'New 18 now is 28': How screens delay teens' emotional maturity

The number of teens who went to emergency departments in Ontario for injuring or poisoning themselves doubled from 2009 to 2017 — a surprisingly sharp rise, say Canadian health-care providers. They are calling for better ways to connect young people with mental health services.

Increasing rates of self-harm among teens in Canada, the U.S., Australia and Europe are a concern in part because those who deliberately harm themselves are at greater risk for repeated injury or for suicide.

In a study published this week in the Canadian Journal of Psychiatry, researchers looked at emergency department visits by those aged 13 to 17 in Ontario, based on national data from the Canadian Institute for Health Information.

"The number of kids who have at least one visit for self-harm in a given year basically doubled from 2009 to 2017 after it had been falling consistently from 2003 to 2009," said William Gardner, a senior scientist at the CHEO Research Institute who holds a senior research chair in child and adolescent psychiatry at the University of Ottawa.

Mental-health visits for anxiety and depression also rose starting in 2009.

Both the self-harm and anxiety trends pose a huge and worsening strain on the mental-health system for young people, Gardner said.

The big question is why. Gardner speculated on three potential reasons:

• The launch of the iPhone in Canada in 2008 and rising smartphone use and engagement in social media.
• The financial downturn in 2008 and its lingering damage through job losses and family instability.
• A greater willingness to seek help after campaigns to reduce the stigma of mental illness.

Smartphones facilitated shifts in how people of all ages socialize.

We can do a better job of taking kids who show up in the emergency department with mental health problems and getting them into care in their community.—  William Gardner

"For a certain group of vulnerable adolescents, kids who are at risk for various social and psychological problems already, a lot of them describe the experience of constant exposure to social anxiety [and] to bullying by peers as very stressful, and so that could be the cause of some of these problems."

For most people, Gardner believes, being online isn't terribly harmful. 

In hospitals, decreasing stigma could also mean physicians who see a laceration on the arm now ask, "Did you cut yourself?" Previously, the question wasn't asked, and the cut would be classified as an injury, Gardner said.

But emergency departments aren't suited for teens needing continuing mental-health care.

"We can do a better job of taking kids who show up in the emergency department with mental health problems and getting them into care in their community."

Continuing a long-standing pattern, the increases in self-harm and emergency visits were higher among females than males.

In focus groups, girls often complain of incessant pressure to present a perfect image on Instagram, as well as a greater willingness to seek out care than boys, Gardner said.

Boys' aggression a 'mental health problem'

The problems boys face tend to manifest differently, such as trouble controlling their anger.

"They will get involved in various kinds of aggressive and deviant activities that could lead them to trouble with the criminal justice system, and we don't talk about those things as mental health problems but in many ways they are."

The study was excellent in its portrayal of a dramatic increase in self-harm happening across Canada, said Dr. Chris Wilkes. He heads the child and adolescent psychiatry division at the University of Calgary and wasn't involved in the research.

"What we say in the area of children's mental health and adolescent psychiatry is that the new 18 now is 28 because there is a delay in the emotional and social awareness and maturation of adult skills."

Read eyes, not screens

More adolescents are living at home longer, often glued to screens. Wilkes called it a paradox that people have never been more connected yet alone. Online connections are no replacement for learning to read another person's eyes — in person.

"Emotional maturation takes time and it takes real experiences with relationships, and if you spend more and more time on screen time, you have less opportunities to practise these skills."

More broadly, Wilkes said, poorer teen relationships with parents, relatives and friends may have combined with cultural shifts to greater materialism and narcissism. Learning delayed gratification is at risk of being lost. 

Wilkes called Calgary ahead of the curve in providing walk-in mental health services in the community, in addition to national resources such as Sen. Stan Kutcher's teenmentalhealth.org.

On the front lines, school-based programs offer the best bang for the buck in prevention, he said.

"For every dollar you invest in early development you save $4 to $9 by reduced costs in education, justice, reduced mental health utilization and better employment prospects."

The future lies in integrating mental health and emergency department services, family and community resource hubs, acute care at home and peer support, Wilkes said.

Rates of self-harm visits in the study rose from 1.8 per 1,000 in 2009 to 4.2 per 1,000 by 2017. Over the same period, mental health visits increased from 13.5 per 1,000 to 24.1.

The teen research was funded by an unrestricted grant from the ScotiaBank Foundation.

Where to get help:

Canada Suicide Prevention Service: 1-833-456-4566 (phone) | 45645 (text) | crisisservicescanada.ca (chat).

In Quebec (French): Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553).

Kids Help Phone: 1-800-668-6868 (phone), www.kidshelpphone.ca (live chat counselling).

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.