Teen mental health and happiness (final)

teen mental health and happiness
research for channel 4 education

commissioned by alice taylor, c4 education, may 2009
written by tassos stevens, pete law and paul bennun

somethin’ else
www.somethinelse.com
+44 (0) 20 7250 5500

not for distribution! please keep confidential — contact Alice Taylor for requests or enquiries: ataylor@channel4.co.uk

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teen mental health and happiness research

Introduction 8

What is Happiness? 10

Happiness 10

Survey: What’s important? 12

Survey: What would make you happier in your life right now? 14

Survey: Happy people 14

Authenticity and Setback 16

Measuring Happiness 17

Variance of Happiness 19

Well-being and Society 21

Where’s the happiest place in the UK? 23

Urban versus Rural 24

Measuring Happiness Part 2 27

Daily diaries of activity 27

The Biology and Physiology Of Happiness 29

Neurological Correlates of Happiness and Depression 29
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What use is happiness in evolutionary terms? 29

Smile! 30

Duchenne Smiles 30

Mental Health and Teenagers 32

Key sources 32

What mental disorders are young people suffering from? 33

Age 11-16 years 33

Age 16-19 years 35

How problems are diagnosed 36

Persistence of disorders 37

Networked effects 38

Aside: Happiness in real-world networks 39

Understanding Mental Illness 39

Treatments for Mental Disorders 40

Talking cures: therapies 40

The Journey of Assistance 42

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Journey from Mental Health to Mental Illness 42

Stressful life events 43

Circumstances 44

Problems posted online 45

About adolescence 46

What teens worry about 46

Feeling Down 49

Dealing with problems – support networks 50

Barriers to seeking professional help 54

Services for ‘casual’ users of mental health services 59

Young People’s Consultation Service 59

States of Being 60

Flow 60

Mindfulness 62

Positive Psychology 63

A Science of Happiness 63

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What’s Important? Dimensions of well-being and resilience 64

Autonomy, Relatedness and Competence 65

Autonomy 65

Relatedness 65

Competence 67

Experimental Insight, Individual Learning 68

The Unexpected Misery of Choice 68

Have a Good Day 69

Remembering Pleasure: Peak-End Theory 69

Count Your Blessings - Savouring and Positive Reframing 70

Signature Strengths 70

Practical application of behavioural insights 71

Resilience 72

The Penn Resilience Programme (PRP) 72

The UK Resilience Programme (UKRP) 72

Resilience in our lives 73
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Grit 75

Synthesis: The SEED framework 75

Wellbeing in the School Curriculum 76

PSHE 76

SEAL 77

Vocation, Community and Belonging 79

Decision-Making in the Local Community 79

Apprenticeship 79

What’s your Mission? 80

Send a Message Back In Time 81

Gender Differences 82

Gender Identity 84

Media Usage 85

What are they doing online? 86

Networks of Communication 87

From our research 89
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‘Digital Health’ and well-being in social media 91

Barriers to Getting Happy 92

Potential Competition for a C4 Product 97

Bibliography 99

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Introduction
Here's an understatement. Mental health, happiness and well-being - as applied to teenagers - cover between them a vast area.
It’s one where an enormous amount of excellent and complementary work is being undertaken worldwide both in research and its application. We’ve had a month
to undertake a survey, creating a primer to the area: who’s doing what, where and to whom, and how do they describe what they’re doing?
Our research had two components:
• a rapid mapping of the available literature, data and research
• original research with teens

Our original research consisted of a questionnaire and subsequent facilitated discussions with six groups of teenagers, divided by age and location (as a proxy for
background). Discussion groups were conducted with teens from London (Stoke Newington & Battersea) and Exeter, divided into either 13 to 15-year-olds (early
teens) and 16 to 19-year-olds (late teens). In total, we had 33 teenage subjects. As we learnt more about the area, we added new questions. Subjects were always
given the option not to answer a question if they'd rather not for any reason. Different questions have different numbers of respondents as a result. We also
disseminated online an extended version of the questionnaire incorporating some of the discussion questions which was filled in by 72 subjects.
While preparing this report we have kept in mind its purpose of giving potential suppliers to Channel 4 Education a head-start in producing proposals that could
make the largest impact on the largest number of people. We’re going to try and keep it brief, and point out where more information can be found. We’ve
assumed you’ll be using a user-centred approach to your design process — something like the NABC framework (needs, approach, benefits and competition).
We want to flag three important issues straight away, which may not be immediately obvious coming at this ‘cold.’
Firstly, mental health disorders directly affect a relatively small although extremely significant percentage of the population. Many of these disorders first appear in
teenage years. 90% of teens will be one degree of separation from someone with a mental disorder, and yet their knowledge and understanding of professional
mental health services and their value is patchy. We’ll catalogue the most common disorders, describe the typical journey towards seeking help that a teen might
take, the likely barriers, and some services already that try to circumnavigate them, as well as the structure of the health services and types of treatment available.
Secondly, the story of psychology is often told as a clinical tale about fixing something broken. However, a great amount of work is being undertaken both to
prevent something breaking in the first place, and to improving happiness and well-being in individuals no matter what their starting point. Lyubomirsky’s
‘equation’ (Lyubomirsky et al 2005) demonstrates that the variance of happiness between individuals is 50% set-point and heredity, 10% from life-circumstances,
and 40% from volitional activities. In our choice of volitional activities, we can all work at improving our happiness and well-being.
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Thirdly, linguistically and philosophically, the word ‘happiness’ doesn’t have one single, simple meaning.
Psychologist Dan Gilbert (2007) asks us to consider the difference between:
• feeling happy, the positive glow – “I’m feeling happy”
• feeling happy because of something, acknowledging that something has value – “I’m happy studying because it will lead to a better life”
• feeling happy about something, acknowledging that one is content that something has merit – “I’m happy that you’re happy about this”

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What is Happiness?
Asking 'what is happiness?’ is a good place to start. So we asked this question of individuals from some of our focus groups at the outset of the interviews, before
they'd answered any other questions. The girls who kickstarted our interviews responded as follows:
Firstly I think happiness is God. I'm not religious.. people normally believe that God has a lot to do with religion but I'm not religious I believe in God fully because
God to me is happiness. Because when you don't have nothing else and there are so many material things in this world when you don't have nothing else, God is
something you can always have. Like when everything fails, to have faith is what gets people through things. And I think God's faith so.
I'd say happiness is a feeling that you get which is positive and it really.. I dunno.. it's hard to describe what it is because say you're a happy person you don't really
know what that is while if you're an unhappy person you'd know straight away what happiness is. So. I'd say you're really positive about life and you're just always
smiling, I think. And yeah.
Basically I think happiness is like a relief. Like when someone is ticking off some things. And you need to get something and you're like at last you're getting what
you're struggling for and you'd be happy. And the relief. Hah. This thing at last. And I think that happiness is like.. summer. When there's summer everyone would be
like yeah it's summertime don’t need to be cold and stuff.
It's a fairly simple emotion, it’s almost a childlike emotion.

