Why early intervention is an essential part of mental health care

 

Growing up, I knew that I was different. School reports often said that I distracted other kids, that I was slow to finish my work, or that my main problem was “a lack of concentration.” In primary school, when I was mercilessly bullied, I told my parents that I wanted to kill myself. I became depressed and developed social anxiety. By secondary school, I retreated further inwards, developing unhealthy coping mechanisms in a bid just to survive.

It wasn’t until my late 20s and early 30s that I was finally diagnosed with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and generalised anxiety disorder (GAD). I am also suspected to be on the autism spectrum.

Finally, my childhood experiences began to make sense. By then, however, the damage had already been done.

– Alexander

It’s no secret that one in five young people aged 8 to 25 experience a probable mental health condition, and that the onset of most mental health disorders peaks at just 14.5 years old. In fact, 75% of mental disorders begin before a person’s 18th birthday, and half of all mental disorders are established by 14 years old.

I am one of that number, but a lack of early intervention directed my life on a trajectory that has had lasting ramifications. The signs were clearly there in my childhood, in my school reports and my behaviours, and yet no actions were taken. In primary school, when I expressed my desire to die, my parents didn’t take me to a doctor; they took me to the headmaster, who did nothing to truly help. Despite my lack of concentration in class, teachers didn’t recommend my parents take me to the doctor; I was punished and bullied further for it. While I went on to university and did well, my ADHD meant I succeeded mostly in topics I had a deep interest in, and not in those I found more boring. I know, looking back, that I could’ve performed much better had I been given the diagnosis, and thus the tools, to work alongside my ADHD and not against it.

After losing my father in 2011, at only 23 years old, I sank further into a depressive cycle that persisted for years. Again, I didn’t have the tools or the understanding to cope. Limited grief counselling meant I wasn’t able to fully heal, and instead I buried the grief beneath alcohol and anger. Even today, I struggle to come to terms with grief and managing my emotions, lacking the tools I could’ve been developing over time.

Much has been discussed about a lack of mental health care on the NHS, about the long waiting lists and inadequate support.

Not enough has been discussed about the lack of early intervention and the benefits that early intervention has on mental health outcomes at any age, but particularly in childhood and adolescence.

Pundits often describe an overdiagnosis of mental disorders, but they fail to see that these disorders have always existed in our youth; they were simply ignored, untreated and left to fester.

– Alexander

In brain development and cognitive health, there is a concept known as neuroplasticity: the brain’s ability to form new neural pathways over time, literally reorganising itself to learn new skills or recover from injury. This means that our thinking patterns are not fixed; we can recover from them with work and effort, such as through cognitive behavioural therapy (CBT). However, neuroplasticity is stronger early in life. The brain reaches full maturity during the mid-to-late 20s meaning as we age, the brain becomes less malleable, making significant changes in cognitive health more difficult. In fact, during childhood, the brain has up to 50% more neural connections than a typical adult brain. As we grow, connections in the brain that are not used are pruned away, while connections that are regularly used are strengthened. This means that our early and adolescent behaviours become entrenched and harder to discard, but that they are more easily changed if we intervene sooner.

While further research is needed in this topic, our understanding of the brain’s ability to heal and form new connections means that the earlier we intervene in mental disorders at any age, the easier they may be to treat and recover from.

In my own case, I can’t help but wonder where I would be today had someone truly paid attention and sought help for me when I was struggling. A significant portion of my depression comes from my frustration at how my life has turned out; how, in my late 30s, I still struggle with the same problems I had in my youth, and how they seem to be getting worse with age. Getting help on the NHS continues to be elusive; waiting times are long, and my local community mental health team is keener that I self-refer to limited charitable therapy services instead of more robust (and longer-lasting) therapies within the health service.

We are experiencing a mental health crisis in the United Kingdom, with NHS waiting lists continuing to grow and our mental health deteriorating while we wait. This problem has only been exacerbated by the lack of mental health care in its early stages of development, and if we are truly going to become a mentally healthy nation, we must attack this problem on both fronts: caring for those already struggling with untreated mental illnesses, and treating those only now showing symptoms of poor mental health.

Early intervention is essential at every age, but we must ensure our young people are given the tools for good mental health early in their cognitive development if they are to grow into mentally healthy adults.

– Alexander

That’s part of the reason why I work at Mental Health UK: to help people understand and become advocates for their mental health, to help young people and their guardians recognise the early warning signs of poor mental health, and thereby help people access the help they need earlier in their mental health journey.

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