Introduction for help, and of those, 50%

Introduction

Adolescence is a time of experimentation and self-discovery. Feeling overwhelmed or afraid is common, but it comes to a point where the manifestation of this development can result in an anxiety disorder (Anxiety Disorders Association of Ontario, 2018). In 2017, Children’s Mental Health Ontario conducted a survey which found that 46% of Ontario students miss school because of an anxiety-related issue. Only 40% had reached out for help, and of those, 50% found it challenging resulting in 42% not receiving the help they need (Beattie, 2017). On average, by grade 12, a student’s stress would have increased by 41%. (Zafar, 2016). Insufficient support allows these stats to continue to rise each year (Bradshaw and Windgrove, 2017; Chai and Vuchnich, 2016). Students are not developing the skills they need to cope with stressful periods. Although stress is inevitable, schools continue to fail to teach students that stress can be managed. Rather, the education system is the primary source of stress that students experience. The stress generated at school is reinforced by stigma associated with asking for help socially, and culturally. When young people are not taught to cope with stress early in their development, they carry its effect throughout their life. 70% of the illnesses experienced by adults originate during adolescence (Government of Canada, 2006). This report will reveal the cycle of student stress and anxiety, and discuss its impact on the individual’s brain development. Then, it will present an analysis of the advantages and limitations of current solutions addressing this issue.

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Causes

The leading cause of student stress and anxiety is our education system. This is reflected in our downward trend of measuring academic success. It starts with the school curriculum on the student’s behalf (Gray, 2012). The structure of our school system reveals an obsession with assessment and overwhelming curriculum content, that can create a toxic environment in which students fail to thrive; rather, the system serves as the source of stress and anxiety (Richard-Gustofson, 2017). This points the dramatic decrease in self exploration that inarguably brings value to fostering adaptive development (Romer, 2017).

Students often receive more school work then they can manage at a healthy rate. This is increasing in elementary grades, and even more than it already was in high schools (Richard-Gustofson, 2017). Researchers have found that teenagers’ brains develop far longer into adulthood. Students may physically resemble young adults, but their brain structure are more like that of younger children than adults. A study conducted at the University College London’s Institute of Cognitive Neuroscience used MRI scans to monitor adolescent brain activity as they attempted to disregard environmental distractions while mentally solving a prescribed problem. The objective was to prove that it is not the teenagers fault for not being able to concentrate and complete the assigned workload but rather it had to do with the structure of their brains not having the capacity to complete the task. The scans revealed a large amount of activity in the prefrontal cortex (the region for decision making and multitasking). This suggests that the brains of adolescents do not have the capacity to keep up with the intense amounts of school work (which was thought to have already developed by that age) because they contain an excessive quantity of grey matter (Hill, 2010) (the cell bodies and connections that carry messages throughout the brain). (Pappas, 2010). The grey matter affects the prefrontal cortex when making decisions as a result of the brain energy and resources being wasted in distractions. When our brain fully develops, there is less grey matter permitting neutral transmission to travel efficiently between brain cells allowing the brain to work in a more effective manner (Hill, 2010). Therefore, until this development occurs, it is highly difficult for youth to keep up with the assigned work load. (Gray, 2012).

As these stressful events accumulate into post-secondary, students sometimes do not have a reliable support system to aid them through these phases of life. “We have lineups out the door and down the hall,” explains McMaster University psychiatrist Dr. Catharine Munn. “Despite hiring more counsellors, we’re drowning.” Post-secondary is often when mental health issues start to reveal themselves. The instability that can result from a lack of parental support may leave students without the skills to care for themselves or to reach out for help, particularly if supports were not accessible in high school (Cribb, Ovid, Lao, Bigham, 2017).

Students see the risk and uncertainty that comes with getting help. Our society has a negative view of students dealing with mental health issues; and, as a result they can resent the vulnerability that is attached to asking for help in our society. Consequently, this stress and anxiety develops into routine of their life often generating an anxiety disorder (Chai and Vuchnich, 2016). Clinical anxiety can be defined as stress and anxiety that doesn’t go away, but progressively gets worse over time (National Institute of Mental Health, 2016). The impact of society’s views on mental illness can worsen the illness. When students are constantly reminded that they just “lack willpower,” (which 1 in 6 people believe) (Meikle, 2011), one’s self-worth begins to diminish, and they truly believe that they are not worth caring for (Tartakovsky, 2014). The social stigma results from one’s psychiatrist label that they have been given. The sufferer interprets it through the perceive stigma affecting their feelings of shame (Cribb, Ovid, Lao, Bigham, 2017).

