youth in the USA suffered from Any Mental Illness(AMI) while 11.4 per cent suffered from Serious Mental Illness(SMI), the latter being so defined as to include serious functional impairment of important life activities.
In Europe also there appears to be a somewhat similar trend of increase of mental health facilities and expenditure co-existing with increasing mental health problems, particularly in the context of the younger part of the population. A recent report on a new mental health initiative states that now nearly half of all young Europeans report poor mental health and depression has been increasing. A draft WHO report on ‘ Mental Health, Social Inclusion and Young People aged 18-29 in the WHO European Region’ says that as many as 64% of all young people are at risk of depression, and young people are between 30 to 80% more likely to report symptoms of depression or anxiety compared to adults. 71% of all suicides in Bulgaria are of young people, this report states.
This WHO report also tells us that in the pre-pandemic phase also the percentage of adolescents in 10-19 age group struggling with mental disorders was higher in Europe at 16.3% compared to 13.2% global average, and the situation worsened after this. The number of young women suffering from anxiety and depression is much higher than young men, while young men who commit suicide are many more than young women, this report says, while also informing us that mental health indicators for LGBTQ+ group are persistently and significantly worse, with as many as 13% attempting suicide in the previous year.
A very recent survey by Renew Europe found 59% of respondents stating that their mental health is ‘not great’ or is ‘bad’. 39% said their sleep experience is bad or very bad. According to statistics given in a report of UNICEF ‘On My Mind’, suicide is the second leading cause of death among young people in Europe and 3 adolescent lives are lost in Europe because of mental health problems every day. One in five European boys of 15-19 age group suffer from mental health disorders, as do 16% of girls. 9 million adolescents (age 10-19) are living with mental disorders in Europe, with anxiety and depression accounting for more than half of these, this report stated.
In UK a recent survey of mental health of children and young people found that in 2022 in England 18% of children in 7-16 age group and 22% of young people in 17-24 age group had a probable mental disorder. According to another survey 31% of women in the 16-24 years age-group showed evidence of depression and anxiety in 2017-18. A survey of 14 year girls in UK revealed 37% of them to be considering themselves very unhappy, worthless or unable to concentrate. In 2017 newspapers reported a 68% increase in hospital admission of girls less than 17 years of age due to self-harm related injuries (26% among boys). In May 2022 newspapers reported that 400,000 children and young people are being treated for mental health problems over a month.
In Sweden increase of mental health problems among young people reported in several studies has been summarized in a report titled ‘Mental health among youth in Sweden, Who is responsible, what is being done’, prepared by the Nordic Centre for Welfare and Social Issues. A study in 2006 found that the number of girls in age group 15-19 treated in hospital for depression increased by 8 times between 1980 and 2003. Another study in 2012 found that among 1000 students surveyed at school 7-8 level, 21% girls and 16% boys reported that they had harmed themselves more than five times in the previous six months. A study in 2013 found that hospitalization of self-harm and self-injury affected females was twice the number compared to males in 15-24 age group. In 2013 another study found that 32% of girls in 16-24 age group reported experiencing anxiety, worry and angst quite regularly, compared to 19% boys. Another study this year stated that 40% of young people had felt stressed several days a week or all days during the previous six months—51% among females and 29% among males.
High levels of alcohol and drug use were reported among youth. Europe has the highest per capita alcohol consumption in world, starting at a very young age. At the age of 16, 90 per cent have consumed alcohol while 23% indulge in binge drinking three times in a month. In the USA 80% of young people consume alcohol, while 50% of this number indulges in binge drinking. Alcohol use among youth results in over a million injuries in a year. 20% of youth meet the criteria of Alcohol Use Disorder. 4,777 youth in USA in a year die from illegal drug overdose. Young people show increasing trend of drinking hard liquor and getting drunk.
When mental health problems go on increasing even after years of substantially increasing treatment facilities, clearly we need to move from just individual diagnosis to also social diagnosis. Of course good mental health facilities and the invaluable help given by brilliant specialists should continue to increase, but in addition there should be social examination and remedial action based on this too.