Happiness
We’re going to talk about philosophy and language for a second.
There are generally considered to be two sorts of happiness. There’s the short-lived kind which the ancient Greeks called “hedonia” and from which we get the
word “hedonism”. This results from external stimulus: good news, drugs, a YouTube video, etc.
Secondly, the profound kind which comes through achieving a lasting virtue and value. The ancient Greeks called this “eudaimonia.” Aristotle saw this manifested
in activity: a life well-lived. Imagine you're on your death-bed: as you look back over your life, will you feel happy? If you do, that's eudaimonic.
We asked our focus groups to consider a number of celebrities: Victoria Beckham; Paris Hilton; Jade Goody; and for later groups additionally Susan Boyle. We
asked them to imagine when all of them have passed away, who would have had the happiest life. And we asked the group to come up with a single collective
answer, so we'd get to hear what they were thinking

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Paris Hilton, there's all those sex-tapes about her and things like that and all those scandals and that must be really depressing no matter how much she puts on a
good show.
Victoria Beckham also gets - well, all of them get slated by the press.
I think that Victoria Beckham’s an idol as well, loads of people look up to her and she has become a fashion icon whereas Jade Goody with all that stuff from Hello
magazine -
- That doesn't mean she's the happiest person.
I think Jade Goody probably had the best life because she's most like herself. She didn't really change to impress anyone or anything, she was just herself.
I would have said Jade, Victoria, Paris.
But then everyone needs to change at some point in their life. Well, I suppose.
I think Jade Goody because she was famous for being herself and she died that way as well. The others haven't died but it looks like they're going to die trying to
struggle, trying to keep their careers alive. So that’s why i think they might not have as much happiness in their life as Jade did.
Victoria Beckham’s got a steady marriage and kids - three kids, four kids -
Well, steady, that's what we think.
She's got 4 kids whom she seems to love.
And they did that Ali G thing and I really think you could tell they loved each other. You can just tell. Even if he is thick and she is a stuck-up cow.
Paris Hilton doesn't really have anything going for her except for the fact she's rich.
And a whore.
And that she can wear a dress this big.
I'd say Jade.
I'd say Victoria Beckham. Then Jade, Then Paris.

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The groups were split between Victoria Beckham and Jade Goody. Those in favour of Beckham tended to cite her family, her loving relationship, that she'd
worked to achieve her success. Those in favour of Goody cited her authenticity, that she was always true to herself, that she'd suffered hardship and learnt from
her setbacks, that she'd achieved what she'd wanted by the end of her life.

Survey: What’s important?
We asked respondents to rank the following in terms of importance for them in their life, marking the most important as 8, the next as 7, putting one on each point
on the scale down to the least important as 1.
Be wealthy
Be wise
Help others
Be good-looking
Be famous
Have the best friends
Be healthy
Love and be loved

Across 100 respondents, we found the following ranking (mean ranking score), here ranked by importance
Love and be loved 6.76
Be healthy 5.63
Have the best friends 5.57
Be wise 4.42
Help others 4.42
Be wealthy 3.66
Be good-looking 3.37
Be famous 2.18

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If we look at the mean rankings broken down by gender and age, suggestive and possibly significant differences arise.
Mean Rankings Male Female
Love and be loved 6.79 6.74
Be healthy 5.44 5.77
Have the best friends 5.42 5.68
Be wise 4.51 4.35
Help others 3.77 4.91
Be wealthy 3.84 3.53
Be good-looking 3.51 3.26
Be famous 2.72 1.77

Although the overall order of mean rankings doesn’t change radically, girls rank Help Others more than 1 point above boys, while boys rank Be Famous nearly 1
point on average above girls.
Let’s compare the early teens and the late teens in the same way.
Mean rankings Early Late
Love and be loved 6.71 6.79
Be healthy 5.71 5.58
Have the best friends 5.24 5.77
Be wise 4.55 4.34
Help others 4.29 4.50
Be wealthy 4.21 3.32
Be good-looking 3.16 3.50
Be famous 2.13 2.21

Again, although the overall rank of mean rankings doesn’t change, Early-age teens rank ‘Be wealthy’ almost 1 point above Late-age teens.

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Survey: What would make you happier in your life right now?
Question: What one thing would make you happier in your life right now? [66 respondents]
Sample responses follow; the remainder are in the Appendix.

“more moneey”
“Have the person i most miss, back living again”
“regular sex with the girl i have a crush on would be great if you could sort it”
“seeing my old m8s in watfoad”
“To be intrusted with independence”

Survey: Happy people
Question: Who's the happiest person you know and why do you think they are so? [95 responses]
Some sample responses follow; the remainder are in the Appendix.

“My dad, he has had lots of bad stuff happen to him and know he has realised that there is no point in being down”
“me - because i feel a connection to nature like keats - so even the little things like cycling and music make me happy.”
“I think both Georgina and Laura are the happiest people i know. I coulnd't choose between them. They always make me laugh and are generally happy all the time
which boosts everyones spirits. They are always smiling.”
“a friend of a friend, who lives in a total bubble, which means he very rarely worries, or thinks hard about things, yet seems to be insanely bright, and never really has
to work at anything. The people around him love him to pieces (and he seems fairly oblivious of any teasing, and nonplussed by that that he does notice), and i guess
gets positive feedback of being so well liked.”
“I'd say the happiest person I know is Cheryl Cole because I think she is really happy with herself and has everything going for her which is mainly positive”

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Survey: Describe a time when you were happy
Question: When was the last time you were really really happy? Do you remember what you were doing then? [65 respondents]
Some sample responses follow; the remainder are in the Appendix.

“2 weeks ago @ enrique inglesius concert :)”
“A drive out to Tan Hill (Britains Highest Pub) with a couple of friends last week. The weather and company was fantastic, it was a good opportunity to relax and
forget those who are not a positive input in life.”
“Achieving an A in biology resit - getting the result i wanted and needed after putting in hard work and correcting my previous mistake”
“I seem happest, when I just stop thinking and let myself by content. Often its with water (hence rowing), or pretty open skys. The lst time properly would be about
two months ago, in an airport looking at a gorgeous sky.”
“the last time i was really happy was when i was on stage at a gig we were doing and a girl in the crowd shouted out she loved me. it did wonders for my self-esteem.”
“the last time i was really really happy was when i got a pb at 800m!”

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Authenticity and Setback
Philosopher Robert Nozick describes an 'experience machine' that presaged The Matrix (Nozick, 1974). When you're plugged into it, you are in a virtual reality
indistinguishable from your life, except that it is filled with only happy experiences, and you would never know that this wasn't your life. Would you choose to plug in
forever, an irrevocable choice? We posed this to our focus groups and a vast majority said they'd rather live their real lives.
The authenticity of real life was important to the teens.
carry on as we are
cos you'd be in there and you’d know it wasn't real, it'd be like you're watching a film
like you're having a dream
it would be fake
Several also wondered whether you could know what was happy without ever being unhappy, and whether you needed to learn through setbacks.
plus like in your life you've got to experience bad and good
you need to have a bit of both
I'd plug into the machine cos you'd have an exciting life
stay the same, I'd stay the same

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Measuring Happiness
How do you measure happiness? You CAN do reasonably well simply by asking people: self-reported happiness ratings of are matched by both friends’ and
families’ happiness ratings and even independent observers ratings (Kahneman et al, 1999).
We asked respondents: How happy are you generally? Answer on a scale of 1 to 10, 10 being happiest.
We received 96 responses, ranging from 4-10
Mean 7.56
Median 8
Mode 8
determinants of happiness
The overall mean corresponds to the usual we’d expect for such a question (Gilbert, 2001a).

Mean reported happiness by age, gender and location
Age
10%
13-15 8.03
16-19 7.31

Gender
Female 7.46
Male 7.68
40% 50%

Location genetics
volitional activity
London (58 respondents) 7.26 circumstance
Exeter (16 respondents) 8.13
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The early teens rate themselves notably happier than the late teens. There is a suggestive although not significant (very large) difference between London and
Exeter teens. We'll look at results from a national survey of emotional health and well-being across different regions in an upcoming section.
A more extensive and robust self-reporting measurement of happiness is derived from the Oxford Happiness Inventory (Argyle et al, 1989). Subjects are asked to
rate themselves from 1 to 5 on agreement with statements like:
• I feel that I am in total control of all aspects of my life
• I feel that life is overflowing with rewards
• I am delighted with the way I am

In psychometric or personality psychology terms there seems to be a strong link between high (happy) scores on the OHI and stable extraversion (Francis et al,
1998). Extraversion is defined as "the act, state, or habit of being predominantly concerned with and obtaining gratification from what is outside the self" and is one
of the key measurements psychologists have historically used to measure personality (Eysenck & Eysenck, 1965). We’ll encounter this idea again when we look
later at the quality of ‘relatedness’ in positive psychology.
Measuring yourself as happy does not of course exclude you from potential mental health problems at other times.

