Thrown off track

It was a sad first reported by the Federal Statistical Office (FSO) at the end of 2022: for the first time, mental disorders were the most common reason for inpatient hospitalisation among 10 to 24-year-olds - more frequently than injuries, accidents or physical illnesses. The main reasons were depression and anxiety disorders.

For girls and young women in this age group, the number of hospitalisations for mental health reasons increased by 30 percent between 2020 and the end of 2021 compared to the previous year - «an unprecedented increase», writes the FSO. Among boys and male adolescents, the increase was 6 per cent. In 2021 alone, the FSO counted around 20,000 inpatient stays. This affected 13,000 children and adolescents who spent an average of 27 days in hospital due to mental health problems. Data for 2022 is still pending, but is likely to indicate little improvement.

A life is narrowly saved every two days

Around 120 children and young people contact Pro Juventute's Counselling + Help 147 directly with their concerns every day. The telephone hotline is the most frequently used channel, as well as chat, email and text messages. «Our counselling workload has increased by 40 per cent since 2020,» says Lulzana Musliu, Head of Policy and Media Relations at Pro Juventute. «Calls are taking longer because children and young people have increasingly complex issues. Some are burdened by multiple problems that require a lot of time.»

It also happens that counsellors have to pull the ripcord and call the ambulance or police because young people express concrete suicidal intentions. The vast majority of such crisis interventions are carried out with the consent of the young people, who voluntarily place themselves in the care of the emergency services. While Pro Juventute counted 57 such crisis interventions across Switzerland in 2019, last year the figure was 161. A life is saved at the last moment around every two days.

What is going wrong that has led to the «unprecedented increase» in the number of patients in child and adolescent psychiatric centres? Why are so many girls and young women among them? And what can parents do to strengthen their children's psyche?

The search for clues begins with a realisation that is considered certain: the current development cannot be explained solely by the coronavirus pandemic. Rather, it has highlighted problems that were previously hidden from the public eye and then acted as an accelerant. «Since around 2010, we have observed an increasing need for diagnostics and treatment,» says Oliver Bilke-Hentsch, Head Physician at the Child and Adolescent Psychiatric Service of Lucerne Psychiatry, «which increased again from 2017.»

During the pandemic, many children and young people lost the emotional support of adult carers because they were under pressure themselves.

Alain Di Gallo, Head of Psychiatry

Alain Di Gallo, Head Physician at the Clinic for Children and Adolescents at the University Psychiatric Clinics in Basel, reports a similar story. «During the pandemic, many children and adolescents lost the emotional support of adult carers because they were under pressure themselves,» he says. «This challenged us to an unprecedented extent and continues to have an impact. But it's also a fact that the use of outpatient centres and clinics was already increasing before the pandemic.»

Data from the FSO also shows that the number of mental health-related hospitalisations among 10 to 24-year-olds has been rising by around 3 percent annually since 2012.

One indicator that provides information about the emotional well-being of children and young people is their perception of stress. What causes stress in young people? A question for a youth exchange group that meets weekly in a large Swiss city. The group is a low-threshold offer launched by the local university clinic for child and adolescent psychiatry together with a family counselling centre. Some of the young people taking part are former patients, others were referred by the family counselling service.

All those present agree that one of the biggest stress factors is school. Carolina, 19, is about to take her final apprenticeship exam. The trial run went badly. Carolina doesn't have fond memories of her compulsory schooling.

Feelings of being overwhelmed and failure characterised her, partly because there was a lack of support at home: «Our mother was a single parent and ill.» The young woman is convinced that her life would be different today if she had got her act together at secondary school or even gone to grammar school. «I would be a different person,» she believes, «I would be loved more.»

«Forget it,» Jan interjects consolingly. «You would have been killed at grammar school.» The 16-year-old himself was expelled from grammar school because of his behaviour. He has worked on his outbursts: «I stopped freaking out and left the room when I felt things were getting difficult. I was told that this wasn't appropriate for grammar school.»

Everything at the school was just bad.

Rahman, 15

Rahman is sitting opposite Jan. He wants to achieve something in life, says the 15-year-old, who also endeavours to ensure that his younger siblings do well at school. «My father constantly held his friend's son up to me as a role model,» he says.

