Prevalence Inflation in mental health
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Today I will be discussing a topic that, honestly, I don’t know the answer to or know my opinion on. Today I am going to talk about “prevalence inflation” or “Mental Health Inflation” which is the idea that the surge of mental health issues, especially among young people, is in large part due to us talking about mental health too much.
My amazing soon-to-be mother-in-law sent me an article written by Ellen Barry from the New York Times that discusses this matter.
In the article, Barry quotes that “this hypothesis is called ‘prevalence inflation.” It holds that our society has become so saturated with discussion of mental health that young people may interpret mild, transient suffering as symptoms of a medical disorder.”
Prevalence inflation is a very Google-able term and leads to scientific and non-scientific articles about this topic. Some of the article titles are “How Anxiety Became Content” in the Atlantic and “Are Mental Health Awareness Efforts Contributing to the Rise in Mental Health Problems?” from the University of Oxford.
So, people are talking and thinking about this.
Lucy Folkes of the University of Oxford was one of the first behind this prevalence theory. In 2018 when she began teaching undergrads, she recalled “They were “bombarded” with messages warning that they might be in crisis, she said.“It seemed like the more we were trying to raise awareness about it, it wasn’t getting better, and in fact, it only seemed to be getting worse.” So, she started to get critical of the teachings of social-emotional learning in schools.
I have been seeing more and more over the past few years that schools are implementing mindfulness training, or social-emotional curriculum in schools. It is interesting because most kids who come into my office and do have this at school,feel like they already know everything about mindfulness, tuning in with their emotions, etc, which is awesome that they have some basic understanding, but also I don’t exactly know what they are learning, and if there is adequate psychoeducation behind it. In California the education department does require SEL or social-emotional learning courses in the academic curriculum, and from what I have heard this could be anything from doing one meditation in class once a week to learning resources and getting appropriate education and tools. It seems a little unclear and up to the school on what is actually being taught, and it's not streamlined. There are also nowadays many discussions in schools around mental health and therapy in the form of workshops, speakers, and in the classroom. It is hard to know what kids are taking in.
A lot of experts defend school-based awareness, advocacy, and training, saying that mental health therapy is still not easily accessible for kids and teens. Child psychologist Zachary Blunkin from Columbia University Medical Center says,“Especially with teens, we need more universal interventions, not less.”
Indeed, mental health services can still be rare and not accessible, especially for lower-income populations. Because of this, kids and teenagers may wait months to see an overworked counselor or psychiatrist and could land in inpatient programs or the ER because of it.
The NY Times article says that “generations are growing up fluent in the language of mental health” which is generally beneficial but can also cause adolescents to apply medical diagnoses to typical everyday stressors inappropriately.
Experts who support the prevalence inflation hypothesis say that the increased talk of mental health among young people leads to the overuse of psychiatric diagnoses, and studies have shown that students who label themselves with a diagnosis often feel powerless compared to those who have the same challenges but don’t label themselves.
The NY Times article says, “The “prevalence inflation” hypothesis asks us to keep an eye on those excesses. People hurtafter breakups and struggle to adjust to new schools; negative feelings aren’t always a sign of mental illness. They can even teach us resilience.”
Therapist opinion
So, what do I think as a therapist?
Well, I definitely think that overdiagnosing is an issue, and accessibility to mental health care is an issue.
Nowadays everyone is diagnosed with anxiety, ADHD, etc, and while diagnoses can help to get accommodations and treatment, the risks of overdiagnosing can lead to over-medicating, excessive treatment, and harm to self-image.
It’s honestly just a systemic issue in my opinion. What really bugs me is that I basically have to diagnose my clients on billing documents if they want insurance to cover their sessions. I have actually had usually parents of clients say that they would rather pay totally out of pocket than have a diagnosis on any documents because they are worried about the stigma if their child’s school found out. It’s just all super messy.
And overall I definitely think it is concerning that the talk about mental health may be increasing the crisis, and it is scary that there is evidence to support this. I have been thinking about this for a bit in relation to suicide. In grad school, during my internships, and talking to other therapists, I have learned that talking about suicide does not make it happen. I learnedthat this is a myth and that by talking about it we don’t make someone think about it more. Talking about it destigmatizes it and opens the door for communication. I completely agree with this still, and I think that talking about suicide openly,and the increase of resources, community, and treatments, has saved so many lives.
However, I have mixed feelings about talking about suicide so openly with kids, especially teens. In the last few years, there has been a huge uptick in teen suicides, and I do fear that since we talk about it more, they see it as an option for them.
Teens are especially impulsive and this is terrifying when it comes to suicide. I fear that because we are talking about it more, kids, especially impulsive teens, see it as an option.
I have noticed in my years as a therapist, that suicidal ideation has increased a ton over the past few years, kids openly talk about death, wanting to die, and even have detailed thoughts about how to do it.
-Another NY Times article that is linked below details the drastic change that American adolescents are undergoing. It says, “The gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy, and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.”
-Some stats from the article from the Centers for Disease Control and Prevention report that
“ In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007.Children and adolescent emergency room visits in that period also rose sharply for anxiety, mood disorders, and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018," according to the Centers for Disease Control and Prevention.
Many hospitals and doctors have called the rising levels of mental health a national emergency.
Many experts attribute this to social media, an epidemic of loneliness, and rising pressures for kids and adolescents.
In my opinion, there are also great things about talking about mental health. I often say that I wish there had been more education about anxiety and mental health when I was a kid because it could have prevented a lot of suffering and uncertainty for me. It is also awesome to teach kids mindfulness, and coping skills to deal with big emotions and life stressors.
So, mixed feelings, and mixed thoughts, I would love to hear what you all think.
Thanks for reading!
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