This stigma is often reinforced by three primary groups: family members (46%), peers (62%), and school (35%), according to a 2010 study of adolescents. Stereotypes of inadequacy, and victims being unstable arise in all three groups repeating the history of people with mental illness being treated different, excluded, and brutalized (Davey, 2013).

Social media has had drastic positive outcomes in removing stigma, but has created psychologically scarring influence that previous generations did not face (Zafar, 2016). The media may be improving their products of ant-stigmatizing mater, but studies suggest that there has not been a proportional decrease in the publication of stigmatizing articles. This reinforces the notion that our media is still a primary source of stigma heavy information (Cribb, Ovid, Lao, Bigham, 2017). It embraces prejudicial attitudes, and discriminatory behavior directed at people experiencing mental health problems (Canadian Mental Health Association, 2017). This results in possible exclusion, poor support, low self-esteem, and worse quality of life for the suffer. This all contributes to hindering treatment outcomes as the more we deny anxiety, the more difficult it becomes to treat. This perceived stigma creates a detrimental recovery (Davey, 2013).

As we look at our fragmented mental health system and the cracks, we also analyze the trends of who asks for help regardless of a stigmatized society. Overall, male and female mental health profiles are similar, but the mental health issues that they experience are not. Males more often externalize their problems and turn to violence and substance use and abuse while females experience problems directly related to anxiety, stress, and depression. Women tend to be more open about encountering issues, while men tend to avoid the subject (Ball, 2013).

Researchers at Cambridge University conducted a methodical review of studies on people facing anxiety in numerous contexts from around the world using precise methods to retain an accurate study. It showed that women are almost 50% more likely to suffer from anxiety than men. This was later justified by the brain chemistry and hormone fluctuation of females connected to reproductive changes that results in hormonal imbalance linked to anxiety (Remes, 2016). Alongside biological mechanisms, men and women experience events differently. Women are often more prone to stress, increasing their anxiety. Once they experience a stressor (anything one finds challenging or promotes fear) (Centre for Studies on Human Stress, 2017), they ruminate about them while men engage in problem-focused coping (Barton, 2017). Society also associates phrases such as “toughen up” more often used on men than women implementing stereotypes restraining men from expressing emotions and deriding women for being too sensitive (Anxiety.org, 2015).

It has also been revealed that people in North America and Western Europe are impacted by anxiety at a greater proportion then other parts of the world. This suggests that current coping techniques are not capturing the cultural presentations of anxiety. In Western societies, fear of social situations or being judged and self-consciousness on academic performance is highly prominent. However, in Asia, the manifestation of perceived personal inadequacies, or the lack of cultural acceptance (that is not usually faced in Western societies) makes people too embarrassed to disclose symptoms of anxiety (Remes, 2016).

Impact

Social support refers to the status of relationships with others, and the role they play to alleviate stress. The stronger and larger your support, the less stress accumulates with negative effects. Social support is linked with a hormone called oxytocin that decreases levels of anxiety and sparks the parasympathetic nervous system that regulates one’s responses to situations. It also stimulates the desire to socialize and create a sense of attachment. When one has an appropriate amount of support, even if stressed, they receive an oxytocin boost. This allows them to cope better, and increases their desire to socialize. As a result, it reiterates the positive cycle of social support. When people experience stress, they may not have social support. This can be the cause of fear that is generated by the stress and anxiety. The stress accumulates, and as it is processed by the amygdala (grey matter inside your head that affects the way you experience emotions), it affects one’s perceived stigma. When fear develops, one starts to withdraw socially from their interactions (Cisler, Feldner, Forsyth, Olatunji, 2010).