The feeling of not being enough was compounded by bullying: «My skin colour and my clothes gave rise to it. Everything at school was just bad.» Rahman fell into a crisis and almost dropped out of school. He has since recovered - and climbed a step up: «I made it into the specialised middle school and was able to show my father what I'm capable of.»

6 out of 10 girls over 14 show increased stress levels

A 2019 study by Pro Juventute also identified school as the top stressor in the lives of children and young people. It was not only exams and homework that caused stress, but also arguments in class, conflicts with teachers and bullying.

The survey involved 1056 children and young people aged between 9 and 15. The study concludes that one in four children under the age of 11 show increased stress levels. Among the over-14s, the figure is six out of ten young women and three out of ten young men. According to the authors, respondents with high levels of stress felt overwhelmed on average by both their parents and their teachers, were often exhausted, emotionally burdened and more often anxious and suffered from complaints such as headaches or stomach aches.

This is not the first time that scientists have given Swiss youth a sobering assessment of stress. In a survey conducted by the Jacobs Foundation in 2014, almost half of the 1,500 participants aged between 15 and 21 stated that feelings of stress and excessive demands were part of their everyday lives. At the same time, 80 per cent of those suffering from stress said that it was not their parents or teachers who were causing them problems, but the high demands placed on them.

Why do young people put so much pressure on themselves? After all, our education system is more permeable than ever. «Permeability sometimes also creates pressure. You can always move up a level, get even better qualifications. This opportunity comes with the invitation to make use of it,» says youth psychiatrist Di Gallo. Where there is the lure of advancement, the downside is the threat of falling, feelings of inadequacy and self-doubt. «In the past, an apprenticeship was associated with the prospect of a permanent place in society, but today the main thing is not to stand still. And the increasing academisation of many apprenticeships is making it more difficult for young people with a lack of schooling to be satisfied.»

«The variety of options for who we want to be is immense»

Has growing up become fundamentally more difficult? «Every generation is faced with challenges,» says Di Gallo, «but the frequency and speed of change has increased over the past 20 years. The variety of options for who we want to be is immense.» In the age of individualism, subjective convictions have taken the place of universally valid values; freedom of choice takes precedence over compulsory programmes. Even gender no longer seems to be a biological determinant, but a matter of interpretation.

«Then there are the many virtual channels to play on, with each change requiring a role adjustment,» says Di Gallo. «The majority of young people can cope with all of this without any problems. For the more vulnerable 15 to 20 per cent, it can lead to excessive demands. Personality disorders that can be traced back to serious problems with identity development are on the rise.»

Is the global situation making young people ill?

Some also attribute the mental distress of young people to the global situation. The pandemic, the climate crisis, then the war in Ukraine: is it the permanent state of crisis that is making young people ill? «It certainly doesn't leave them unaffected,» says child and adolescent psychiatrist Bilke-Hentsch. «We perceive these problems as threatening and see a need for action, but realise that neither our individual abilities nor social forces are enough to change the situation.»

In this context, one speaks of a learnt helplessness - the conviction, matured through negative experiences, of being exposed to life and having no influence over its destiny. Such feelings of powerlessness also characterise the clinical picture of depression.

One could argue that we parents also witnessed crises as adolescents. Think Chernobyl, the Cold War, terrorism after the turn of the millennium. «There is a difference,» says 19-year-old Emil. «You could switch off the TV at some point. Nowadays, the news just pours in without interruption.»

Carolina from the youth exchange group believes that social media is partly to blame for the mental misery of many young people: «Comparing yourself to others, the negative news - it makes you unhappy.»

Meanwhile, Valentina, 15, suspects the matter is more complex. «I don't believe that mental well-being can be linked to media use,» says the prospective high school student. «Instead, you should look at the parents: They shape the child the most. I wish that parental education programmes were compulsory.» She has a difficult relationship with her parents, says Valentina.

A strained relationship with parents does not appear to be the problem for the majority of young people. This is suggested by studies such as the German Shell Youth Study. «Since 2002, the proportion of young people who have a positive relationship with their parents has been steadily increasing,» concludes the latest survey from 2019, in which over 2,500 12 to 25-year-olds took part.

