The rates of people using self-harm as a coping mechanism are rising dramatically, just as social media is helping to normalise and reinforce dangerous or desperate behaviour.
Prince Harry, a mental-heath advocate, recently said, "Social media is more addictive than drugs and alcohol, yet it's more dangerous because it's normalised and there are no restrictions to it."
But is it really? The findings are conflicted, says psychologist Lucy Foulkes, with the harms often overlooking the gains, including fun, entertainment and relaxation, especially during the pandemic when social media has kept friendships and relationships alive, as well as providing a way to feel connected when locked down at home.
A landmark 2018 study from the US with more than 500,000 young participants concluded that digital screen time and depressive symptoms were linked. But critics found many flaws in the research, including the data being collected at a single point in time rather than longitudinally, meaning there was no control for the social-media usage being the key contributing factor for unhappy teens (other suggestions included sleep, social-anxiety disorders or pre-existing, untreated depression).
A more recent study, by Amy Orben and Andrew Przybylski of the University of Oxford, used data from teenagers who were interviewed eight times between 2009 and 2016.
"The results suggested little cause for alarm," writes Foulkes in Losing Our Minds. "They found that 99.6 per cent of the variation in girls' life satisfaction had nothing to do with their social media use. In other words, if I knew how many hours an adolescent was spending on social media each day, this information would allow me to predict just 0.4 per cent of her total life satisfaction score. The rest would be down to other factors like her health, her family's finances and whether or not she was being bullied, for example."
To quote Orben, "These effects were minuscule by the standards of science and trivial if you want to inform personal parenting decisions."
The influence of the internet is far less benign when it comes to rising self-harm rates and suicide.
The research in this area is scant, as most would not pass an ethics board, Foulkes writes. But what is clear is that while the internet can play a beneficial role for people experiencing a mental illness – allowing them to access help and providing supportive chat rooms, for example – its capacity for fuelling darkness in people already in a dangerous place is profound.
There are numerous chat rooms, web pages and advice groups dedicated to instructing people on how to self-harm and suicide, effectively normalising this extreme behaviour. Methods can be researched and planned and equipment purchased anonymously; self-harm or disordered eating is glorified in chat rooms peopled by other sufferers, populated with real-life images of self-inflicted injuries or very thin bodies serving as "thinspiration".
"We can't definitively measure what effect these images are having," writes Foulkes."But evidence from qualitative studies – those that interview a small number of participants and analyse what they say in lots of detail – suggest we have reason to be concerned."
In 2019, Professor Louis Appleby, the head of the National Suicide Prevention Strategy for England, said there was evidence more young people were turning to self-harm and suicide in distress.
"If mental disorder appears to have risen over several years but self-harm and suicide have risen more steeply, that suggests that mental disorder has become more risky," he said. "That could happen if young people are increasingly seeing self-harm as a way of coping with stress, and we have evidence that this is the case."
A UK 2019 study of more than 6000 participants found self-harm rates rising, with the number of people self-harming "in an attempt to draw attention or change their situation" roughly doubling between 2000 and 2014, while the number doing it to relieve feelings of anger, tension, anxiety or depression approximately tripled.
The evidence for suicide and self-harm being "contagious" among communities and friendship groups, especially in young people, is also strong, as these defective coping mechanisms become troublingly normalised, or push moderately sick people into more at-risk behaviours.
Meanwhile, while more people than ever before are struggling with their mental health, it is also paradoxically harder to get treated. Ian Hamilton, a UK suicide academic, writes that while the UK has "improved detection and acceptance of mental health problems", funding cuts and squeezed treatment budgets mean there are fewer specialist resources than ever. "This mismatch must have contributed to the surge in suicides."
Best ways to self-care
Adolescence is a time of heightened risk for the development of a mental illness, writes UK psychologist Lucy Foulkes, not least because of surging hormones and a peer-oriented – even obsessed – world view.
"If you are ever going to develop a mental illness, more likely than not it will start in your adolescent years," writes Foulkes, with about 50 per cent of diagnoses appearing by the age of 15, and 74 per cent by the age of 18 for a host of disorders, including anxiety, depression, bipolar, schizophrenia, eating disorders, personality disorders and substance-addiction disorders.
"The majority of mental illness starts by the age of 24. If you make it to 25 without experiencing a mental illness, the chances that you'll get one beyond this age – although it certainly does happen – are reduced considerably."
Foulkes has some suggestions for adolescents to take care of their mental health.
• Exercise: Foulkes writes that for many people, mental illness is experienced in the body, such as a hollowed-out feeling in the chest during depression or electricity in the blood during a panic attack.
For this reason, getting the body moving can be an important way to boost sensation and activity in the mind. "There is now a wealth of evidence showing that exercise is helpful for preventing, treating and reducing the relapse of mental illness," Foulkes writes.
Any kind of physical activity is good, but social team sports are particularly beneficial for the added social bonds they create. If all exercise is off the cards, either through disability or physical or mental sickness, Foulkes recommends people train their muscles to relax and reduce physiological stress by deploying mindful relaxation techniques – look up a simple technique developed in 1929 called "progressive muscle relaxation". A number of apps are also well regarded, including Headspace, which may appeal to teens.
• Sleep: "Disrupted sleep can cause a mental disorder in itself," writes Foulkes, saying that improving our sleep habits is one of "the best ways" to improve our mental health.
Poor sleep, particularly when chronic, impacts emotional and cognitive skills, the ability to concentrate, and mood regulation. Sleep problems can not only exacerbate illnesses such as depression, schizophrenia or bipolar, but can contribute to their onset, prolong or deepen an episode and significantly impact recovery.
There is no way to overstate how important quality sleep is to good mental health. So what to do?
People who exercise more often tend to sleep better. Not working and avoiding social media before bed is beneficial, as is steering clear of caffeine or alcohol near bedtime and keeping the bedroom cool and dark.
Some specialised therapies, such as variations of cognitive behaviour therapy, target insomnia, including an app, Sleepio, developed by University of Oxford researchers. A visit to a sleep clinic should be in order if issues are chronic and persistent.
If you want any "superpower" to help deal with your mental health problems, sleep is it.
• Some stress is good: "Within reason, some degree of distress might actually be a good thing," Foulkes writes. "We shouldn't design our lives – or our children's – to avoid stress altogether. In fact, the evidence suggests a certain level of stress is better than none at all."
Stress that is time-limited and allows opportunity for recovery might be "protective" in terms of coping with future hardships, as is stress that further develops skills and talents, often leading to a boost in self-esteem and confidence.
"The idea of stress inoculation is that mildly stressful challenges teach us ways to cope," writes Foulkes. "When future stressors arrive, we are more likely to believe they are manageable."
Where to get help:
• 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202
• NATIONAL ANXIETY 24 HR HELPLINE: 0800 269 4389
If it is an emergency and you feel like you or someone else is at risk, call 111.