Editor’s note: Following on from last week’s statement by the Psychological Society of Ireland that psychiatry should not be in sole charge of youth mental health, Welsh psychologists outline what good services for children should look like.
As psychologists we work with babies, children, young people and grown-ups experiencing distress and right now, kids are the unhappiest they’ve been for over 10 years (Kessler, et al., 2005). Our children have become some of the most anxious in the world. In 2011 an estimated one in eight 10 to 15 -year-olds has a probable mental health problem. More recently, that’s grown to one in five (NHS England, 2020; Children’s Society, 2025). But this is not an individual problem. It is a societal one. We know the gap in income equality continues to grow and none of us exist in a vacuum (Wilkinson, 2006). So, rather than locating these needs within individuals, we need to focus on relocating intervention within the contexts we are living in (WHO, 2015; Kirkbride, et al., 2024).
Lots of grown-ups are reaching out to people like us to try and understand what’s going on and get help. There are now so many people reaching out for support that waiting lists for things like child neurodevelopmental assessments are years. Services typically take a medical approach to organising this support. This gets locked in as the dominant solution because as a non-universal support and a very finite resource it needs some management. This, like many other public services, is largely gatekept by the DSM-5 diagnosis (diagnostic and statistical manual of mental disorders) and/or ICD-11 (International Classification of Diseases; WHO) rather than by a system that can reflect need. Once you get a diagnosis, support isn’t guaranteed. It also takes a lot of resources to provide a diagnosis in the first instance.
It’s helpful here to understand that psychiatric diagnosis is primarily a classification system (Insel, 2022). It is not based on identifiable bio-makers, chemical imbalances or specific genes identified with medical tests (Mate, 2024, Davies, 2022). You would be right to then ask why are we still using it? This is a very sensible question. A lengthy history of a lack of regulation and accountability between the pharmaceutical industry and academic psychiatry play a huge global role (Keefe, 2022). These errors have then been replicated and embedded into our domestic systems too; see for example IAPT (Davies, 2021). The lack of specificity in the definitions means that there is a lot of overlap between categories and two people within one category can have very different presenting problems. This is because human emotions and behaviours are far too complex, socially interdependent, and changeable depending on the context.
It’s important to recognise that chronic stress can look like neurodevelopmental or other mental health difficulties (Moran, 2015). That’s things like the diagnosis of ADHD or autism. It can be hard for parents and schools. Over the past few decades rates of diagnosis have increased significantly. Evidence shows this is about how stressful and disconnected our society is today. We are not getting our relational needs met in the way we need (Perry & Winfery, 2021).
It’s also important to know that there is growing evidence that a DSM disorder diagnosis may not be having a completely positive impact (Batstra & Timimi, 2024). The 2020 National longitudinal study of Irish children found by age 13, those who had held a ADHD diagnosis at 9 years showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept, than those who did not receive a diagnosis despite similar levels of symptoms (O’Connor & McNicholas, 2020).
A similar study, the Longitudinal Study of Australian Children, included a comparison of 400 children diagnosed with ADHD, matched to a group with similar presentations but no diagnosis. By 15 years old those with the diagnosis were doing worse on a number of variables including self-harm, feeling that they could succeed academically, sense of self-efficacy, and had negative social behaviours (Kazda, et al, 2022).
Labeling children as ‘abnormal’ or ‘disordered’’ helps services gatekeep resources but the benefit to children’s health is questionable (Batstra & Timimi, 2024). Instead we need an approach that recognises needs through a strengths based lens, takes a contextual ‘sense making’ approach and celebrates difference and inclusion by creating the conditions for us to thrive.
Putting People and Relationships First: Rethinking Support Systems
In a changing and complex world, it’s crucial to ensure that support systems and assessments truly serve the individuals they aim to help. It is easy to organise things around systems needs especially when resources are tight. Rather than relying on stereotypy assumptions and a one-size-fits-all approach, we need to meet people where they are and understand their unique needs. This is because there are complex rather than complicated issues (Carroll, et al., 2022). This shift from ‘doing to’ individuals to working in partnership can make a significant difference in the effectiveness and sustained impact of support.
Investing in assessments and services that provide diagnoses is important in today’s world, but it’s equally vital to ensure that these efforts are accompanied by meaningful support. Without this, we risk seeing a growing need for assessments without addressing the underlying issues. We will only see demand grow if we don’t also address root causes. Specialised support and assessments play a crucial role in understanding individuals and providing access to necessary services. However, we must not overlook the importance of context and the need for a systemic shift in society’s approach to inclusion, meeting our relational health needs and creating thriving conditions from the go, for everyone.
Everyone is of equal value and we must respect and understand the diversity of perspective and beliefs across humanity. Developing systems and support that reflect this understanding is key to ensuring provision reflects culture and identity. There are many factors that impact individuals’ experiences, and we should consider these together to provide the best possible support. In recognising the complexity of human experiences and society we must also recognise the complexity embedded in solutions too which must be unique to place and people. Dr Lisa Feltman Barrett in her work on ‘How emotions are made’ describes how the complex interaction between people and environment constructs our emotional world and our responses to it at the neurological as well as social level (2018). We must therefore prioritise our provision around evidence-informed principles and values that can flexibly accommodate differences of experience, language use and culture at the point of application. To be truly inclusive and drive change, we must move from equality of provision to equity and consider what different approaches and support might be helpful to individuals in their own contexts.
The ‘what next’ in terms of understanding and support is crucial. By focusing on collaboration and context, we can create a society that supports everyone, considering their individual needs and experiences. Since most support is of benefit to people generally there is a rationale for offering needs and context based support prior to (and in spite of) an assessment process (Batstra & Timimi, 2024). The Welsh Government Whole School Approach policy is an outstanding example of putting this into practice. There are cost and time saving implications here too in utilising a preventative approach as standard.
What can individuals and grown-ups do?
- Don’t overlook the power of connection and relationships. Make some time daily to help your child connect with people and things that matter to them and support opportunities for this (especially offline).
- Learn how to soothe your nervous system. This helps us feel safe and calm. Although the way to do this will be individualised, there is always something that can be done to help, even if we cannot completely remove someone’s distress or change their circumstances. Feeling someone is present and alongside you is key.
- Accept, embrace and celebrate your child but yourself too. Collaborate with your child to discover what is meaningful to them.
What can services and government do?
- Keep a focus on equality, social justice, inclusion, living conditions and so on means fewer people will need to rely on mental health services.
- Prioritise primary prevention strategies that take a whole family and whole system community embedded approach.
- Take a relational rather than a behavioural approach. Specialised support is important but without a strong foundation of connections and relationships we are at risk of mental health problems.
The views represented here are of the authors in their capacity as professional practitioners. This article was originally published in the spring edition of the Children in Wales magazine in 2025. The authors have added back in the references which were not able to be included in the original due to the short word count. The authors have also expanded on some areas to better capture the complexity involved based on questions and comments following the original publication.
References
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