It is possible that children today lack the ability to deal with demands.

Eliane Perret, remedial teacher

Children and young people don't seem to lack love. So how is it possible that so many lack support? «Adults have the task of showing children what life is - that it presents us with challenges and that these can be overcome,» says Eliane Perret, psychologist, curative teacher and co-founder of a type A special school in the canton of Zurich, where children and young people whose behaviour makes them unsuitable for mainstream schooling end up.

Perret ran the school for 30 years until her retirement in 2020. She still teaches handicrafts there today. Are young people confronted with ever-increasing demands? «I'm not sure,» says Perret. «It's possible that they lack the ability to deal with demands.»

When parents and school relieve the child of all difficulties

Perret sees the mental crisis in young people as an expression of a lack of resilience in everyday life. Many children today lack the practice areas they need to strengthen their resilience. They rarely experience the ability to overcome challenges. When difficulties arise, they quickly become discouraged.

«They often try to avoid the requirements at first and are quite creative in doing so,» says Perret. «They hope that someone will take them off their hands.» Many are used to this from home, but also from school, where a child is exempted from the class learning objectives in case of doubt. This is problematic: «It should actually be about encouraging the child and showing them how they can master the tasks set,» says Perret. «That would strengthen their sense of self-efficacy in the long term.»

Zurich psychologist Allan Guggenbühl has been working with young people and their parents for 30 years. The latter are now much more committed to doing everything right. «The danger of this more committed parenting is that parenting becomes overloaded with ideals and too focussed on the child,» he says.

A strong bond is not created by parents always immediately fulfilling the child's needs.

Allan Guggenbühl, psychologist

This is how you prepare your child in the mind for a society in which justice and equality prevail. «Unfortunately, the world that awaits the child is not like that. It can happen that teachers are unfair, the flatterer gets ahead and nobody waits for you,» says Guggenbühl. «As parents, it's our job to prepare children for the paradoxes and injustices of life. I have the impression that this is often forgotten.» Many parents find it difficult to let their children have unpleasant experiences. «If something goes wrong, they prefer to intervene,» observes Guggenbühl.

Affect tolerance: How children learn to tolerate frustration and conflict

«Many parents no longer want to bring up their children the way they themselves were brought up, but at the same time they lack role models for alternatives,» says Perret. It's not wrong to look for these in how-to literature, but there are mistakes in thinking. «Attachment theory, for example, is often misunderstood,» says Perret. «A strong bond is not created by parents always immediately fulfilling the child's needs. Not every child's wish can be categorised as a need.»

Perret often observes that parents don't dare to frustrate their children and find it difficult to endure conflicts because they fear that the relationship with the child could be damaged. «It gives the child a sense of security when parents set guard rails. They can rub up against them from time to time.»

For a young person to be able to mobilise their inner strength in difficult situations, they must have learned to endure what feels unpleasant: that the answer is no, the teacher has given a poor mark for the presentation, the neighbour plays better football - without their parents immediately trying to placate them or spare them such emotions.

In psychology, this is called affect tolerance. «It refers to the ability to tolerate immediate, violent and intensely negative feelings,» says psychologist Simone Munsch, head of the psychotherapy practice at the University of Freiburg. «There are so-called transdiagnostic factors that can be found in most mental disorders: A lack of affect tolerance, i.e. problems dealing with negative emotions, plays a key role here.»

Psychologist Guggenbühl finds the tendency to involve the younger generation in social responsibility later and later problematic. «Children realise early on that work is a sign that you are integrated into society and have achieved significance,» says Guggenbühl. «We exclude the young from this, we banish them to the waiting room with eternally long school and further education programmes. As a result, almost half of 20 to 24-year-olds are in education. Many young adults feel that they are useless.»

Teacher Perret has found that an apprenticeship often has a corrective effect after bumpy times: «During an apprenticeship, young people have to develop solutions to real problems, you rely on them.» This was also the case for Jan. After being expelled from grammar school, he started an apprenticeship as a carpenter. During the discussion, he pulls out his mobile phone and shows pictures of furniture he has worked on. «The apprenticeship was the best decision,» he says. «My vocational trainer says that the company has a debt to pay. He teaches me everything, but I'm the one who has to demand things. I like that.»