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GENERATION ANXIETY

When I was deep into my therapy with Veronica, I picked up a book called My Age of Anxiety, hoping to bolster my road to recovery. This vivid memoir by Scott Stossel, a journalist and editor with The Atlantic, is an exhaustive exploration of the toll anxiety has taken on a man desperately trying to wrest back control from a condition that has haunted him since he was two years old. Seven pages in and after reading his list of all the ways he has tried to overcome it — including psychotherapy, role-playing, hypnosis, prayer, self-help books, yoga, drugs, alcohol, and a smorgasbord of pharmaceuticals — I got to this sentence: ‘Here’s what’s worked: nothing.’

A tip for those playing at home: when you’re in the midst of a breakdown and feel like you’re going mad, reading a book about a man who suffers chronic and debilitating panic attacks, describes himself as a ‘twitchy bundle of phobias, fears and neuroses’, and believes nothing can help him is a terrible idea. After the first chapter triggered my own panic attack, I put the book down and promised to revisit it when I was stronger. What struck me when I picked it up again was Stossel’s take on his predicament as a snapshot of a wider malaise. He says that anxiety has become a ‘cultural condition of modernity’, afflicting more than 40 million — or one in seven — Americans. And yet, he points out, as recently as 30 years ago anxiety did not exist as a clinical category. Stossel argues chronic stress is a hallmark of our times. ‘We live, as has been said many times since the dawn of the atomic era, in an age of anxiety — and that, cliché though it may be, seems to only have become more true in recent years as America has been assaulted in short order by terrorism, economic calamity and disruption, and widespread social transformation,’ he writes.

The same could be said of Australia. These are unstable, confusing times. And the people who seem to be the most on edge are younger generations. They have never known a life before screens and digital overload. They face a daily barrage of bad news and crushing social comparison, all in the palm of their hands. At the same time, they’re bombarded with advertising and social media telling them that happiness is their ultimate goal.

But it’s more than just a problem with their dependence on technology. They live in a vastly different world to the one in which their parents and grandparents grew up. There are no jobs for life. The workforce is increasingly casualised and unstable, the planet is broken, and thanks to tax incentives that favour older investors over young homeowners, they are all but locked out of the property market by the very people who often tell them to toughen up and get a job.

Writing in The Guardian, Australian journalist Simon Copland argued that anxiety had become a ‘way of life’ for Generation Y. ‘Whether it is the commercialisation of public space or increasing working hours that reduce time for social activity, we live in a society in which we are all increasingly socially isolated and lonely, destroying one of the key mechanisms available to protect against mental anguish,’ he writes. ‘Anxiety disorders are not just medical problems. They are inherently social illnesses, ones that are becoming more of an issue as economic insecurity increases and social connections are destroyed.’

I’ve often heard baby boomers declare that younger generations have ‘never had it so good’. Former Collingwood Football Club coach Mick Malthouse complained on the radio recently that rookie footballers were reluctant to move across the country to play for interstate clubs because they would get homesick. Calling them ‘snowflakes’, Malthouse said he applauded one father who told him he wasn’t worried about his 18-year-old son getting homesick if he took up an offer with a club on the other side of this vast continent because ‘at his age, I had a rifle on my back’. Military combat seems a pretty high benchmark for one of the acceptable causes of stress. But this is what older generations were taught: showing vulnerability is a sign of weakness. Children should be seen and not heard. Suck it up and be happy.

But happy they are not. Figures released in 2016 show that youth suicide rates are at their highest level in a decade. An Australian male aged between 15 and 29 dies by suicide every 18 hours; that’s almost 500 lives lost each year — significantly more than the Victorian road toll. The number of teenage girls taking their own lives or self-harming has doubled since 2005. Among marginalised groups such as indigenous, LGBTIQ, and homeless youth, suicide rates are even more devastating. And yet, only 35 per cent of people with a mental-health condition are accessing services. Just 16 per cent of those with clinical depression receive adequate evidence-based care, despite it being one of the most significant risk factors for suicide. Many are caught in a system that tells them they’re either too sick for treatment or not sick enough.

I think back to the genesis of my own childhood anxiety and it seems heartbreakingly apparent that without the right help at the right time, these kids — who face additional pressures I never did — are staring down the barrel of a mental-health crisis.

Over the years, I have often discussed these issues with my friend Michael Carr-Gregg, one of Australia’s most high-profile adolescent psychologists. Like me, he is troubled by the rocketing stress levels among children and young adults.