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Variance of Happiness
What are the factors that influence the differences in happiness Bhutan was rated eighth happiest country in the world by the World Values Survey in
between individuals? Sonja Lyubomirsky and colleagues 2006, the highest-ranking nation in Asia.
(Lyubomirsky et al 2005) concluded from a cross-sectional review The Kingdom of Bhutan in the Himalayas in 2008 adopted a Gross National Happiness
on previous research that there are three main factors. Index, which reflects the values of happiness, and sets benchmarks for tracking and
Genetic, hereditary influences account for around 50% of assessing government policies.
happiness variance. This is suggested by studies of identical twins. The King allegedly rebuked a Western journalist who’d asked about economic reform:
The circumstances of one’s life give 10% of individual happiness “Gross National Happiness is more important than Gross National Product”
variance. This may seem surprisingly low. It’s been demonstrated
though that humans adapt quickly to new circumstances, whether As the Centre for Bhutan Studies, which runs the programme, explains:
positive or negative, through a process of adaptation dubbed the
The objectives of the kingdom of Bhutan, and the Bhutanese understandings of
Hedonic Treadmill (Brickman & Campbell, 1971).
happiness, are much broader than those that are referred to as ‘happiness’ in the
The remaining 40% of happiness variance is due to intentional and Western literature. Under the title of happiness, we include range of dimensions of
volitional activities – ‘what you choose to do’. Crucially, this is human well-being. Some of these are quite traditional areas of social concern such as
empowering because it is something that we all can immediately living standard, health, and education. Some are less traditional, such as time use,
and directly pursue. emotional well-being, culture, community vitality, or environmental diversity.
We’ll return later in the section on Positive Psychology to some of http://www.grossnationalhappiness.com/
the activities that Lyubomirsky and her colleagues would argue can
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affect your level of ongoing happiness.

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Well-being and Society
Which is the happiest country in the world? It’s a question that has preoccupied economists, who’ve conducted many versions of this survey using both self-
reported happiness measurements and also external markers for well-being. The answer to that question might tell us something about how different societies,
surroundings and lifestyles could make us happier.
We asked our focus-groups, not so much to see if they knew the answer but rather to hear what they thought about it. We gave them a list to choose from that we
thought would be well-known exemplars, including additionally for some groups countries from which subjects’ grandparents had originated.
The starter list was: Denmark, USA, Australia, Jamaica, Brazil, Switzerland.
Jamaica! cos they're all high. they're on the beach all the time
but they've also got Kingston
I'm inclined to say America
Australia, I've never seen an angry Australian to be honest
I don't think America's happy
the thing is with America it's a very American thing to be proud of being an American
America are so naive about everything, that makes them happy
most of the bad news comes from America
Australia. Guess. I dunno really.
Australia cos it's hot, there's lots of beaches and they have fun
Jamaica cos they're just chilled
I think Switzerland cos they've got chocolate there and apparently did lewis Hamilton move there cos they don't pay tax. and they're the only neutral country. and
they made the Swiss army knife
I"m kinda torn between Australia and Jamaica. they both have great weather. I've never seen an angry Australian, and -
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have you ever seen them lose against England?
have you ever seen an angry Jamaican? that's what I wanna see
I’m gonna say Australia, although I'm also torn between there and Jamaica
I’m gonna say Denmark just cos no one else has said it and I know someone from Denmark and they’re really nice

The ‘right’ answer, according to the World Values Survey in 2008, was Denmark. Survey director Ronald Inglehart argued that the critical factors appear to be
freedom of choice, gender equality and tolerance (reported in Business Week available under this link).
Surveys like these have robustly shown that wealth does have an impact on reported happiness at the bottom end of the scale, so to be a poor nation does tend to
mean lower happiness, but beyond a certain income-point – around $10,000 – the curve flattens. Only so much money can only buy you happiness, perhaps only
that to cover basic human needs.
The Spirit Level, an influential book published recently summarising decades of research by Richard Wilkinson and Kate Pickett hammers an identical case
through its subtitle alone: Why More Equal Societies Almost Always Do Better.

What’s very clear is that the country in the world with highest levels of happiness and well-being is not the UK.
Recently published was a league table of child well-being of 29 European countries in which the UK was placed 24th (see www.cpag.org.uk/info/
ChildWellbeingandChildPoverty.pdf). The table includes 43 separate indicators summarised in seven domains of child well-being. The Netherlands came top
followed by Norway and Sweden. Only Romania, Bulgaria, Latvia, Lithuania and Malta came below the UK.
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A UNICEF study in 2007 examined the welfare of children aged 11-15 years-old in 21 of the world’s richest countries. Britain and the USA scored bottom on all
significant markers: children in single-parent or step-families; friends involved in a physical fight; overweight or drunk; teens giving birth; out of education or
employment; income greatly less than the national median.
Richard Layard, dubbed the Happiness Tsar by the press and a Professor at LSE, co-authored the recent Landmark Report for The Children’s Society: A Good
Childhood. He combined a study on well-being with child poverty data from previous studies and demonstrates a strong correlation between the levels of child
poverty, inequality and child well-being (Layard & Dunn, 2009).
Layard also believes that well-being is one of the most important drivers of economic wealth for a nation, not least because we can do something about it.
Relatively small improvements might have disproportionate positive impact.

Where’s the happiest place in the UK?
It isn’t grim up north, according to the 2008 results of a national survey conducted by Ofsted and the Department of Children, Schools and Families.
150,000 young people aged between 10 and 15 were asked questions to measure their emotional well-being using five markers:
• emotional health, as measured by how many friends they had and how easily they can talk to them about problems
• levels of bullying
• levels of participation in sport and volunteering
• levels of substance misuse
• how happy they are with access to parks and play areas

The highest scoring local authority was Knowlesly in Merseyside, which consistently sits at the bottom of league tables for educational achievement and health. The
crucial factor was that Knowlesly children reported having stronger friendships than anywhere else in the country.
The lowest scoring authority was Richmond in southwest London. Suburban London authorities reported the greatest levels of substance misuse, above Inner
London authorities who actually reported the lowest levels in the country. Young people in London score highly for access to parks, play and other activities.
Local authorities will be set performance targets to improve services for children based on the report.
A Guardian article on the report can be read here can be read under this link, along with interviews from some respondents.
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Urban versus Rural
The factors that affect well-being in rural communities as opposed to urban communities are pretty clear.
In rural areas, networks and communities are typically smaller. This can be positive, giving a greater connectivity to a particular community or group – as friends,
you’ll tend to do things together. But it can also be negative, if you happen to drop out of group activities or are identified as an outsider and don’t conform to
group norms.
Peace and quiet are often cited as attractive factors for living in the countryside, and this may facilitate greater space for reflectiveness.
There is a greater diversity of available activities in urban areas but more opportunity for outdoor and physical activities in rural areas.
Wide open spaces, fresh air, green and wild spaces are obviously more readily accessible in rural areas. The BTCV (British Trust for Conservation Volunteers)
runs an initiative called Green Gym (link to how a Green Gym works), a volunteer scheme for working improving the local outdoor environment, combining
physical fitness with Rosie Milner at DCSF cited the Green Gym as an excellent initiative for improving well-being, and the key factor appears to be that it’s
outdoors in green and natural space (link to DEFRA report, 2008). Evaluation indicates that participants scoring low for mental well-being at the outset of joining
a Green Gym were three times more likely to improve, and over 90% of participants agreed that their confidence and self-esteem had improved.
According to this MIND factsheet, the provision of mental health services is sparser in rural areas. Poorer quality of transport networks also make it difficult for
people to seek professional help, and those who have more difficulty in accessing transport services are also often those most needing support – including young
people.

