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19 March 2022

Inside the mental health epidemic among teenage girls

Our girls are struggling. How can we help?

By Rachel Kelly

Picture the scene: a school in west London. A wood-panelled hall, around 80 girls aged 14 to 15 assembled on tiered seating, a sea of ponytails, backpacks and tracksuit bottoms. How many of them have suffered from any kind of mental health problem, I ask, as part of a workshop I’m running on psychological wellbeing. Almost every hand shoots up.

It has been the same story whenever I have given talks at schools over the past two years as a mental health advocate and ambassador for several charities. Girls are struggling. It is young women who confide in me at the end of the workshops, when most of their male peers have left the room. They tell me that they suffer low self-esteem, feel that things are out of control, worry about their body image or are concerned about passing exams. Often they tell me that they haven’t been able to talk about any of these issues openly.

This anecdotal evidence that teenage girls are finding life hard was confirmed by a study of 15,000 secondary school pupils published in February. The mental-health focused company Steer Education and the social enterprise Minds Ahead found that girls were more than twice as likely as boys to suffer mental health problems by the time they were 18. Eighty per cent of girls were hiding their distress, compared with 60 per cent before the pandemic, the study said. The NHS found last year that one in six children in England aged five to 16 identified as having a probable mental health disorder in 2020, up from one in nine in 2017. In a study of 40,000 teenagers conducted by Manchester University, published in March, 22 per cent of girls reported emotional difficulties compared with 7 per cent of boys; social media and a lack of sleep were reported as possible contributing factors.

Louise Chunn, founder of the therapy website, says that girls are finding the modern world a miserable place. “During the Covid period, more parents are reaching out for therapeutic help for their adolescents, and the majority have been for daughters rather than sons,” she says. “Anxiety and depression have been the main reasons cited, though eating disorders, self-harm and low self-esteem have also been mentioned.”

Our daughters are clearly facing difficulties. But the reality of adolescent mental health is especially nuanced and complex, and there are three main reasons for this. The first is that teenage boys suffer, too, it’s just that they are even less open in talking about and acknowledging their problems. Harriet Frew, a therapist at Cambridgeshire and Peterborough NHS Trust, says that girls are more likely to be “empaths” and will often talk more about their feelings. “Boys may still be experiencing similar triggers, but do not express this openly.”

Take eating disorders, a specialism of Frew’s, often characterised as a problem for girls. “I believe that many more boys [than we realise] suffer from eating disorders but do not access help.” This, she thinks, is partly due to stigma and partly because their food-related issues tend to develop in the pursuit of fitness. “That normalises certain disordered practices, and people don’t realise they have a problem.”

Carmine Pariante, a professor of psychiatry at King’s College London, agrees that boys’ suffering can be harder to detect: “It is important to notice that adolescent boys may express their distress with behaviour that might be disruptive and impulsive, and not recognised as an expression of emotional suffering.”

The second reason adolescent mental health can be particularly complicated terrain is that we sometimes medicalise what Freud called “ordinary human unhappiness”. Some girls are suffering agonising mental health problems, especially when it comes to eating disorders. Others, particularly those who are generally anxious, may mistakenly categorise themselves as ill.

David James is deputy head of Lady Eleanor Holles, a private girls’ school in south-west London. “We seem to have gone from one extreme [of internalising and repressing difficult emotions] to oversharing and catastrophising ordinary human unhappiness,” he says. James also says that students often pathologise themselves, encouraged by Google self-diagnosis.

A third reason for complexity is that, from a demographic point of view, girls’ mental health varies according to background. Studies suggest that the greatest suffering has been among those who also report financial hardship, poor housing and who are growing up in dysfunctional families, where conflict and neglect are more common.

