UCL News


Opinion: Mental health is a care we must share

14 October 2019

Professor Peter Fonagy, Head of UCL Psychology & Language Sciences, writes about how wide social networks can help to shield people from mental disorder, arguing that we should celebrate this collective responsibility.

Peter Fonagy

The government published its first national review of children and young people’s mental wellbeing on 10 October, World Mental Health Day. The report found that four out of five children are happy with their lives. Or, more worryingly, that one in five are not.

But what lies behind these figures? Between 2012 and 2018, the number of children and young people referred for mental health treatment increased by about two-thirds. The number of university students reporting a mental health problem rose fivefold over the same period. How can we understand these dramatic increases? Has there been an actual rise in mental disorder?

In fact, reports of a rise in mental health problems are for the most part exaggerated: the prevalence of mental disorder in five- to 15-year-olds has increased, but only by 16% in the past 20 years, although the increase for emotional disorders for young women aged 16-24 is far higher.

The most likely explanation is that in recent years we have become better at expressing our thoughts, feelings, beliefs, wishes and desires and have passed this on to our children. Describing our mental states helps us, as a society, to collaborate, allows us to share our emotional experience and to build social support. This has tremendous benefits for mental health and wellbeing. People who are not able to collaborate are much more likely to express their difficulties through physical illness or anger.

Having a language for our emotional experiences enables us to share them and helps us feel less alone. Decades of research confirm that social support has tremendous benefits for mental health. The presence of others, particularly adults, makes a critical difference to a child’s ability to deal with adversity. Adversity is ubiquitous, but it becomes traumatic when we feel we are alone. Without social support, we are deprived of our most powerful source of protection: someone who can help us mitigate the threat we feel not just from the outside world, but from within ourselves.

Many of us can recall feeling as children that there was no choice but to suffer in silence. Today our healthcare system has highly effective treatments and ever-increasing numbers benefit from effective evidence-based therapies. Yet people who experience severe anxiety often wait a decade or more before presenting to mental health services. Healthcare cannot be the only answer.

Our social nature as a species holds one of the keys. Loneliness and isolation amplify mental health problems and “feeling like the only one with a problem” is characteristic of any severe condition. It’s like being in an echo chamber in which our feeling of isolation is constantly reinforced. That’s why connecting to others is so critical.

The networks of social connections we develop through childhood, adolescence and adulthood can help to shield us against mental disorder. A recent study from Michigan University which followed up eight- to 10-year-olds after 23 years concluded that a very close family may protect a young child but the same family structure makes an older person, a young adult or a mature adult vulnerable to unhappiness. It seems that the close family becomes less advantageous as the child matures.

This may be because, as children grow, they need experience of broader social networks, but in recent decades our culture has tended to emphasise the importance of the parent-child relationship and the nuclear family.

In non-western cultures, children are brought up to be more sensitised to attend to others’ wishes and interests. However, research has prioritised the western-educated, industrialised, rich and democratic world, with 12% of the world’s population but 96% of research findings. This narrow focus has contributed to a lack of attention to the importance of communities in bringing up a child. Parenting is the hardest job in the world. It is also a job for which no qualifications are required. In order to do a good job of raising children, parents need support from the communities around them.

Poor mental health is not simply in our individual minds. It is part of a social condition. We are collectively responsible for each other’s mental health. And, conversely, we can support those around us who are experiencing distress by being available and empathic. World Mental Health Day should be an opportunity to learn from a more global experience and celebrate this collective responsibility.

This article was first published in The Observer on 13 October 2019.

Professor Fonagy is also CEO of the Anna Freud National Centre for Children and Families.