Our focus group teens in Exeter talked about living in outlying villages.
my village does have cars and tarmac
there's nothing to do, but I still love it, it's pretty picturesque when you look at it
in the summer, laying on the beach it's the best thing in the world, plus there's all the holiday-makers and they're easy
when I do most hobbies and stuff, I don't do them there, like I do kiteboarding and I go miles away to do it, whenever you do fun stuff. when

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what is there to do? nothing. All there is to do is pub, takeaway, tar rolls once a year. the majority of the population are over 80.
you've got a cinema and a swimming pool. the cinema's pretty shit though. Think they’ve got Spiderman2 on there now
there's one high school, everyone goes to the same school and you basically know everyone.
pretty much everyone years below me and above me, you just know them
you can tell someone who doesn't go the school cos they just look different

We asked a London-based focus group how they’d feel about moving to the country
I'd prefer the city, I'd hate it
I'd really like it, I like the idea of that whole community thing
but then there's not that kind of thing when you can just call up a friend and say hey let's meet in 5 minutes
you'll have a month of doing things and then that's it, there'll be nothing else to do
I'd prefer it, I'm quite a country person
the only advantages is that no one would hear your arguments, like your big arguments

We also asked our Exeter-based focus groups how they’d feel about moving to London
moved to London?
i'd be scared
I think we would die
depends on what part of London
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it just feels like according to the media it's just such a rough place
I wouldn't mind living there, I live in such a small quiet village and I wouldn't mind living up there - there'd be more stuff up there, more clubs and stuff
I dunno, I dunno if I'd want to move to London cos it's obviously more compact, less space, more buildings but here there's like open spaces
London's too far away from like good beaches

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Measuring Happiness Part 2
Daily diaries of activity
This question was based on a simplified version of Kahneman’s Daily Report Measure (Kahneman, 1999), an exercise asking participants to list the activities
undertaken over a specific day, no matter how routine, and rate their happiness at that time.
Question: Run through yesterday in your mind, in two-hour time slots from 6am to 2am. Write one thing that you did in each time slot and ALSO how happy you
were then on that scale of 1 to 10? [95 respondents]
Mean happy scores over all activities from all respondents
7.27 (including scores for sleep), 7.00 (discarding scores for sleep)
We categorized the activities and calculated frequency counts and mean happy scores for each. These can be seen in the following table. The responses can be
seen across all respondents in the Appendix.

category count mean happy
revision 54 5.56
exam 24 5.58
get up in the morning 41 5.66
work 12 6
homework 8 6
theatre 4 6.25
bath 4 6.25
school 100 6.29
travelling 59 6.93
online 31 6.97
reading 9 7.11
TV 75 7.16
eating 78 7.33
family 10 7.7
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music 13 8
gaming 15 8.07
phone 10 8.1
relationship 9 8.11
physical activity 44 8.32
shopping 5 8.4
friends 72 8.45
sleep 148 8.54
drugs 5 9.4
cinema 2 10

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The Biology and Physiology Of Happiness
Neurological Correlates of Happiness and Depression
There are neurological correlates to happiness. Functional Magnetic Resonance Imaging (MfRI) scans, according to Barnes (2007), demonstrate that “only
limited areas of our brain controlling both mental and physical responses are supplied with blood in periods of depression and that much larger areas are activated
when we are in a state of positive emotion”, although Dan Glaser at the Wellcome Trust counsels caution in interpreting too deeply these kinds of brain pictures.

What use is happiness in evolutionary terms?
Helen Mayberg and colleagues use an MfRI technique called Diffusion Tension Imaging,
Neurologist Antonio Damasio suggests that everything that that looks at the connectivity of neural circuitry rather than simply activity. A junction box
happens to us generates an emotional response. They are tagged in an area of the brain called Brodmann’s area 25, connecting several areas of the brain
by the brain, good events with a positive tag and bad events with a involved in mood and cognition, was found to be hyperactive in depressed patients.
negative. Mayberg’s techniques might not just aid diagnosis. Deep-Brain Stimulation devices
Emotions are not just messy toddlers in a china shop, running applied to that circuitry in depressed patients brought relief to 60%, although DBS
around breaking and obscuring delicate cognitive glassware. remains a controversial technique.
Instead they are more like the shelves underlying the glassware; http://www.scientificamerican.com/article.cfm?id=insights-into-the-brains-circuitry
without them cognition has less support.
http://www.scientificamerican.com/article.cfm?id=turning-off-depression
But these tags don’t just provide support and organisation. They
are also somatic markers, meaning that they provoking
physiological and physical responses. And applying a similar tag to
a future event will elicit similar emotional and physical responses, meaning that we can respond quickly and effectively to similar new events. Homo sapiens is an
animal whose brain very likely evolved through the pressures of being a social primate (De Waal, 2001). We focus much of their emotional energy on
relationships, and emotions are the means for the brain to organise and evaluate its environment (Damasio, 2003).
Not only this, but when our body is operating efficiently we feel a sense of well-being. We describe this efficient state in various ways: joy, happiness, security, well-
being, contentment and so on. These beneficial feelings all result in positive mental and physiological outcomes. Damasio summarises the neuroscientific
importance of happiness as follows, ‘Joyous states signify optimum physiological coordination and smooth running of the operations of life.’ (Damasio, 2003).

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Smile!
The archetypal depiction of happiness is a smiley face.
Actors know that there are two ways to depict happiness authentically. You can concentrate on feeling happy, perhaps
remembering something lovely that happened, and wait for the smiles to break out on your face. Or you can smile, and
wait for the happy feelings to come. The emotional systems and the motor systems are interwoven.
One crude but effective hack for happiness therefore is simply to stick a pencil in your mouth and force a smile (Stafford &
Webb, 2004). You'll feel happier when you do, although this might not be sustaining.

Duchenne Smiles

We can all recognise a Duchenne smile - it's the one we recognise as authentically happy. The muscles surrounding the eyes are crinkled: 'smiling with the
eyes' (Ekman et al, 1990).

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As opposed to Gordon Brown on Youtube.

Psychologists Harker and Keltner (2001) looked at the yearbook photos of a girls school in California over 40 years previously and rated 'how Duchenne' the
smiles were. These girls had grown up into women participating in a longitudinal survey asking them, amongst other things, how long and satisfying their marriages
had been. Harker and Keltner found that the more Duchenne the smile in a yearbook photo, the more likely a long and satisfying marriage.
When we asked some groups the happy celebrity question we showed them googled pictures of Victoria Beckham, Paris Hilton and Jade Goody. Many of the
respondents noted Jade Goody’s Duchenne smile.
Why I suppose, judging by those pictures I would have assumed Jade Goody had the best life just because she's smiling properly. Paris Hilton looks like she's fake
smiling and Victoria Beckham's not smiling at all. But you can't really judge -
We tried to find pictures of Goody smiling non-Duchenne. We failed and worried that the picture had been skewing responses; but it’s perhaps more interesting to
suggest that the smile is an accurate depiction of mental happiness that we are hardwired to judge.

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Mental Health and Teenagers
Anecdotally we know that many young people experience mental distress at one time or another, such as anxieties, depressive feelings, panic, problems with their
weight or self-image. Professional mental health services diagnose problems that are serious and stable as an illness, or a ‘mental disorder’. Mental disorders are
problems which cause significant distress and life problems for the sufferer and are ‘clinically recognisable’. They can therefore be classified - e.g. using the
WHO’s ICD 10 classification system http://apps.who.int/classifications/apps/icd/icd10online/ - and treated systematically. In this section we will look at how many
young people suffer from these some forms of mental ill health, how many recover.
Key sources
Our two key sources come from surveys carried out by the UK’s Office of National Statistics (ONS). Results published in 2005 (from a 2004 survey) relate to 11
to 16 years old which we link to here. The 2005 survey and a report dealing with adult mental health published in 2000 (from a 1999 survey) covers 16 to 19
year olds. Both surveys used clinical questionnaires to identify which of their subjects were experiencing ‘mental disorders’ as above at the time of the survey
(whether these had been diagnosed by a doctor or not).
We cover the headlines results below and some of the key findings.
Suffering from some form of mental disorder
All Women Men
11-16 11.5% 12.6% 10.3%
16-19 29% 28% 29%

We need to treat these figures with some care and understand what ‘disorders’ they’re counting, but even when you’ve done that it is clear that older teens suffer
more from serious mental health problems. Things looks even worse if you add up the problems over a whole year: a New Zealand lifetime study (Fergusson and
Horwood, 2001) found that a staggering 42% of 18 year olds met the official (DSM) criteria for a mental disorder at some point over the course of a year.
Comparing these with previous studies, there has been little change in prevalence of disorders in young people since 1999, but a big rise between 1974 and 1999
(Layard and Dunn, 2009). Remember that these figures are for young people suffering from a diagnosable mental illness as defined by professional mental health
services. A far greater number may be ‘feeling depressed’ or historically have dealt with similar problems.