In an open letter to Malcolm Turnbull, he recently urged the Prime Minister to act. Writing in The Huffington Post, he said youth suicide rates had reached ‘catastrophic levels’, and the number of young people with anxiety, depression, and substance abuse he was seeing in his clinical practice was so high it was the first time he had been compelled to write to a prime minister.

Carr-Gregg, or MCG as I call him, is a fierce youth mental-health advocate and a tireless campaigner against bullying who sits on the Project Rockit board. Our bond has been strengthened in recent years by a mutual love of the Hawthorn Football Club. Having a friend who is a psychologist is both a blessing and a burden when you’re not at your best. There’s no hiding the anguish from a man trained to see right through you. When things deteriorated for me, he immediately wanted to know what treatment I was receiving and was quick to offer suggestions for ways in which I could further enhance my chances of recovery. He dug up the latest research on anxiety and depression, and offered referrals to colleagues he thought might be able to help. I was grateful for his care and compassion.

When things were beginning to get a little better, I talked to him about that letter to the Australian prime minister. What prompted him to write it? And what could we do to prevent more young people ending up, as I had, saddled with chronic anxiety in the pursuit of a life that exists only through the fairytale filter?

‘I actually reached the point where I thought, what the fuck can I do about this?’ he told me in his inimitably direct way. ‘The fact that we’ve now got the highest level of boys’ suicide in ten years — that’s just the tip of the iceberg. For every one of those kids there’s hundreds that try. So let’s go back and look at what’s creating this problem in the first place.’

In his letter to Turnbull, he highlighted a Mission Australia report that surveyed more than 21,000 young people aged 15 to 19 from all backgrounds and areas and found that the top three issues concerning them were coping with stress, school or study problems, and body image. The survey has been carried out every year since 2002, and each year the proportion of young people saying that they don’t have the strategies to cope with stress has increased.

In 30 years of practice as an adolescent psychologist, Carr-Gregg said the levels of stress he was seeing among young people had never been worse. He partly blamed ‘developmental compression’, where adolescents are developing faster than they once were, in an environment they’re not psychologically equipped to handle. ‘Physically, the kids are maturing earlier, so you’ve got these kids who look all grown-up but their brains, of course, aren’t all grown-up. The boys won’t be grown-up till the mid-twenties, minimum,’ he said. ‘Today’s 11-year-old is yesterday’s 15-year-old. That’s causing a whole lot of pressures on young people. They’re seeing porn, for example, at the average age of 11. Most of them are seeing this stuff before they have their first kiss. The divorce rate is 40 per cent — the average family now stays together for eight years — so you’ve got the pressures of divorce, separation, the blended family.’

An obsession with tests is also causing high levels of stress. The National Assessment Program — Literacy and Numeracy (NAPLAN) was brought into Australian schools in 2008, testing students in Years Three, Five, Seven, and Nine. There has been growing concern that it has not only created a ‘teach to the test’ culture in schools but has placed undue pressure on students to achieve high scores. Children are learning that their self-worth is tied up in a number. Some behavioural experts have warned that the constant testing has helped fuel an ‘anxiety epidemic’ in primary school–aged children. Perth paediatrician Dr Elizabeth Green told the ABC that every child she was seeing in Years Five, Seven, and Nine was scared about NAPLAN. Psychologists and counsellors around the country have reported an upswing in children seeking support for test anxiety.

Carr-Gregg believes that one of the other major drivers of mental-health problems among young people is disconnection from their local communities. He said many lack purpose and that boredom is a key risk factor for emotional stress. When kids are disengaged, they’re more likely to self-medicate with drugs and alcohol, or turn to crime with other disaffected young people. The decline of religion, volunteering, and youth groups such as the Scouts and Girl Guides has left a void. ‘I’m seeing more spiritual anorexics in my office than ever before — kids who believe in nothing. Kids who aren’t part of anything that is bigger than themselves. One of the reasons why I’m an enthusiastic supporter of the Hawthorn Football Club is because I see there’s an opportunity for the club, the family club, to actually provide young people with a sense of purpose, meaning, belonging, and maybe even some hope.’

