Not Everyone Needs to Go to Therapy

At The Atlantic, the latest episode of Jerusalem Demsas’ ‘Good on Paper’ podcast features this conversation with psychologist Lucy Foulkes on the downsides to universal mental-health campaigns and programs, particularly in schools: 

Jerusalem Demsas: Just go to therapy. It’s the kind of thing that’s become very common to say, regardless of the circumstances. For many, therapy—or mental-health treatment—has become less like health care and more like exercise or eating healthy foods: prescribed to everyone broadly, regardless of their individual circumstances. . . . 

In a provocatively titled psychology article, our guest today, Dr. Lucy Foulkes, asked the academic community, ‘Are mental health awareness efforts contributing to the rise in reported mental health problems?’

She and her co-author theorize that mental-health awareness efforts are leading to more accurate reporting of often-ignored mental-health issues but also that awareness efforts are ‘leading some individuals to interpret and report milder forms of distress as mental-health problems.’ . . . 

Why did you decide to look into this? Was there something you saw in the literature or something you saw when you were working in schools that made you concerned about this problem?

Foulkes: I was working in schools as a researcher, so I was observing what teenagers were being taught in schools about mental health, and I was interested in that. You know, if you go to the bathroom when you visit a school, there are signs in the bathroom, telling you to think about your mental health. For example, there’s information on school websites. There’s information they receive via assemblies and lessons. So quite early on, I was interested in the fact that young people are learning about mental health now in a way that my generation never learned about in school.

And I was also then working as an academic, as a lecturer at the University of York. And I was noticing that the undergraduate students were also receiving an awful lot of messages, encouraging them to notice and talk about their mental health. And there was one particular incident where I remember becoming a bit more skeptical. My colleague, underneath her email signature, she had in big letters: In crisis? Get help here.

And I thought, That probably is helpful for a student who is in crisis and doesn’t otherwise know where to go. But I realized that every student that she emails will see that message, and they’ll see that message in the context of everywhere else being told that they are at risk of experiencing mental-health problems and that there’s certain language that they should use. And I think that was a bit of a turning point of starting to think, Hang on. Are there some side effects to this that might be a problem? Even if there are benefits for other students or other young people.

Demsas: . . . Something you said in a video you did struck me, which was that all this awareness isn’t reducing rates of mental-health problems. Do we have causal evidence that the increased awareness is leading to an increased rate of mental-health problems?

Foulkes: Not straightforwardly, because it’s a difficult thing to measure as a causal effect on a societal scale. But firstly, it’s certainly not been the case that it’s reduced the problem, because almost year on year, more people—more young people, in particular—are reporting mental-health problems. So the decade or so that we’ve had of really encouraging people to talk about their mental health has not yet worked.”

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