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What mental disorders are young people suffering from?
We’ll look at the two age groups separately. Types of mental problems are classified slightly differently for the younger and the older ‘adult’ age groups.

Age 11-16 years
These figures broadly support the observation that girls tend to internalise their problems and boys tend to externalise and socialise them. Girls suffer more from
emotional disorders - anxiety and depression - than boys; boys suffer more from conduct disorder - roughly speaking, severe bad behaviour - than girls.

A summary follows, and more detailed analysis can be found in the ONS 2005 survey.

Emotional disorders 5.0% (Girls 6.1%, Boys 4.0%)
Note that emotional disorders are reliably diagnosed more often in girls than in boys. Emotional disorders break down into two main categories – Anxiety
disorders and Depression.
Anxiety 4.4% (Girls 5.2%, Boys 3.6%)
Anxiety disorders are emotional, and differ from normal worries and anxieties in being either not specific to a cause - 'freefloating' - or through being
disproportionate, even incapacitating e.g. separation anxiety, social and other phobias, panic, agoraphobia, post traumatic stress, obsessive compulsive and
generalised anxiety.
Depression 1.4% (Girls 1.9%, Boys 1.0)
A mood disorder whose manifestations can include low mood, insomnia, and a tendency to attribute events pessimistically: the exam went badly because I'm
stupid; the party was fun but everyone was just pretending to be nice to me.
Self-harming is often but not exclusively a symptom of depression. It varies in severity from 'cutting' to suicide. ”Among young people aged 11-16 with an
emotional disorder, 20 % said they had tried to harm or kill themselves.” (ONS 2004)

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Conduct disorders 6.6% (Girls 5.1%, Boys 8.1%)
Bad behaviours which can't easily be controlled by the subject and which are usually destructive.

‘Hyperkinetic’ disorders (ADHD) 1.4% (Girls 1.1%, Boys 1.6%)
Overactivity and inattentiveness.

Eating disorders 0.4% (Girls 0.1%, Boys 0.6%)
Anorexia and bulimia are most commonly associated with girls, although in recent years their prevalence has been rising in boys too.

Schizophrenia, perhaps the most archetypal mental illness in lay perception, only rarely onsets before late adolescence.

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Age 16-19 years
We’re most interested here in the results for emotional neurotic disorders and how they break down. To an even greater extent women suffer disproportionately
more than men from ‘internalised’ or emotional disorders while men are more susceptible to ‘externalised’ behavioural problems like drug and alcohol misuse. We
counsel caution below about interpreting these drug and alcohol results, as the criteria of measurement are unclear.
Emotional disorders 13.3% (Women 19.2%, Men 8.6%)
We’re most interested in the disorders that fall under this heading, so here they are broken down into their types:
Mixed anxiety and depressive disorder 8.3% (Women 12.4%, Men 5.1%)
Generalised anxiety disorder 1.4% (Women 1.1%, Men 1.6%)
Depressive episode 1.7% (Women 2.7%, Men 0.9%)
All Phobias 1.3% (Women 2.1%, Men 0.6%)
Obsessive compulsive disorder 0.9% (Women 0.9%, Men 0.9%)
Panic disorder 0.5% (Women 0.6%, Men 0.5%)

Personality disorders 3.4% (Women 1.7%, Men 5.2%)
Probable psychotic disorder 0.2% (Women 0.5%, Men 0.9% )
Alcohol dependence 13.8% (Women 7.4%, Men 19.0%)
Drug dependence 9.6% (Women 5.9%, Men 12.6%)

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How problems are diagnosed
The study used a fairly typical diagnostic interview called the CIS-R, whose primary focus is on describing clinical symptoms for anxiety and depression. For each
symptom reported, the interviewer asks follow-up questions to derive a severity of between 0 and 4. The percentages of respondents reporting each of the
symptoms with a severity of at least 2 are tabulated as follows.

Age 16-19 Women Men All 16-19 all ages

Sleep problems 36 23 29 29

Fatigue 35 15 24 27

Irritability 35 15 24 20

Worry 28 11 19 19

Depression 16 8 12 11

Concentration and forgetfulness 13 4 8 10

Depressive ideas 20 7 13 9

Anxiety 7 6 7 9

Somatic symptoms 4 3 3 7

Worry-Physical health 8 4 6 7

Obsessions 7 5 6 6

Phobias 8 5 6 5

Compulsions 5 3 4 3

Panic 2 3 2 2

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Persistence of disorders
For many young people their mental illness is the beginning of a long and difficult journey. “Longer-term longitudinal studies suggest that for many young people,
mental health problems in childhood mark the early stages of difficulties that continue well into adult life”. (ONS 2004) and that half of all lifetime mental disorders
start by age 14 (Kessler et al, 2005).
A 2007 follow up to the 2004 ONS study found that 30% of the children and young people who had an emotional disorder and 43%of the children and young
people who had a conduct disorder in 2004 were assessed as having an emotional or conduct disorder three years later.
The 2000 shows us too how problems for young people compare to older age groups. If we look at all disorders, a greater proportion of younger people suffer.
Age group % with one or more disorder
16-19 27
20-24 28
25-29 26
30-34 23
35-39 23
40-44 25
45-49 20
50-54 25
55-59 19
65-69 15

But considering only emotional/neurotic disorders, the level of problems increases with age. It’s only among the 65+ age group that the prevalence of neurotic
disorders drops below the levels for 16-19 year olds, and the peak is among 50-54 year olds (19.8% had neurotic disorders as opposed to 13.3% of young
people). Page 40 of the ONS 2000 report tabulates this in more detail and makes for interesting browsing.

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Networked effects
The percentages of young people with diagnosed mental health disorders represent a significant minority of the teen population. It is very important to bear in
mind though the impact of mental illness on networks of friends and family. In this way mental disorders can affect a far larger section of the population.
We asked our respondents simply if they believed they knew anyone with any of the following disorders.

Question: Do you know anyone who you believe has ever had any of the following problems? Simply ring
YES/NO. No more probing on this :) [99 respondents]

Answered ‘Yes’ Overall Male Female Early Late
[respondents] 99 43 56 39 60
Depression 70% 72% 68% 54% 80%
Anxiety 57% 60% 55% 36% 72%
Eating Disorders 58% 51% 63% 49% 63%
Severe disruptiveness 36% 37% 36% 38% 35%
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Insomnia 42% 35% 48% 31% 50%
Self-harm 68% 56% 77% 64% 70%
Others mentioned 8% 5% 11% 10% 7%
None 10% 9% 11% 23% 2%

The results are overwhelming. 90% of the sample are one degree of separation from someone they believe to have one of these disorders. Perhaps this is
unsurprising: it might only need a few children in a school to suffer a disorder for many to know them, and one focus group talked exclusively about one peer who
had significant clinical problems. But there were also difficult experiences reported by individuals: one focus-group respondent spoke candidly about having the
responsibility of taking his mother to the GP to make sure she renewed her prescription for anti-depressant medication.

Aside: Happiness in real-world networks
Fowler & Christakis (2008) examined over 4000 individuals in a cohort from a Framingham Heart Study and measured their happiness and connectedness.
Clusters of happiness and unhappiness were visible in the network, and connectedness to happy people was a causal factor in increased happiness in a subject.
Their conclusion: happiness depends on the happiness of others with whom you are connected.

Understanding Mental Illness
We asked our respondents what they understood it meant for someone to have a mental illness.
Question: What in your opinion does it mean for someone to have a mental illness? [61 responses]
Some sample responses follow; the remainder can be seen in the Appendix.

