One third of teens have been prescribed antidepressants whilst access to therapy is at an all-time low

The national charity for teenage mental health, stem4 has released the results from a nationwide survey of over 2,000 young people between the ages of 12 and 21. The concerning findings point to a mental health service that has become over reliant on the prescribing of antidepressants while access to therapeutic treatments has hit an all-time low.

How have services come to be over reliant on antidepressants?

The stem4 survey results found that:

• More than a third (37%) of 12-to-18 year-olds reported having been prescribed antidepressants to treat depression or another mental health condition.
• This number rose to 43% among 19-to-21 year-olds.

Currently, the guidelines from the National Institute for Health and Care Excellence (NICE), state that the antidepressant Fluoxetine – which is the form of antidepressant appropriate for children and adolescents – should only be prescribed following an assessment and diagnosis by a child and adolescent psychiatrist.

However, more than one in ten (13%) of 12-18 year-olds involved in the stem4 survey reported being prescribed antidepressants by their GP and had never been assessed or diagnosed formally by a psychiatrist at Child and Adolescent Mental Health Services (CAMHS).

The survey also found that:

• Only 7% of teens had been prescribed antidepressants by a psychiatrist or CAMHS mental health professional.
• 17% of respondents said they were prescribed antidepressants by their GP after seeing a psychiatrist or CAHMS mental health professional.
• 49% of adolescents aged 12-18 were prescribed antidepressants by their GP were given the prescription within their first two GP visits.

The survey, which spoke to 2,007 young people found that 42% of 12-to-18 year-olds are currently experiencing mental health problems such as depression, anxiety, eating disorders and self-harming behaviours. Of that 42% just over one quarter have been able to access a form of treatment.

stem4 also recently polled 1,001 GPs and found that one half of doctors reported an ‘overstretched NHS CAMHS service’ that was rejecting somewhere between 60 and 100% of all referrals for ‘moderate to severe depression and anxiety disorders in young people.’

GPs admitted that primary and secondary mental health services are telling them that their patients are ‘not sick enough to warrant specialist treatment’, stem4 said.

As well as this, GPs have been finding themselves under pressure to dismiss the NICE guidelines laid out above, and prescribe antidepressants to young people under 18 without a formal diagnosis. With the most frequent reasons being that they have either been refused access to psychological intervention services or because they are on a long waiting list for therapy.

Currently, the NHS simply do not have enough psychiatrists, or psychologists to resource services with the number of assessments or treatments that reflect the demand. The Royal College of Psychiatrists has long been calling for more funding that specifically targets the staffing issues within NHS mental health services and to hire more psychiatrists immediately.

“I was diagnosed with depression over the phone where they prescribed me with antidepressants.”

Survey respondents shared some of their experiences attempting to access services for their mental health problems. One young person spoke about how their diagnosis happened over the phone and how they were then immediately prescribed with an antidepressant, they continued:

“This is wrong, and everyone should be able to access counselling.”

Another anonymous respondent said:

“In the past six months, my cousin took his like at the age of 22. He asked for help but did not get it.”

stem4 have also shared some of the insights from GPs from their previous survey. One GP shockingly recalled a time when they attempted to refer a teenager who was suicidal to CAMHS in the South East of England, a CAMHS consultant psychiatrist advised this GP that:

“Oh, they hardly ever end up killing themselves…Just manage in primary care.”

Another GP in the North West of England reported that a self-harming teen who was rejected from psychological therapy was told by CAMHS to consider starting the teen on antidepressants.

A GP in Scotland reflected on the situation with sympathy, saying its:

“Terrible, horrific, and heart-breaking. Diagnosis is done by mental health nurses, inappropriate medications started in HUGE doses, lots of use of benzodiazepines and antidepressants (SSRIs). I am finding it unbearable to watch these young lives being destroyed and there is literally nothing I can do, and I've tried. There is no access to psychology.”

stem4 takes a stand against the prescribing of antidepressants as a replacement for psychological interventions

Dr Nihara Krause, who is a consultant clinical psychologist, CEO and founder of stem4 has spoken about the survey findings, stating that antidepressants “can be effective in treating depression and other mental health conditions under assessment and guidance of a specialist.”

However, “When prescribed as a replacement for a psychological intervention – and not as a part of a combination of therapy – they just mask the mental health difficulties young people are experiencing.” Dr Krause said.

Dr Krause also spoke about how those teens and young people who have only been prescribed antidepressants will likely “face still more anguish when trying to come off them” and that the survey’s findings suggest “we are probably heading toward a deepening mental health crisis which will require more extensive intervention in the long term.”

“The NHS is treating more young people with mental health difficulties than ever before, but if only half of young people who ask for help are able to access effective psychological treatments, then our ambitions aren’t big enough.” Dr Krause said.

She also mentioned that it is vital that “meaningful” investment in secondary care is imminent, and that support is provided in every school, college and university. A recent pilot that joined-up university wellbeing services and the NHS from Greater Manchester showed real promise, and will now be rolled out nationally, this could provide a solution to many of the young people between ages of 18 and 21 who are struggling to access help.

Finally, Dr Krause spoke about the young people’s voices in the survey:

“The young people in this survey have told us they want direct access to one-to-one mental health support in schools and the local community. They want to be able to self-refer, and talk anonymously and confidentially with people who care and can help.”