As I drove home from a recent night out, a young woman stumbled out of the darkness into the road ahead of me. She was extremely distressed so I offered to drive her home. During our journey, Lara* told me that her dad hated her and that she was totally devastated by this.
On the face of it, this was perhaps little more than a commonplace tale of drunken young adult angst. But then Lara, 21, revealed that she was constantly burdened by black thoughts and had tried to commit suicide by overdosing only a few months before. She'd tried speaking to friends, she'd had some short-term counselling and had rung helplines in desperation a few times but "I still feel like I'm getting nowhere."
Since then I've thought a lot about Lara. Lara who is old enough to be out on her own in the dead of night after drinking with friends yet not yet old enough to have the financial means, the political clout, the life experience and relevant social connections to do anything constructive about her immense sadness.
Old enough to be burdened by the pressures of modern life & to see suicide as a real option but not young enough that anyone in authority would scoop her up and say, 'This shouldn't be happening - we can help you!' Lara who has cried for help in several ways but still, it seems, isn't being heard.
At 21, Lara is, of course, legally an adult. She can vote, get a mortgage, get married, even adopt a child. But it is globally recognised that girls like Lara aren't yet fully-fledged grown-ups. The World Health Organization classifies those between the ages of 10 and 24 as young adolescents and young people. A 2000 study by Dr Jeffrey Jensen Arnett goes even further. He coined the phrase 'emerging adults' to describe those between 18 and 29 years old - the years between 'late teen' and 'independence'.
Perhaps it's because of this dichotomy - not young yet not old - that when it comes to mental health issues, this age group seems to fall through the net. A 2007 study published in The Lancet reported that mental disorders such as anxiety and depression account for a large proportion of the disease burden in young people in all societies, with most mental disorders (including depression, bipolar disorder & schizophrenia) beginning between the ages of 12 and 24.
Yet despite this, the study's authors said that 'most mental health needs in young people are unmet, even in high income countries'. And recently, a new survey by the Channel 4 show Embarrassing Bodies has revealed that 18-30 year olds are more likely to suffer from anxiety & depression than people in any other age range.
So what is going wrong and what can we do about it?
* Not her real name
WHAT ARE THE UNIQUE PROBLEMS FACING YOUNG ADULTS?
They are embarking upon the most complicated time in a human's life
Dr Melissa Deuter is a Texas-based psychiatrist and expert in the mental health of emerging adults. She says,"When young adults leave home for education or work, they are beginning a new life: new school, living in a new home, taking on responsibilities for the running of their entire lives for the first time, falling in love, beginning careers - all while trying to develop a self-identity. It may be the most complicated time in any person's life." Dr Ian Drever, consultant psychiatrist at The Priory Woking, agrees - "And all this without a great deal of life experience of having had the opportunity to learn psychological strategies for dealing with these stresses."
They are misunderstood
"Young adults are often not getting the care they need," says Dr Deuter. "They are certainly vulnerable because they fall in between childhood and adulthood and professionals seem to have trouble understanding what is 'normal' for young people - culturally, socially or behaviourally. Also, "because rough and rowdy youthful behaviour and emotional intensity can be typical in young people, young adults may believe their genuine symptoms are normal," adds Dr Deuter.
Psychiatrists aren't always qualified to treat them
Many psychiatrists feel ill-equipped to deal with this age group and so tend to stick to treating adults, leaving gaps in care provision. "When psychiatrists welcome young adults into their care, unfortunately they may still be unqualified to treat them," says Dr Deuter. "Many of my patients complain that child psychiatrists and child psychologists treat them like infants, while professionals who treat primarily adults do not address them with respect. It's easy for young patients to become disillusioned with their care."
They are falling through the care net
Jenifer Phillips, of the YoungMinds charity, says: "Transition from child and adolescent mental health services (CAMHS) to adult services (AMHS) is a notoriously challenging time. There is not necessarily a smooth transfer from CAMHS to AMHS - the threshold for treatment is higher for adult services than for CAMHS, so a young person may previously have received help but not be eligible for help under AMHS. This can lead to issues being left until they reach a higher level of concern and severity."
Drastic budget cuts have been made
Research by YoungMinds found that 34 out of 51 local authorities in England have reduced their CAMHS budget since 2010, with one council reporting a drop of 41 per cent since that time.
Age-appropriate research studies are needed
In addition to posing a difficult group to understand socially, culturally and behaviourally, young adults can pose a pharmacological difficulty, too. This is partly because neuroscience shows that brain development is ongoing until the mid twenties (closer to thirty in some individuals). Psychiatric medication studies are conducted on groups of 18-65 year olds, but Dr Deuter says we have good reason to question this practice. "A young adult brain may not respond to medications like a middle-aged or elderly brain," she says. "When it comes to research, studies should encompass the period from puberty to adult brain stage, in line with the state of knowledge about brain maturity. Then we could develop safer, more effective treatments for young people."
Young adults find other ways to 'cope'
Dr Drever says: "As well as being overlooked, mental health-wise, this age group may also be somewhat reluctant to come forward, or be more likely not to seek help but to drown their emotions in alcohol, drugs, or chaotic or destructive behaviour." But these actions are either temporary fixes or may even worsen mental ill-health.
WHAT CAN WE DO TO HELP YOUNG ADULTS?
• Make it easier for young adults to find appropriate help
Dr Drever says: "Finding child and adolescent psychiatrists and psychologists is very difficult - they're a rare breed, indeed. And if I find it difficult to locate appropriate professionals, imagine how difficult it must be from the young person's point of view!"
• More 'joined-up' help
Jenifer Phillips, of YoungMinds, says: "At this stage of life there is often a lot going on for a young person and this should be taken into account with support being accessible, joined-up and readily available should it be required."
• A more flexible assessment of a young adult's mental health service needs
Dr Ian Drever says: "Probably the greatest systemic change will be to develop something more flexible than the arbitrary line which determines whether someone uses a child/adolescent service, based entirely on chronological age. This needs to be something which looks at a range of factors around emotional maturity."
• More impartial research into mental health for young adults
"By impartial I mean not funded by big pharma," says Dr Deuter. "We need sensible research, based on the state of knowledge of science, rather than based on tradition or convenience."
• Talk or write about the issues
The more we do this, the more the unique mental health needs of young adults will be acknowledged. Dr Deuter says: "The other thing to do is donate time and money to raising awareness, decreasing stigma and improving care." If you're a young person and want to share your story (or read about other young people's experiences) visit the Real Life section of the YoungMinds website. Or why not read blogs - or blog yourself - at the Time To Change website?
• Seek appropriate help online
Beth Murphy, head of information at Mind, says: "Social media can have both a positive and negative impact on mental health. We have all heard of cyberbullying and we know that there are websites that encourage people to harm themselves or worse. But often those we interact with on social media can also be the part of our support network and help us to better manage or cope with our mental health problems."
WHERE TO GO NEXT
If you are a young adult or someone who is worried about a young adult, here are some useful contacts:
YoungMinds has a fantastic website with a range of resources for young people, parents and carers, and professionals. It has also just launched Headmeds, a website for young people about mental health medication.
Elefriends. Mind has an online community called Elefriends where people come together to talk about their experiences and support each other.
Get Connectedis the UK's free, confidential helpline service for young people under 25 who need help but don't know where to turn. Freephone 0808 808 4994 Text 80849
SupportLine offers confidential emotional support to children, young adults and adults. Helpline 01708 765200 or email email@example.com
The Samaritans can offer help 24/7. Call 08457 909090
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