“a person whose view of the world is distorted in a reversible or irreversible way. a mental illness is not always harmful to a person, but the ones listed above
definitely are.”
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“It just means they have one thing wrong with nothing serious, there still the same person”
“it means a chemical imbalance in there brain , they need people around them who love them and are prepared to help them”
“Someone who 'Fails to Function Adequately'.”
“we all have mental health, which can be good or not at any point in their life.”

Collectively, respondents demonstrate a sophisticated and diverse understanding of mental health and illness, although not in all individual answers.
I know people who've had mental illnesses and stuff like that and you don't really notice but then once you've been told and it's out in the open. Because you always
call somebody bonkers or mad or whatever, once that's in the open, then everything you do you really question.
I just don't think I'd think about it that much.
Treatments for Mental Disorders
Crudely speaking, the treatments offered by professional mental health services can be divided into lifestyle (the preventative cures), counselling and therapy (the
talking cures), and pharmacological medication (the drug cures).

Talking cures: therapies
We can usefully focus on two categories of talking therapy:
Surface therapies focus on obvious problems in behaviours, beliefs and attitudes. A good example is Cognitive-Behavioural Therapy. They tend to be goal-driven
and have immediate practical outcome. As a result they often require less investment of time and emotion from the patient and crucially tend to cost less to deploy;
they are therefore favoured by economists like Richard Layard.
Deep therapies focus what may be underlying the disorder by closely examining past experience or present difficulties. Depth therapies have been around a long
time and there are many schools of thought - psychoanalytic, existential, humanistic and others. Therapists sometimes draw on ideas and methodology from
several of these. Courses of treatment tend to be longer and so more expensive.

40


What often happens is that in either the referral or the first consultation - or both - the patient is aligned with what appears to be the best therapy available for their
particular needs. They may also be treated in several different ways at different times.

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The Journey of Assistance
Young people making use of the mental health support services will typically move through several tiers of assistance. Each tier may refer young people with more
severe or complicated problems onto the next for more specialized assistance.
Tier 1 – Community based professionals
Psychological assistance for young people begins in the community. Teachers, youth workers and GPs all play a part, promoting mental health, acting as a first
point of call and helping young people in difficulty access more help.
Tier 2 - Community mental health teams
Often based in GP’s surgeries, schools or colleges these are trained counsellors, therapists and other mental health professionals. They can deliver therapy and
refer young people with enduring or complicated problems on to more specialist treatment.
Tier 3 – Specialised multi-disciplinary teams
Usually based in specialist clinics these teams combine the skills of counselors, therapists, social workers, nurses, psychologists and psychiatrists. They can often
deliver a variety of therapies over extended periods and can offer assistance to patients with severe or long-term problems. We spoke to psychotherapists Dr
William Crouch and Dr Vicki Holt in the Adolescent Directorate of the Tavistock-Portman Unit in North London; the clinic also includes psychiatrists who deal
with pharmacological interventions and psychologists who assess patients psychometrically.
Tier 4 – Specialised hospital-based teams
Here young people whose disorders may put themselves or others at a high risk can be treated in a hospital setting, either as outpatients or admitted for treatment.

[Diagram and descriptions sourced from http://www.mentalhealthcare.org.uk/content/?id=87]

Journey from Mental Health to Mental Illness
We also need to consider an earlier journey, from mental good health to mental illness. Life throws all sorts of events at young people and everyone is differently
equipped to cope. Sometimes the struggle makes young people ill.

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Stressful life events
Often significant events cause or precipitate the journey to mental illness.
The ONS study (2005) found that the young people they encountered with mental disorders were all more likely than those who were well to have lived through
the following stressful events:
- parental separation or and of a parent’s steady relationship
- major financial crisis (loss of 3 months or more wages)
- parents in trouble with police (goes to court)
- parent has serious physical illness
- parent has serious mental illness
- parent, brother or sister died
- close friend died
- child has serious illness which requires a stay in hospital
- child in serious accident or badly hurt
- child breaks off steady relationship (age 13+) or close friendship ends (any age)

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Circumstances
The ONS survey found several other long-term precipitating factors, all of which were more likely to affect the lives of the young people they met who were
suffering from mental disorders:
- Socio-demographics – roughly speaking lack of money, poor education, lack of work and instability
- Poorly functioning families
i.e. several of the following factors applied
1. Planning family activities is difficult because we misunderstand each other.
2. In times of crisis we can turn to each other for support.
3. We cannot talk to each other about the sadness we feel.
4. Individuals are accepted for what they are.
5. We avoid discussing our fears and concerns.
6. We can express feelings to each other.
7. There is lots of bad feeling in the family.
8. We feel accepted for what we are.
9. Making decisions is a problem for our family.
10. We are able to make decisions on how to solve problems.
11. We don’t get along well together.
12. We confide in each other.
- Family breakdown e.g. separation, divorce, death
- Mental ill health of parents
- Child’s physical health
- Failure of child’s support networks
- Failure of child’s social networks
- Weaknesses in the child’s social skills

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Problems posted online
To get a sense of what problems young people present online (rather than to the ONS researchers) we also looked at ‘Tears’, a messageboard for teens who are
down and want to tell someone: ‘Something making you sad, down or bitter? Tell someone... As they say, a problem shared is a problem doubled.’
http://www.teensay.co.uk/boards/tears
Collectively, the 51 postings we analysed mentioned nearly all of the life problems above. They also mentioned bullying (including homophobia) and school
pressure. Exactly half of the posters mentioned more than one problem and it’s easy to see from the posts how one problem often comes with others.
e.g.
“S.”
Join Date: 30 Sep 2008
Sex: Female
Posts: 15
Rep Power: 0

Tell me how I should feel about this…
hey,
i have lost all trust in my dad lately and have no love for him. the house was as usual disfunctional but running smoothy, however when my dad woke up he was in a
really bad mood and he flipped. he decided he was going to move out and live with this woman who he has had relations with behind my mams back since i was 2.
now apprently he is staying in her spare room (yeah right) and he needs to get his head together. he has apprently been to the doc's and is suffering depression and a
breakdown.
i think that this is just the easy way out for him and all the crap he has sturred up. my mam is having ago at me for not having any simpathy towards my dad. what
should i do, should i just pretend i care to keep her happy? how should i feel about this because to be honest he is the least of my worries and i really don't want to be
around him anymore.
what would you do in this situation? any advice would be helpful :-) thanks x

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It should be said that events whose impact demands coping strategies are not necessarily negative. In a famous study, Brickman et al (1978) demonstrated that
lottery winners were not happier than controls, and took less pleasure from mundane events; nor were there significant differences in comparison with a group of
accident-victims who had become paraplegic.

About adolescence
Adolescence can be defined as the process of becoming an adult. The major life events that occur are about transitions into independence and adult life, such as
exams to enter college, work, relationships and home. Dr William Crouch pointed out that independence is a desire for adolescents but also a pressure, and we
can see that sometimes they still crave dependence and support structures, for example the teen who is adamant that they are old enough to go to a gig but then
might ask his mum to drive him there.

What teens worry about
We asked our focus groups what events they worried about.
the future.
everything.
I worry about how I look. quite a lot of the time. Won’t go into details because I don't want to be too self-indulgent. I worry about what certain people think about
certain things that I say, and I don't mean it like that but it might get misinterpreted.
changes, I don’t like changes and I worry about that
well right now I see the future and but in more detail, cos like in year 11 I thought secondary school would last forever to tell you the truth and now year 12, it's all going
so fast and I know everyone's growing up so I worry if I’m just going to be in the same place or if one of my friends is going to be in the same place and left behind. but
I just try and take it in my stride.
yeah I worry about actually having to grow up and pay bills and stuff like that, it make me feel sick.
I try not to worry about things like that. but I worry about the little things, like work and homework deadlines, even if it's not that important because I think I've got

46


my future planned out it's safe but with the little things they are always constantly in the back of my head. like I'd find it more difficult to get to sleep if I thought I had a
1000 word essay to hand in the next day then I would if I as thinking about debts and stuff like that
I worry about not being successful. I don’t necessarily want to earn lots of money but I want to be good at what I do and I want to be recognised for that and I worry
about not achieving that
I tend to worry about stuff that's just happening to me now, like I'm not revising or stuff, but I don’t lose sleep about it unless it's really important. but I don't tend to
worry about stuff that's too far in the future.