To give an example of what may be at work, schizophrenia is a mental illness often defined in terms of big disconnect with reality, or very strange/abnormal interpretation of reality leading to strange behavior patterns. But then hasn’t USA policy , when it pursued relentless wars in the name of peace, or when it toppled democratic regimes and installed or supported dictatorial ones while chanting the mantra of democracy all the time, itself been repeatedly schizophrenic? Or even in domestic policies, while talking all the time of the welfare of ‘the American people’, have not policies actually led to decline of welfare of the genuinely needy sections by deliberately increasing inequalities and gifting big gains to the richest billionaires, again displaying a schizophrenic streak.
The social diagnosis should not fight shy of such difficult issues, and it should examine deeply the hypocrisy, the double-speak, the glaring difference between the stated ethical norms and reality. In terms of sincere remedial actions, it should suggest ethical values which should guide national life and policy.
In particular, as pointed out earlier, we should look at the possibility that there is nothing wrong with several persons, particularly idealist youth, who under the prevailing system may exhibit withdrawal symptoms or may show signs of not being able to adjust to prevailing social norms. In many such cases it is not such individuals who are mentally ill, it is the social system that is very ill so that the more spiritually and ethically healthy citizens are finding it difficult to adjust with the diseased social system. It is the system that needs medicine, which may be wrongly administered many times to the more enlightened individuals.
Most western countries rightly talk about a justice and just rules based world order, about care and compassion for all poor and weak people, about protection of human rights, about worldwide promotion of democracy and protection of environment, about firm commitment to peace and disarmament, but the reality differs very much from this. The USA-led west moves more often in an opposite direction. In this, more often than not, Europe follows the USA, whether it is the invasion of Iraq or the proxy war of Ukraine. When it comes to exploiting most other countries in matters of trade or patents or investment or resources, again it is the same selfish reality traced back to colonial times, but repeatedly dressed up as aid and help. Such selfish, deceitful external policies invariably give dominant internal roles also to those elites, billionaires and politicians who by habit also use deceit with large numbers of their own people too, although taking care to try and win elections in some way or the other.
All this makes it very difficult, if not impossible to create a society based on ethics and truth, peace and stability. In fact USA led western alliances or forces have very frequently toppled or destroyed or harmed those efforts in several countries which tried to create societies based on equality and justice, whether in Nicaragua or Venezuela, or in Congo or Chile, or in Bolivia or Brazil, or in many other countries, while lending support to some of the worst and most cruel dictators and their regimes, while all the time speaking of promoting justice and democracy and human rights. A very strange situation has arisen, in which best-intentioned citizens who wish to serve their country as soldiers or diplomats, or even as trade or technology officials, are often pushed into roles which are exploitative and unjust towards the poor and weak people of world, something that can be confirmed from an unbiased study of wars and military interventions, trade and investment policies, export of hazardous technologies and products, violence and deceit used for control of energy and mineral resources, relentless support provided by governments for corporations known for their plunder and exploitation.
This is the wider reality of western society which creates a base of hypocrisy and duplicity. It is very difficult to create a society based on ethics and truth in such circumstances. Many individuals may desire this but they feel overwhelmed by more powerful forces.
When we look at the crisis of mental health within these wider realities, we realize that while the experts should of course continue to make their valuable contributions to reducing stress and distress, in addition much bigger changes in society are needed which can create a strong base of ethics and truth. Briefly, what is needed for western society is to be at peace with itself a well at peace with the rest of the world. Internal and external peace and stability are related much more closely than is generally realized, and this has been the missing dimension of several well-intentioned western efforts to reduce not just mental health problems but also several other social problems including substance abuse, racism, crime and violence including gun violence and gender violence. When injustice and violence are inflicted externally, this invariably leads also to internal violence and instability. In any acts of dominance and violence, victims suffer but perpetrators also suffer—directly or indirectly, sooner or later. So the west should aim to achieve a harmony of internal and external peace with justice, which can bring true happiness to its people while also paving its path for an enlightened leadership role.
Note of caution–For anyone having depressive thoughts helplines and other help are available.
Bharat Dogra is Honorary Convener, Campaign to Save Earth Now. His recent books include Protecting Earth for Children, Planet in Peril, Earth without Borders and A Day in 2071.