Recognising a mental illness in teenagers

Teenagers are particularly at risk of developing mental health problems. The proportion of those affected has risen in recent decades. For every six teenagers, approximately one teenager develops a mental health problem that can affect school, relationships and their quality of life. Unfortunately, many teenagers are not diagnosed and do not receive treatment.

Being diagnosed with a mental health disorder can be a difficult and lengthy process. Young people may be reluctant to seek help because of the stigma attached to mental health problems. They may face financial barriers due to the cost of travelling to support services. And once they have decided to accept professional help, they are confronted with long waiting lists.

Symptoms of mental health problems, such as depression and anxiety disorders, often overlap.

What happens when a young person overcomes all these hurdles and reaches a specialist? Clinical psychologists usually use a diagnostic manual that categorises psychological problems based on certain symptoms and draws clear boundaries between the various diagnoses. A professional who assumes that a young person has a generalised anxiety disorder will assess them based on the criteria for this diagnosis. But they are unlikely to ask about symptoms of depression, even though the young person may be suffering from these symptoms. This «taxonomic» approach is useful in that it gives researchers and clinical therapists a common language when discussing the mental health problems of teenagers.

One diagnosis - many different courses

However, diagnostic categories cannot capture the complexity of a young person's unique experiences and needs. For example, depression can change a young person's appetite, causing them to eat more or less than usual. For others, depression can disrupt sleep patterns, making them feel constantly exhausted and impairing their ability to concentrate. In addition, the symptoms of mental health problems often overlap - for example, certain symptoms of depression are often also found in anxiety disorders. In addition, changes in sleep patterns are not uncommon during puberty, which makes it difficult to recognise the causes of certain symptoms. As a result, parents, teachers and professionals can struggle to understand the cause of a young person's problems and provide the appropriate support.

A new approach to understanding mental health problems

Researchers and clinical professionals have begun to adopt a new «transdiagnostic» approach, rather than focussing on specific diagnoses. This means moving the focus away from the symptoms of specific diagnoses and instead trying to identify and treat the underlying factors that exacerbate mental health difficulties. Specialists can, for example, clarify whether mental health problems run in the family. Or look for other factors such as high levels of stress, trauma, physical illness or dysfunctional family life.

This perspective recognises that mental health problems manifest themselves differently in every young person. And that each person can also suffer from more than one mental health problem. It also encourages more individualised treatment, based not just on a diagnosis, but on an open discussion of an individual's very personal experiences.

The complex changes that teenagers go through affect mood, sleep, appetite and performance at school. These changes are not necessarily a sign of mental health problems. However, if they persist or worsen over time, the teenager is likely to need the support of a professional. If mental health is viewed as a spectrum rather than categorised in specific ways, it is easier to distinguish between normal mood swings and mental health problems.

Learning the ability to recognise feelings

Given the benefits of this transdiagnostic approach, we have integrated it into our own support services for teenagers. We have developed a new type of mental health intervention, the Reset programme, for teenagers who may be at risk of developing mental health problems. Instead of focussing on different diagnoses, we focus on common causes of multiple mental health problems. In this programme, participants learn skills to recognise and manage emotions and build healthy relationships.

By focussing less on rigid diagnostic categories, individual needs can be better addressed.

We have chosen to focus on emotional processing skills and positive social relationships because these contribute to resilience against a range of mental health problems. We hope that training in these areas during this important developmental phase will prevent the onset or exacerbation of mental health problems.

The transdiagnostic approach changes our understanding and treatment of mental health problems. By focussing on common causes rather than rigid diagnostic categories, we can treat individual needs. We hope that interventions like ours, which take a transdiagnostic perspective, will equip young people with the skills and resilience they need to stay mentally healthy.