We also asked each focus group collectively to arrange the following in order of importance to them and come to a consensus agreement (again so we could
hear their thinking).
WORK
HOME
FAMILY
GIRLFRIEND/BOYFRIEND
FRIENDS
MONEY
COLLEGE
EXAMS
ENVIRONMENT
WHAT’S IN THE NEWS

Quite consistently across both age groups, FAMILY and FRIENDS dominated. EXAMS, WORK and COLLEGE depended on their current topicality for the
individuals. Both ENVIRONMENT and especially WHAT’S IN THE NEWS had only few champions.

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Here’s part of a group discussion of late-age teens:
I worry about swine flu, I don't give a shit about swine flu that goes at the bottom
friends have become very important to me, family have very recently become very important to me,
ok who cares about the environment.
environment. let's be real.
I think about how great it is to live in London, I mean how great it is not to live on the side of a cliff in Wales. Let’s be real (to the bottom)
home, I’d rather be out
exams - at the moment yes
family at the top? family and friends being at the top
I don't worry about my family I lie with them so if something's going to happen to them, it's going to happen to me too
to be honest at the moment it' s exams
who worries about work?
to be honest at the moment I'd put family friends exams
but then again I'm in that frame of mind where I think, I don't need college
who works? me, I work in an icecream parlour
all three and then college underneath
Resulting in:
1=) FRIENDS, FAMILY 3) EXAMS 4) WORK 5) MONEY
6) HOME 7) GIRLFRIEND/BOYFRIEND 8) COLLEGE 9) ENVIRONMENT 10) WHAT’S IN THE NEWS

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Feeling Down
Question: When was the last time you felt down? Do you remember what happened to make you feel that way? [93 responses]
Sample responses follow; the remainder can be found in the Appendix.
“A week ago. I felt i was going to fail my exams not because i hadn't worked hard enough but because i wasn't as good as id like to be at the subject which meant i
couldn't do it for a degree option and wouldn't get into my first choice uni and all my friends would be able to go to their choices.”
Couple of days ago. Just dumped my girlfriend.
couple of weeks ago, felt a bit isolated, as if i were loosing people ( perhaps slightly over exagurated)
i was annoyed another girl told another girl i said something when i never
Last week. Me and a friend are moving into a house next month and we are fed up of people being negative by saying we won't be able to afford it etc. Also an ex
girlfriend just won't go away.
when Scrubs ended :(

Responses range from the profound to the relatively trivial televisual, and certainly cover the kinds of stressful events we might expect from the literature.

49


Dealing with problems – support networks
Often young people deal with these problems by talking to networks of friends and family.

Question: Did you talk to anyone when you were feeling this way... who? [62 responses]
Sample responses follow; the remainder can be found in the Appendix.
“My bestie”
“my friends”
“not really, if a friend asked me what was wrong then i would explain, but wouldnt go into full depth.”
“yes, everyone - they should feel my pain!”
“Yes, I was impressed a mate asked, but only got half way through the conversation, then we got moved on, when i suggested we went back to it, she never
replied (this was a text)”

We also categorised and scored these responses, examining them for differences across gender.

Talked to… F no F % M no M% total total %
everyone 0 0 2 9 2 3
friend 11 28 4 18 15 24
friends 6 15 5 23 11 18
gf/bf 2 5 1 5 3 5
nobody 10 25 7 32 17 27
parents 9 23 3 14 12 19
sibling 2 5 0 0 2 3
total respondents 40 22 62

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While 27% of respondents talked to nobody, this also meant 73% talked to somebody. The largest differences between genders are suggestive that boys are
more likely to talk to nobody or to friends plural, while girls are more likely to talk to parents, friend singular or nobody (although less likely here than boys).
We also found a significant desire to talk things through face-to-face. Phone and online communication are usually employed to facilitate a face-to-face meeting.
Question: How did you talk to them? Face-to-face, phone, text, messenger, facebook etc [52 respondents]

mode number %
face2face 25 48
phone/text 4 8
online 3 6
face2face & phone 10 19
face2face & online 2 4
phone & online 1 2
all 3 6
none 4 8
total 52

And one choice quote from online respondents:
“face to face. talking about real emotions any other way is slightly pathetic.”
Here’s what some of the late-age teen focus groups had to say:
definitely talk face-to-face
when I was younger I was more serious for some reason and I'm trying to get off that because what you type online can be so easily misinterpreted, or copy and
pasted to someone else or something. so I don't even have facebook because I want to avoid that kind of thing but some people just like post their whole life up on
facebook and comment look what she was doing and meh meh meh
- you don't question anything on the internet
- I've got facebook, I've got msn but I don’t tend to talk about serious things
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- no real issues - no it's generally just like what did you do yesterday
- like the conversations on msn and facebook always start off like hi, hi, how are you, I'm fine, you? I'm fine and then you just go and chat a load of crap, it's nothing
serious ever

me, recently I had a barney with my girlfriend and one of the things she made me do was post a list of things I love about her so that everyone could see and it was to
show that I was willing to be in touch with my feminine side
- but I do admire that
- yeah but I hated it and as soon as it goes up there was loads of lists from other women, men know not to do anything, not to type, but there were loads of messages
from other women. no, I hate it.
- I'd love it if a guy did that for me.
[boys shake their heads]

I hate when I sign onto msn and people's usernames are like ihatemylife
and you go what's wrong? and they go o it doesn't matter 'I want you to know I'm unhappy I just don't want you to know what I think'
sometimes I prefer people over msn, know that sounds weird but once I met up with this girl there and she was like really sound, and I met her once (so I know she
wasn't like some paedo) but just in passing to say hi, then I found her on Bebo and added her. but when we met up she was not so much fun.
was she ugly?
she was a different person on msn, like we had all these in-jokes and she was really funny
she broke up with Olly and said 'oh I preferred the MSN Olly'
like when you say LOL, no one actually laughs out loud
you'd want to moan first, and that'd normally be done by MSN or text and then when you're not over it, but you talk to them face-to-face the next day and they'd try
and cheer you up

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More often than not, whether through the support of our networks or our own personal resilience, we bounce back.
The ONS (2005) study asked about networks and found that young people with mental health difficulties tended to have weaker social and support networks,
and weaknesses in the social skills necessary to maintain and extend them. Obviously there’s a complicated relationship between cause and effect here. It’s not
simply the case that kids with poor social skills are more likely to become mentally ill, but it’s part of the story.
The survey asked about the following
1. How many relatives in same household does child feel close to.
2. How many other relatives does child feel close to
3. How many friends would child describe as close or good
friends.

&
1. There are people I know who do things to make me feel happy.
2. There are people I know who make me feel loved.
3. There are people I know who can be relied on no matter what happens.
4. There are people I know who would see that I am taken care of if I need to be.
5. There are people I know who accept me just as I am.
6. There are people I know who make me feel an important part of their lives.
7. There are people I know who give me support and encouragement.

If those fail, we might seek wider networks, whether that be professional networks like The Samaritans.
Or, going back to the Tears message board, we see another way of seeking help. As the byline says ‘Something making you sad, down or bitter? Tell someone...
As they say, a problem shared is a problem doubled.’ Out of 51 postings 29 specifically asked the Tears community for advice, e.g.
“anyone got any ideas how i could manage to sleep at night? and to start eating again?”
Other posts any were either angry and venting, looking for support (one explicitly asked for a ‘hugs’) or a combination of the two.

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Most of the posters were girls (76%). Just under half (44%) were first time posters or anonymous ‘guests’. The rest had posted several times on other boards on
the teensay network. Only a fraction (10%) posted more than once on the tears board.
All of the posts got responses – just over 8 responses on average – but only half (51%) of the initial posters came back with a reply. It seems that the Tears message
board is not for conversations, or conversations that follow posts take place elsewhere.