While we should be wary of generalising about differences between the sexes, girls do face some specific psychological challenges. The ubiquity of mobile technology and social media points to a good example. While both sexes have ready access to pornography, girls tend to be more objectified by it. Studies suggest that porn use can reduce the capacity for intimacy, feed body shame or encourage coercion into unwanted sexual acts. According to James, “Girls are objectified and classified more quickly and publicly than ever before.”

A related challenge that particularly affects girls is “unhealthy perfectionism”, identified by the Steer Education report. Part of this perfectionism is a concern with looks, exacerbated by social media. Girls can compare and despair when faced with influencers sharing their perfect bodies with millions of followers. In an August 2020 study Girlguiding UK found that 48 per cent of girls and young women aged 11-21 regularly use apps or filters to make photos of themselves look better online.

One 17-year-old girl told me that the pressure to look good is relentless; such images on social media are impossible to avoid. “You need your phone constantly, for school stuff, for meeting up with friends,” she said. “So even if you are not wanting to be, you are always on your phone and seeing this stuff, always thinking about how you look.”

Female perfectionism is also about the fear of making mistakes. Girls in general are less likely to take risks than boys. Chunn says that teenage girls are vulnerable to feeling that they might get something very wrong. “There is a fear of making a mistake that can never be rectified, and of being cancelled for having thoughts or opinions that vary from the acceptable norm. There is enormous pressure to be fair, kind, scrupulously supportive of those with lesser advantages.”

A further challenge lies in the pandemic, which has affected the more traditional support networks for teenage girls. “Adolescent girls are more likely to engage in social behaviour, such as close, supportive friendship,” says Pariante. “They might have been more at risk from the disruption in social interaction.” This is a view confirmed by recent research: one Swiss study of 250 students found that female students appeared to have worse mental health trajectories when data was controlled for different levels of social integration and stressors related to Covid-19.

How, then, can we support girls facing these challenges? It’s a shared responsibility. James argues that problems to do with objectifying young women won’t – and shouldn’t – be dealt with by teaching girls how to “cope”. “That reinforces the idea that it’s the girls who have to put up with unacceptable male behaviour, and it is the girls who have to change,” he says. “The same goes for technology. Boys need to be educated in what is unacceptable – and most are, but many are not. Parents need to play a full role as well, but so do the technology firms, which need to be more closely regulated.”

Schools need more staff who are trained in supporting students’ mental health, given the existing burdens on teachers. In general, says Frew, schools need to teach pupils about mental health and promote the message that it’s OK to talk. They should “signpost students to the school counsellor or pastoral support as appropriate”.

Frew added that children who are finding life hard should speak to a trusted adult. Her advice to a teenager who is struggling would include: “Journal. Have interests and hobbies that you enjoy. Develop ways to self-soothe and self-care. See a counsellor if you are struggling. Seek out online support and resources. Follow helpful social media accounts, and read recovery stories.”

Meanwhile parents need to be supportive and good listeners; use open rather than yes or no questions; and acknowledge their children’s feelings. Frew added that we should avoid “ignoring the problem”, but equally “avoid either lecturing or fixing”.

Writing in the Times in September 2021, the psychologist Tanya Byron made the point that we should be wary of overprotecting our offspring. A childhood without stress would mean a lack of opportunity to develop inner strength and the ability to bounce back from adversity and trauma, she argued.

Yes, teenage girls and indeed boys are facing many challenges. But feeling anxious, sad and overwhelmed at times is a normal part of life. We need to be careful not to have unrealistic expectations that we should always be happy and content. This was a message I tried to convey to those teenagers sitting in that wood-panelled hall. It was hard to tell how many girls agreed, but one told me afterwards that she felt relieved. “I like the idea that we are aiming to turn the worry dial to, say, a three or four out of ten, rather than an eight or nine. That all of us will be anxious from time to time – and that’s OK.”

Rachel Kelly’s latest book is “Singing in the Rain: 52 Practical Steps to Happiness”, published by Short Books.

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This article appears in the 23 Mar 2022 issue of the New Statesman, A Dream of Britain