Quickly more hospitals!

Referrals to adolescent psychiatric services have suddenly increased with about a third throughout Finland. Epidemiological studies, however, do not support the assumption that adolescent mental health disorders would be increasing in prevalence in Finland or elsewhere, particularly not all of a sudden.

Perhaps this is positive – destigmatization of psychiatric problems has succeeded and people dare ask for help? But how can the population have survived until these days with all that morbidity untreated?

Or may be services are simply fulfilling their own mission to grow. If there is a service, there will be service users. If there are service users, more resources are needed. If there are more resources, more service users are welcome. If there are service users…

Then it could also be that the society is medicalizing normative developmental phenomena. Adolescents attempt to bend rules and test limits, and also normatively keep swinging from elation to despair. Anyone who is moving has ADHD, anyone who is not on the move has depression?
Parenting is suggested to have changed in a way that produces adolescent mental health problems. Parents may no more be competent or willing to act as parents. Instead they act as friends, unless they act as children and place too much responsibility on the shoulders of the adolescents. This coud be due to work life being too demanding and taking all the energy of parents. On the other hand, parents nowadays are lost in social media and do not interact with their children.

It has been suggested that with increasing submersion to online world and constant connection to everybody in social media, adolescents are more lonely than ever, and have ample opportunity to feel inferior and excluded when all others appear to have a super cool life together.

Personally, I think that certain changes in school world and work life play an important role. School and work demands more and more social competencies and self-direction. Planning your individual learning path and going to a different room with different peers and a different teacher for every class may offer choice and opportunities for those who are healthy and intelligent, but for those with less competencies and developmental difficulties it offers a chaotic experience and ample opportunities to fall out. There are further no low threshold jobs any more. Uncomplicated jobs with predictable routines and little change may sound boring and unambitious to some, but if you cannot tolerate constant change, perhaps don’t have social skills to connect with everybody every day, or struggle with anxieties, routine job could offer safety, not to mention dignity.

However, even that favourite explanation of mine does not explain the sudden increase in referrals in past two years. It happens to be exactly those two years we have used intensively planning the perfect new order of all services to children, adolescents and families, where co-operation between all possible actors will be perfectly seamless and all will be offered support (naturally evidence-based) so early that psychiatric disrders will be prevented altogether. What if we have created a discourse that results in professionals recognizing mental health needs everywhere, and feeling so insecure about their own competence that they cannot but refer?