He wants governments to fund programs that engage young people in art, music, dance, drama, and sport, particularly in rural and regional areas, where the risk of suicide is higher than in metropolitan hubs. And he says parents must have the courage to enforce rules, even if it causes them angst. ‘There’s been a fundamental shift in parenting. We’ve moved from authoritarian — which is the stuff that I got, where children should be seen and not heard and if you did something wrong you got belted and you basically learned to shut up — to authoritative, which is good parenting and you set limits and boundaries. You have consequences, but you have a developmental perspective. And now we’ve got the laissez-faire parenting, where we’re not going to do anything to upset the little darlings.’

He said parents needed to go back to setting boundaries rather than trying to be their child’s best friend, but conceded that this is a challenge in time-poor, stressed-out households, citing a 2010 Australian Childhood Foundation study which found that 80 cent of parents lacked confidence in their ability to parent. It comes back to that critical sense of safety children crave as they grow up. If the adults around them are strung-out and too busy to attend to their needs in a world where they feel disconnected and alone, more children are going to struggle with anxiety, just as I have.

Without change, Carr-Gregg believes the rates of mental-health problems and suicide in young people will only go up, and that intervention has to start young. He said 50 per cent of psychological problems that occur in adulthood start before the age of 15, and that this is where the focus should be, with no rationing of psychological services. ‘Would it not make sense to at least provide adequate psychological services to that primary-school population and at transition, where we know a lot of the problems really consolidate, to have an unlimited amount of psychological help?’

When it comes to emotional distress, allowing people to talk and be seen and heard are vital pieces of the puzzle in figuring out what drives that pain. But there’s little time for that in a quick-fix system that still treats a problem of the mind as the poor cousin to a physical ailment.

The lack of progress on fixing our mental-health system has been a source of endless frustration for me as I’ve reported on the failure of successive governments to address the problem. Every time I’ve told the story of a parent who’s lost a child to suicide or listened to a mental-health nurse break down in tears describing the swollen waiting lists that force them to turn desperate people away, it leaves me reeling.

It’s been seven years since the Gillard government committed a record $2.2 billion to mental health — the greatest investment in Australian history. It followed years of intensive lobbying by Professor Patrick McGorry, who in 2010 harnessed his Australian of the Year profile to shine a spotlight on the ‘national emergency’ of youth suicide. A quarter of the funding Gillard announced went to a national rollout of headspace centres — one-stop shops for young people with mild to moderate mental-health problems — and specialist youth early psychosis prevention centres, both services founded by McGorry. Yet still the death toll rises. The reasons for that are complex and varied, and I know it can’t be solved with money alone, but there is no doubt there are major failings in the system.

The idea of headspace seemed sound — to intervene in the early stages of a young person’s psychological distress, before a condition becomes debilitating or even life-threatening. Headspace’s funky, bright-green drop-in centres, where 12- to 25-year-olds can receive counselling for a range of issues, from sexual health, anxiety, and drug and alcohol problems to bullying, relationship troubles, and exam stress, have proved popular with young people. Importantly, teens who might not want to share their troubles with their parents can turn up without a referral or medical records and be seen free of charge by a team of psychologists, social workers, doctors, and mental-health nurses; they can also receive counselling online. Internal surveys show 86 per cent of young people are satisfied with their experience at headspace, while 56 per cent reported a reduction in their psychological distress after three sessions.

When I first wrote about these centres, I was buoyed by the idea that young people would be given the time and space to be heard in a welcoming environment. It was a long way from the scary, white-walled outpatient wing of the psychiatric hospital I attended as a teen.

But like many noble ideas, a lot has been lost in the delivery. There have been concerns about how many young people headspace is actually reaching, and whether those with the most complex needs are falling through the cracks.

After I wrote a series of articles in which several former senior executives within the organisation raised concerns that it had become the ‘McDonald’s version of healthcare’, the National Mental Health Commission released an independent report finding there was little evidence that headspace had increased access to treatment for young people, particularly those from disadvantaged communities or rural and regional areas. It said headspace’s ‘one-size-fits-all shopfront approach’ was failing to meet the needs of young people from diverse backgrounds, including those with complex mental-health problems. Another major study found that less than a quarter of young people seen by headspace showed significant improvement, while the wellbeing of one in ten went backwards. Many in the sector felt that the headspace concept was good but the execution poor, and they were left to lament the fact that in a historically underfunded sector, precious funds had been squandered for little gain.

The troubles at headspace offer a neat snapshot of the wider problems within our woefully neglected mental-health system and the failure of politicians to adequately address the significant gaps in treatment, prevention, and research. There are few areas of health where the cost of inaction and underfunding is so deadly. All too often, young people pay the highest price.

