‘Tip of the iceberg’
Talks to Sir Peter Gluckman about his grave concerns over teenagers’ mental health
New Zealand is facing another pandemic of “overwhelming magnitude” as the numbers of children and teenagers with poor mental wellbeing increase, one of the country’s most influential scientists has warned.
Sir Peter Gluckman, a leading paediatrician and former adviser to National and Labour governments, says the breakdown of child and adolescent mental health services exposed by the Weekend Herald is a product of a bigger crisis among young people that has been brewing for years and amplified by Covid-19.
“That’s the tip of the iceberg,” Gluckman says, referring to an investigation that last week revealed how specialist mental health services across the country are crumbling as more young people seek help for serious mental conditions.
Rising numbers of children and teens experiencing depression, anxiety, eating disorders, self-harm and other major problems is the sharp end of a wider issue, Gluckman says: many more young people now have poorer emotional wellbeing, and are less psychologically resilient, than previous generations.
“The real pandemic that is emerging is this pandemic of loss of subjective wellbeing in that critical stage of life, adolescence, which is affecting 25 to 40 per cent of Western populations,” Gluckman told the Weekend Herald from Paris, where he chairs the International Science Council, a non-governmental organisation.
While more young people are experiencing serious mental health problems, there’s a much larger group who don’t have a diagnosable clinical problem but are struggling to cope with stress in ways that could profoundly affect their education, health, relationships and futures.
Rates of young people with poor emotional wellbeing have doubled or tripled in recent years, depending on which data you look at, Gluckman says.
In New Zealand, the latest version of the national Youth2000 survey, carried out in 2019, found that the rate of secondary students with symptoms of depression rose from 13 per cent to 23 per cent in seven years.
“All these surveys are showing exactly the same trends,” Gluckman says.
It is happening across high-income countries — “New Zealand is not standing out here as being particularly different” — for reasons that are not yet well understood.
“Social media, smartphones and other technological advances are often blamed, but experts believe a host of complex, interrelated factors are at play, including changes in how children are brought up and increased stress on parents.
“The stresses of childhood and adolescence are now far greater than they were 50 years ago,” Gluckman says — but young people have not been given the emotional resilience early in life to be able to cope with those pressures.
Gluckman is so concerned about the rising tide of mental distress that he rates it as one of the biggest risks the world faces, up there with infectious diseases, violent conflicts and climate change.
And yet he doesn’t think any government is responding to the problem with sufficient urgency — including New Zealand’s.
“The issues of young people’s mental health are going to overwhelm every country,” Gluckman says. “Just overwhelm them.”
The Weekend Herald’s investigation found that child and adolescent mental health services run by district health boards across the country are more stretched than ever after the Covid-19 outbreak, with some reaching “crisis point”.
Interviews with people across the sector and documents obtained from numerous health authorities showed that a surge in referrals and drastic shortages of skilled clinicians has undermined the quality of care, putting patients at risk and causing staff to burn out.
“This has been an orphan service for 30 years,” Gluckman says.
But while he agrees more investment and recruitment are needed in specialist mental health services for the people who desperately need treatment, he argues that alone will not come close to resolving the crisis.
Improvements to services, he says, must be accompanied by an enormous increase in the amount of attention and funding given to prevention and early intervention, to stop mental health problems developing in young people in the first place.
This includes more support for pregnant mothers, improved early childhood education, teaching resilience in schools, using digital technology to deliver therapy, and restricting the availability of alcohol to young people.
“Nobody is showing an interest in doing the proper work that needs to be done to understand the factors in play,” Gluckman says.
“It’s all very well to say we need more psychologists or counsellors — and don’t get me wrong, we need them for the kids who are falling off the cliff, of course we do — but we’ve got to stop people getting to the edge of the cliff.”
“There’s not really much thinking going on in New Zealand about preventative mental health for young people,” he adds. “And that’s a much more complex and yet more urgent issue.”
In its 2019 Wellbeing Budget, Labour made “taking mental health seriously” a top policy priority and allocated $1.9 billion to the sector.
Its main policy in the area is the “Access and Choice” initiative, which provides early intervention in primary care settings for people with mild or moderate mental health difficulties.
Gluckman did not specifically criticise
Social media, smartphones and other technological advances are often blamed, but experts believe a host of complex, interrelated factors are at play.
the policy, but said the government’s overall approach to mental health — like that of its predecessors — has been too narrow. “I think every government, whether it’s left or right, [ Jacinda] Ardern, [ John] Key, [Bill] English, [Helen] Clark, whatever, they always want to be seen to make singular programmes that work.”
“We remain superficially focused on quick wins,” he says.
Resolving the mental health crisis, Gluckman says, will require a concerted, bipartisan effort across all government departments for several decades, spanning prevention, early intervention and treatment. It will be difficult, he says — there is not a “silver bullet” — but it is achievable.
“It’s a systems approach. It’s not just health, it’s education, it’s social welfare, it’s housing, it’s justice, it’s alcohol reform.
“There’s a lot of areas that are part of it. If you just look at health alone, we will not solve the problem.”
“It’s just like climate change,” Gluckman adds. “If you just focus on methane production from cows, you’re not going to solve the problem.”
Gluckman, who now runs the think tank Koi Tu¯: The Centre for Informed Futures at the University of Auckland, was National’s chief science adviser for nearly a decade. In 2017, near the end of his term, he published a report calling for a crossgovernment approach to mental health that warned New Zealand as a whole did not grasp the severity of the problem. And it still doesn’t, he believes.
“I think the magnitude of the problem is still grossly underestimated,” he says.
“And the implications for the longterm health of New Zealand society are grossly underestimated.”