By Professor Susan Sawyer AM (MBBS 1985, MD 1995), Geoff & Helen Handbury Chair in Adolescent Health, Department of Paediatrics, University of Melbourne, Murdoch Children’s Research Institute.
Adolescence has long been seen as a challenging time. New views embrace young people as one of society’s greatest assets and we need to take a systems approach to supporting them.
The anatomy of a mental health crisis
There are growing concerns about the state of adolescent mental health and wellbeing. A recent cohort study my team and I published in The Lancet Psychiatry found that 74 per cent of 1,200+ participating adolescents in Melbourne had experienced significant symptoms of common mental disorders at some stage between 10 and 18 years of age. These were not one-off events. Persistent symptoms were rife – especially in adolescent girls.
Our findings correlate with other global studies that suggest that young people today are experiencing much higher rates of anxiety and depression than previous generations.
The dynamic development of adolescent brains
Puberty is a defining feature of early adolescence. Beyond its effects on the reproductive system and physical growth, hormonal increases also change the brain structures that process emotions, including the amygdala – which encodes fear and stress, and the ventral striatum that’s involved in reward and motivation. This makes adolescents particularly reactive to emotional rewards and threats to their social status, especially from peers.
For adolescents today, social media has emerged as an ‘uber peer’ that is creating increasingly toxic social environments. Professor Susan Sawyer AM
The adolescent brain’s emotional response system – responsible for more impulsive behaviours – develops earlier than higher order cognitive decision-making skills and the capacity for emotional regulation. In the modern world, this ‘developmental gap’ increasingly places young people at risk, especially in the context of their peers.
For adolescents today, social media has emerged as an ‘uber peer’ that is creating increasingly toxic social environments. The wiring of a young brain and its emotions makes adolescents uniquely vulnerable to the constant judgement of manipulative, addictive, algorithm-driven social media feeds.
Beyond risks for mental health, body image and sexual grooming, time spent in the digital world also displaces activities that provide rich opportunities for meaningful social and emotional learning, including the skills and rewards that can come from delaying more immediate gratification.
Adolescents: our most undervalued asset and opportunity
In 2016, the first Lancet Commission on Adolescent Health and Wellbeing described the triple return from investing in young people’s health: improved health and wellbeing in adolescence, adulthood and for the next generation.
Recently published, the second Lancet Commission on Adolescent Health and Wellbeing also acknowledges the incredible potential of adolescents to contribute to solutions. Adolescents’ brains make them curious, courageous, creative, energetic and adaptable – traits that make them critical partners in shaping our collective futures.
Beyond the health system, we need to invest in the breadth of systems that can support, respect and empower young people to thrive.
Credit: Michael Kai
Rethinking the power and purpose of schools
One of the most important of these systems is education, where there is renewed interest in how schools can better promote health and wellbeing alongside learning.
Traditionally, the health sector has viewed schools as useful platforms for delivering health education. But we now recognise that schools are where young people learn how to engage with the world – not just intellectually, but socially and emotionally. The tone and safety of the school environment, and the behaviours those environments reward, can shape life-long health outcomes, including mental health and wellbeing.
We saw emerging evidence of this 25 years ago through Victoria’s Gatehouse Project, which studied whether secondary students’ sense of security, trust and their ability to engage in positive social behaviours could be fostered by enhancing their social connectedness to their school community. The results were remarkable – intervention schools saw a 25 per cent reduction in substance use, antisocial behaviour and early sexual activity.
Globally engaging adolescents for better mental health and wellbeing
The Gatehouse Project’s approach has since been replicated in diverse contexts across the world, bringing benefits for a variety of health and learning outcomes, including mental health. Known as ‘whole-school’ approaches and promulgated by the World Health Organization’s ‘Health-promoting Schools’ framework, such interventions can be highly efficient by addressing health risks and social determinants that influence a variety of health outcomes.
For example, Japan’s primary school lunch program, known as Kyuushoku, provides a daily nutritious lunch. Underpinned by a set of standards that ensure nutritional value and promote healthy weight, teachers eat alongside students to promote social connections, enjoying meals that are balanced, seasonal and local. The program enhances student wellbeing and mental health by promoting social connectedness with peers and teachers, while teacher supervision reduces bullying – a key risk for poor mental health.
Whole-school interventions are intended to benefit all students, but when implemented well, offer the greatest benefit to the most disadvantaged students. This includes LGBTIQA+ youth, who are more likely to experience bullying and who experience higher rates of depression and anxiety, as well as suicide and self-harm.
Victoria’s Safe Schools program is an example of a whole-school approach to supporting LGBTIQA+ students. These approaches also particularly benefit students with neurodiversity, First Nations students and those outside mainstream cultures and religions.
Driving systems change
The benefit of fostering student wellbeing in schools is clear. But schools cannot make this shift without dedicated resources and government policy that articulates new leadership models, and teacher training.
A critical starting point is improving our understanding of adolescents. Primary teachers have a good grounding in early childhood development, but most high school staff lack a similar understanding of student needs. It’s time that everyone working with, or forming policy for, young people has some training in adolescent health and development.
To achieve system transformation, piecemeal adolescent health programs must be positioned within a wider approach that ensures interventions target the most pressing social determinants (rather than the ‘loudest’ voices or issues) and identify where synergies are possible – including what can be discontinued.
Policy interventions such as the Australian Government’s world-first social media delay may be helpful, but only if part of a broader strategy. Just as adolescent mental health is impacted by a complex set of related concerns – body image, sexual identity, weight, bullying, loneliness – its adequate support will also be found at the intersection of multiple, interconnected and aligned approaches.
What do young people do as they seek distraction?
As a community, we have a duty of care to both address the risks of adolescence and amplify the strengths of curiosity, courage, energy and adaptability embodied in young people. Fostering wider understanding of adolescent health, engaging young people as genuine partners in co-designing the solutions that support them, and taking a systems approach to the settings in which young people are growing up are all required.
We will all benefit from the next generation of young people focusing their energy, creativity, curiosity and passion on building a better world. Professor Susan Sawyer AM
Our fully online Master of Adolescent Health and Wellbeing equips nurses, doctors, teachers, social workers and lawyers to plan, implement and evaluate effective prevention and intervention strategies for adolescents.
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