There is direct correlation among the amygdala and psychological, cognitive, and behavioural response of fear that can lead to social withdrawal. The amygdala is the first to process a response that then motivates the other responses. Low order indicators of fear are suggested to be products of a singular fear structure focused around the amygdala. Since there are weak connections amongst the lower-order indicators, and the inputted interpretations that revitalize the requests, influencing connections between indicators. This results in it being more likely that other factors, such as the amygdala, neutralize the effect that the fear system changes in lower order outputs. To summarize, higher order process influencing lower order process of fear, focusing on perceived stigma (Zinbarg, 1998; Cisler, Feldner, Forsyth, Olatunji, 2010).

The process of emotion regulation is concentrated around altering the experiences of specific emotions before they occur by eliciting the stimuli in a stressful situation. However, emotion regulation can also occur by altering the experience of the perceived emotion after occurring (this is after being processed by the amygdala). Regardless, the regulatory process can be automatic or deliberate. It often starts off deliberate as emotion regulation is taught, but later becomes automatic as if it were a developed habit as it is nurtured behavior. These techniques affect several indicators of emotion including subjective, psychological, and behavioral which can either increase or decrease emotional response. Two examples of emotion regulation would be re-appraisal and behavioral suppression. Re-appraisal is subject to lower psychological reactivity, and lower self-eliciting affects, while behavioral suppression does the opposite. (Cisler, Feldner, Forsyth, Olatunji, 2010). However, this is not being taught to students—that they can regulate their response to stress. As a result, the stress and anxiety worsens continuing the cycle on the lack of social support affecting perceived stigma, increasing the levels of fear within an individual, who begins socially withdrawing because the grey matter surrounding their amygdala changes their perception of the situation. (Mills, 2008)

                                                                     Solution

The organization Jack.org is addressing mental health literacy. It is creating a national network of youth aiming to change the way we think about mental health through Jack Chapters held at schools, talks held provincially, and summits held nationally. The objective of each initiative is to catalyze the change of what currently is an awkward conversation regarding mental health. It is very statistic-based, ensuring a consistent evaluation is made to measure their success (Jack.org, 2017). However, it is not directly educating youth on how to cope. It provides resources about how to ask for and receive help, but it is not openly focusing on youth who require help recognizing when they need to take that step. An extension it has created is RightByYou.ca for one to be educated about mental health (RightByYou.ca, 2017), but it lacks the tools to teach self-awareness that all youth can develop to identify when something is wrong, and the things they can do to prevent it from turning into a mental illness. It is not reaching out to all youth, only those who choose to get involved, and so the youth who do not have the courage to speak up, continue to suffer.

Supporting Minds, created by the Ministry of Education, is a guide for educators to promote student well-being from grades K-12. It provides educators with information on classroom support strategies, and how to identify beginning stages of mental health issues. It provides numerous open-ended solutions regarding learning accommodations so students can continue to excel academically. It tries to incorporate mental health into classroom discussions (Supporting Minds, 2013). However, the execution has not been very successful. As its implementation is not mandatory, it is not being used to its capacity, if being used at all by educators. This can be the result of teachers not being provided with the training on how to use it, or they are not aware of it as it is not part of the curriculum. If not compulsory, educators do not prioritize it, or see it is worth if the Ministry of Education itself does not believe that it must be taught to students. It also does not have a measurable standard, nor timeline to set, and achieve goals. It is trying to create a big shift, however, as discussed in the causes, people with different cultures exhibit mental health differently as norms and acceptance change from culture to culture. Symptoms of mental distress across different cultures are disclosed differently. People with Asian ethnicities are more likely to report physical symptoms, yet when prompted with questions, they acknowledge symptoms of emotion (Lin and Cheung, 1999). This outcome reinforces the interpretation that people of different cultures reveal symptoms in ways that are culturally acceptable depending on how much stigma surrounds it (Kleinman, 1977). Supporting Minds does not take this into consideration, or that certain illnesses are perceived to be “real” or “fake” by different cultures (Kleinman, 1991).

Conclusion

Current students will soon represent the major population and views of society. They are the ones that will shape the stigma revolving around mental health. When the primary cause of student stress and anxiety is derived from the school system, but reinforced by social and cultural stigma, educating each generation in schools would influence the social stigma as the next generation molds society’s perspective. We haven’t had that paradigm shift due to health only being taught as physical, increases the difficulty of teaching coping mechanisms to prevent stress and anxiety from turning into anxiety disorders. If this pattern continues to reiterate, then cycles mentioned throughout this report may potentially worsen through the progression of generations.