Why are we still talking about broken brains and not broken circumstances?

Written by Francesca Keynton, SOHK Behaviour Specialist

I have had the privilege of working with young people for over 20 years, seven of those within the School of Hard Knocks charity, and I have seen first hand the rise of the mental health crisis within our young people. In fact, since COVID it has been referred to as an epidemic. As a charity, our disclosures have risen dramatically over the past two years and we are now dealing with young people in crisis on a weekly basis. 

In September 2022 there were 1.6 million people on waiting lists for mental health services, while another 8 million needing help can’t even get on these lists. Children are showing up at A&E in despair, wanting to die. In the areas I work in London, CAMHS (Child and Adolescent Mental Health Service) has a waiting time of 18 months to 2 years, and that is for young people who are actually experiencing suicidal thoughts and therefore meet the ‘crisis’ threshold. 

I recently read an article written by the psychologist Dr Sanah Ahsan, and I instantly felt a huge connection to what she was saying. The article is Headlined “I’m a psychologist – and I believe we’ve been told devastating lies about mental health”. It demonstrates how we are failing people by locating their problems within themselves rather than looking at the external reasons as to why someone may feel low or depressed. She uses this wonderful analogy: “If a plant were wilting we wouldn’t diagnose it with “wilting-plant-syndrome” – we would change its conditions. Yet when humans are suffering under unliveable conditions, we’re told something is wrong with us, and expected to keep pushing through. To keep working and producing, without acknowledging our hurt.” 

Doesn’t it make sense that so many young people are suffering? Of course it does - they are living in a traumatising and uncertain world. They live in a high-pressure, highly exposing digital world, where everything is instant. Parents are trying to stay on top of rising living costs, whilst revelations about the police murdering women and strip-searching children shatter their faith in those who are supposed to protect them.

A large part of my role at the charity is to listen to the lives of the young people, and hear their stories:

One is of a 13 year old boy who, at the age of 9, made it from Ethiopia with his brother and pregnant mother, hiding in trucks at the borders, living in refugee camps before making it to Calais. He arrived in England speaking no English at all and spent two nights camped out in Norbury Council Offices before finally being housed in one of the most notorious social housing blocks in South London. A few weeks later his neighbour on the left murdered his neighbour to the right. 

Another is of an 11 year old who has not seen her mother since her mother was sent back to Kenya by her father when she was two. Her father works away a lot and goes back to Kenya for months at a time. She is left at home alone, and when her father goes to Kenya she is ‘looked after’ by an Uncle whom she is made to wait on and cook and clean for, as this is part of her culture.

 I could go on… 

How helpful is it for these young people to be placed on a two-year waiting list for mental health services? They need an effective response now. Last year a 15 year old student was placed on our programme due to her low moods and disengagement at school. Once I had listened to her circumstances it was clear that having to share a bed with her mum was severely affecting her mood. As a charity we were able to respond quickly, and get her, her own bed. This improved her situation significantly. We at SOHK speak a lot about our 5Cs – one of which is control. We teach our young people to focus on things that they can control within their lives, but sometimes external intervention is essential. How would a CBT (cognitive behaviour therapy) approach, designed to target “unhelpful” thinking styles, have helped this young woman to feel more positive?  

---

There are many campaigns trying to destigmatise mental distress; “mental illness” is framed as an “illness like any other” – rooted in supposedly flawed brain chemistry. I often see phrases such as ‘’we can help you manage your condition” and “we can help you recover”. These approaches place the emphasis back on the young person as being the cause of their “condition”. 

The suggestion of a broken brain increases disempowerment and the danger of being stigmatised. What’s most devastating about this myth is that the problem and the solution are positioned in the person, distracting us from the environments that often cause their distress. In reality, recent research has concluded that most forms of depression are not caused by a chemical imbalance of the brain.

 In her summary Dr. Ahsan explains,

“For too long, the dominant narrative locates problems in individuals, medicalises them and leaves people feeling helpless, ill and stigmatised. It is as though they are defective, and not positive and resilient enough. This lie affects people from all walks of life, but most severely those who are already disenfranchised through poverty and inequality.” 

So is there another way to see this crisis – one that doesn’t place it firmly in the realm of GPs and CAMHS?

What if there was a solution, sitting right under our noses? What if, early on, before their circumstances lead to crisis, we just listened to young people, heard their issues and worked in a focused manner to support them in what they are facing. Instead, when we hear highly emotive and highly charged phrases such as self-harm, depression or eating disorders we instantly place them on yet another waiting list and leave them. 

We know that lack of time for staff in schools is a major issue. No one has time to sit and listen to these young people. In fact, staff are always shocked when I retell the experiences that some of the young people are facing. One school even joked that I have ‘a gift’ that gets young people to open up, but in fact what I have, is the time to empathise and listen. I believe the charity sector could fulfil this role and mend the gaping hole in early mental health help for these young people. We have the training, time and ethos to meet this need.

I am lucky in the job that I do, to genuinely feel I make a difference. People often say to me ‘how do you do what you do?’ The answer is very simple: I listen, and when I say listen, I mean truly listen rather than just hear. Then once I have listened, I ask questions to gain deeper knowledge. I then retain this so that I can return to the conversation a week later.  Through these chats we identify areas of possible concern, areas of strength and future goals. The power of these conversations can be life changing for the young people.

Schools are excellent at base line testing students academically, but what about emotionally; what if, as part of their transition into every year, young people had the opportunity to sit and talk to a trusted adult? Talk to someone whose time isn’t limited, who shows empathy and a desire to listen. Imagine how many young people we could stop reaching that ‘crisis’ threshold - and how much money we would save the NHS and schools if charities were asked to fill this gap.