Barriers to seeking professional help
The young people we interviewed had collectively a relatively sophisticated understanding of what it means to have a mental illness, and many mentioned that this
was an illness that needs to be treated. But presented with a hypothetical scenario describing a friend becoming depressed, the first steps respondents identified
were almost exclusively about providing personal support through peer networks, only 2 out of 63 mentioning a GP or professional services.
Question: If a friend felt down all the time, and there were no obvious reason for that, what different things might you do to try and help them feel better? [63
responses]
Some sample responses follow; the remainder can be found in the Appendix.
“try and understand their situation/ what they're feeling 2. adjust my behavior to make them feel comfortable 3. give them time and space and let them
know i'm here if they need to talk about anything - not necessarily about their issue if it helps them 4. if they don't change then sit down and talk with them”

“cheer up you soppy bastard”

“Demonstrate you are there (sometimes actions speak louder than words). If you can work out the sort of area the problems are from, creating
opporutnies, and chance for hope. e.g plans to set them up, talking to people who are being horrible. See if you can set realisitic goals to getting "happier",
and follow them up.”

“try to make them laugh and try to get them to speak to someone professional”

Equally, few of our focus groups in interview had any idea of how to take the next step, out of their networks and towards professional services. Asked directly
about what their next steps might be if their first attempts to help their depressed friend failed, few of the late teens interviewed mentioned without further
prompting the seeking of professional services. A more common response was to give up, even to take the failure to help personally.
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drown your sorrows in alcohol
shoot them or something
give up
keep out of it for a bit but then maybe if they were in big trouble refer them to help, like a professional
oh I wouldn't do that, I would speak to someone in authority more like their parents
sometimes people are just down anyway, you just want to stay away
just tell them straight that they're being a bit stupid then they might actually listen to you
if a friend was diagnosed with a mental illness, I'd feel bad, even if it wasn't my fault
I think it would be a bit awkward, maybe they've had something for a long time and I should have known

One focus group of early teens all confirmed that they had counselling services available at school, but seeking help so publicly could be difficult.
If you get seen going, it’s like you’re a headcase
I've been to mine once but that's just cos I got sent
not with anything serious, they're really sarcastic
they're there to help because it's their job, not like a friend who's there to help because they want to, and it makes it less personal you feel you're here because you
have to.
but they tend to have talked to a lot of depressed people, so it does help when there are things you don't want to talk about to other people
Some young people simply don’t recognize that they need help, or that they can be helped. The New Zealand study of older teenagers (Fergusson and Horwood,
2001) found “at [15 & 18 years] it was found that less than a quarter of those meeting criteria for disorder received any form of treatment or assistance. Treatment
seeking was more common amongst those with mood disorders. Questioning at age 18 revealed that the major reasons for young people with psychiatric

55


disorders failing to seek assistance were that they believed that they did not require treatment, they felt that the problem would resolve itself or they did not think to
seek treatment”.
Sometimes the mental health services fail to diagnose the situation correctly. The following message from the Tears message board makes clear how complicated
these situations can be.
lil_baby_me_xoxo
GUEST
My brother tried to kill me
last week my little brother (who is disabled) tryed to slit my throat because i wouldnt play footie with him because it was raining and i had flu so he went into the
kitchen and got a knife then came back and tryed to slit my throat. but i moved so he slit me wrist instead and i lost loads of blood so i had to go to hospital but
because i wouldnt snitch on my brother for trying to kill me the social think i tryed to kill my self and i have to go to counceling. i wont ever grass on ma brother but i
dunt want to go sit in a room talking about "my feelings and why i feel like that" to some stupid person who thinks talking will solve war or something! i have to be
monitered everywhere i go in school incase i try to kill my self "agen" and because i was in the house alone with my brother my big brothers and my dad think i tryed
2 kill my self aswell but i cant tell them what my brother did because my two big brothers
hate him and I'm my dad's little angel and I'm daddys little girl so he would kill my brother
because i have a violent family so should i tell them my brother is an attempted murderer
or let them think im suicidal
i changed this because lil kay doesnt like how i write.

It’s also important to recognize that the Tier 4 Mental Health Services have the power to
section patients, and however infrequently that happens, it still contributes to an
impression of professional mental health services as being disempowering institutions.

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Fear of the mental health services came through clearly in our survey of the Tears message board, e.g.
Twinkleees
Join Date: 09 Jul 2008
Age: 16
Sex: Female
Location: Scotland
Posts: 127
Rep Power: 0
Knackered
Okay...I havnt had any sleep at all since Friday.
I told my mum about it and she just said its because i havnt ate could this be true?
I'm actually scared i will get put into hospital for exhaustion.
I tried to eat today aswell but i just couldnt. This all started after i had an argument with someone over MSN on Friday night, they were sitting calling me fatty and
ugly the usual crap teens say to each other nowadays. But i have just got to the stage where i just cant bare it any longer, bullying in my life has went on to far and i am
just seriously pissed off. Anyways, anyone got any ideas how i could manage to sleep at night? and to start eating again?
Would be much appriciated.

Or the young people have an imperfect model of how the assistance will work.
Donna
GUEST
Ah fuck
Lately i've just been feeling really depressed.. which is stupid because i have nothing to really be depressed about..i find myself crying every 10 minutes over nothing..
and im too young for anti-depressants.. i've tried talking to people..but it dosn't really help.When i'm out and about i'm fine. . it's really when i come back home that i
feel totaly depressed..but nothing bad is happening at home.I know this probably dosn't make any sense,and it's not really a BIG problem..but.. i just want to know if
anyone feels this way ? or has any idea..why i would mabey feel like this..i'm not sure why i expect you to know when even i don't know but yep.. :s

57


?????
GUEST
doctors nd depression ...help?
I've had weight problems since the age of 12-13 and im 16 now an i still hate my weight i had a while were although unhappy i would eat properly but in the past
months i just cant look at food never mind eat it and when i have to if im unable to make my self vomit it makes me feel depressed. ive been depressed for quite a long
time but in the past few months with exams coming up nd homophobic bullying from people in my school im and a general dislike of my self im not having a gd time.
wen i was anorexic for the first period time i was selfharming for 6-7 months and stopped but iv started it again and it really dont know wht to do anymore and i cant
talk to people at school . i want to go to my doctor and see if i was able to have medication instead of goin to a clinic like i was tried to be made to go to before, while
my exams are goin on etc but im worried that he'l tell my mum ive selfharmed etc . would he be able to do that ? as im 16 the r good points in my life but atm the bad is
just takn over and i just cant get out f feeling so low and hating myself . is it safe togo to the doctors and b sure il have my confidentuality ?

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Services for ‘casual’ users of mental health services
Professional health services are also consuming in terms of time investment. Therapeutic programmes may last months, demanding regular attendance, and not all
treatments are available on the NHS. But not all services immediately require ‘heavy’ involvement.

Young People’s Consultation Service
As designers of interactive experiences, we look to make it easy for players to engage casually, which may then lead them into deeper engagement. It’s good
participation design to help overcome the barriers for players.
Similarly there are services in mental health that look to hurdle the barriers for young people’s engagement and make services more accessible.
The Tavistock-Portman Unit runs the Young People’s Consultation Service (YPCS), more information about which can be seen at http://bit.ly/MgggN It was set
up precisely to tackle these barriers. We spoke informally to Juma Woodhouse, a 21-year-old student on long-term placement at the Unit who’s been helping
facilitate the YPCS under Dr Frank Lowe.
The YPCS is a lower investment of time, requiring only 4 one-hour sessions weekly to complete and which are available free of charge on the NHS. It’s accessible
for immediate self-referral, so you can phone the clinic to start the referral procedure, although the clinic usually request after a telephone referral that a written
request is also made. And it’s confidential and user-centred, responding to the issues and challenges that the young people present and aiming to give them
greater understanding of their problems and how they might help themselves.
Woodhouse also helps run a 10-week group discussion programme for high-achieving young black people at a transitional stage in the context of their school. It
runs through an essentially similar programme to the YPCS - although through group discussion rather than one-on-one therapeutic practice - and also considers
ethnic identity and the role that can play.

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