A year after my own journey to the edge began, I was back at work and found myself covering a story that had become depressingly familiar. I turned up at a modest bungalow in Melbourne’s northern suburbs to meet Hong Vo, a former refugee from Vietnam who came to Australia in 1982 and went on to raise two sons. Daniel, her eldest, was there with her when I turned up at their home. Her younger son, Martin, was not. Pictures of the cheeky 22-year-old were everywhere. His high-school swimming bag still hung on a door handle in the hallway. But Martin’s absence was palpable. It had been a year since his suicide, and Hong’s grief was still so raw she occasionally slipped into talking about him in the present tense. She told me they were telling Martin’s story because, ‘We want to remember his life and also how we lost him. We want to eliminate this loss for other families.’

Martin was a high-achieving, popular young man who had recently graduated from university and was completing an internship in radiology at a hospital a few hours out of Melbourne. During a four-week placement he became convinced he was failing in his new job, and struggled with feelings of inadequacy and isolation. His family were unsure how long he’d been suffering, but his condition deteriorated rapidly. Towards the end of his placement, Martin’s girlfriend told the family they should intervene because he was talking about ending his life.

‘That was a huge shock for Mum and me,’ Daniel told me. ‘When he got home he was sitting down with his back against the couch and it took him ages to respond; he was really down. We later found out that he wasn’t eating. He had been depressed throughout that week, but he didn’t reach out.’

Hong took Martin to a doctor, who, despite hearing of his suicidal thoughts, told him he should hang in there and that ‘life will move on’. The GP referred him to Orygen Youth Health — a public mental-health service for 15- to 25-year-olds in Melbourne’s north — and he was assessed over the phone. They told him the earliest appointment he could have in person was in a month’s time. Martin took his life two days later.

Pat McGorry, executive director of Orygen, told me he had ‘enormous sympathy’ for the family and that sadly stories like this were common. Orygen wasn’t resourced to cope with the rising demand for treatment and had been forced to turn away more than 1,100 young people in 2015 alone. ‘These people simply cannot wait, and the risk of dying is significant,’ he said. ‘Imagine if this were happening for people with chest pain, at risk of possible heart attack.’

On the day Martin died, Hong, a social worker who had been vigilant about her son’s condition since discovering he was suffering from depression, checked on him around 3.00 am. ‘He was sound asleep and snoring gently. In the morning I went to wake him up, but he wasn’t in the bed. I looked around the house; no sign. So I rang him but the phone was at home. I looked out in the driveway and no car.’

She called Daniel, and Martin’s girlfriend. Neither had heard from him. Her next call was to the police. Soon, two uniformed officers were at her door. ‘They came in and asked me to take a seat and that’s how they said to me, “We found him.”’

Martin had left the family home in the early hours of the morning in his mother’s car, driven to a bridge on a nearby freeway, and parked on the side of the road. The car was found abandoned with its hazard lights on.

After Hong and Daniel told me this story, while an Age photographer took their portrait in the lounge room I excused myself, stood in their front yard, and cried. The loss of this bright young man was so pointless and most likely avoidable. It was almost exactly a year ago that I too had nearly lost the will to live. Only through good fortune and life’s financial lottery was I able to get immediate help when I needed it by paying to see a psychologist in the private sector. Martin was just one of 2,864 Australians who died by suicide that year.

These are complex problems. I don’t pretend to have the answers. But when I think back to my primary-school days and how much I worried, even as a young child, I wonder if the trajectory that ultimately led to an anxiety disorder could have been changed if I’d had a teacher or a psychologist who had taught me how to manage my catastrophic thinking. Perhaps if I’d learned from an early age that what I was feeling was valid, that failure was okay, and that living in a permanent state of unbridled happiness was an unrealistic life goal, I’d have been saved a lot of heartache.

The pressures today’s young people face are unlike those we’ve seen before. They live in a true age of anxiety, confronting a bewildering set of political, economic, and social challenges as they come of age. Cyberbullying and the pressure to project the perfect image on social media pose unique challenges at a time when family and community structures that used to provide support are splintering. Young people are taught that test results are everything, and failure is not an option. They live in a culture that insists they be happy but makes the quest for calm and contentment increasingly difficult. It’s hardly surprising their mental-health outcomes are so poor.

Something has to change. No system will prevent every person from falling through the cracks, but when those cracks are cavernous, the risks are higher. Young people such as Martin Vo shouldn’t be told they’re not sick enough for help. They should be given help when they need it. They should still be here.