All or nothing?

Public discussion assumes repeatedly that adolescent mental disorders are constantly increasing. In fact, no such evidence is provided by epidemiological studies. Research among adolescent populations has not demonstrated systematic increasing trends in either internalizing or externalizing disorders. As to Finnish adolescents, some problem behaviours that on more severe end merge with diagnosable disorders, such as antisocial activity and substance use,  have actually shown a decreasing trend over 2000’s.

However, request for mental health services is increasing. For example in our hospital district, all the municipalities have over past ten years established some specific adolescent mental health service, and all these services are maximally utilized all the time. Despite that, the number of referrals to specialist level adolescent psychiatric services provided by the hospital district is increasing all the time. It appears that the more services are offered, the more needs are recognized.

Does this mean that most adolescents with mental disorders earlier remained untreated, and if so, how did they manage? If services are increased accordingly, shall we finally reach a steady state where all in need are appropriately treated, or will request of services continue increasing with presentation of milder problems?  So far the increased request has not been due to milder problems entering services. Our recent evaluation showed that adolescent psychiatric patients are as ill now as they were 10 years ago.

The School Health Promotion Survey of the National Institute of Health and Welfare offers a unique possibility to observe changes in health and well-being of adolescent population in Finland. In Tampere, our own Adolescent Mental Health Cohort Study’s 10 year replication adds more specifically mental health focused information

The results of these surveys demonstrate that there are no alarming increases in psychosocial risk factors for mental disorders either. More adolescents than before report that their parents are positively involved in the adolescents’ lives, know their friends and whereabouts and are available for the adolescent to talk seriously, and adolescents report no alarming increases in parental substance use behaviours. Less and less feel marginalized in school.

Why, then, are more and more services needed? Has something changed in a way that it is more difficult to cope if you have mental health problems?

Finnish society has been concerned about too much rigidity and too little opportunities. Numerous witnesses have stood out to speak about the anxieties related to narrow options, predefined paths, obligation to comply with rigid social norms. But what about anxieties growing from too open options, and obligation to create yourself again every day, to take responsibility of navigating without any fixed coordinates? If the previous generations felt that they had too fixed coordinates, does the current generation have to live without support from any, and how does this influence the development of personality and identity? Too much pursuit of individuality may end up in detachment and isolation. May be the obligation to be special, individual and different every day is becoming a new lack of opportunity: ideal that is too far to reach, so why bother trying at all.