Mental health data
Several studies indicate a deterioration in mental health among young people over the past 50 years [1, 2]. In the UK, an analysis of three studies shows a rise in emotional problems in young females and males over the study period 1986 – 1999. However, data from the US provide no evidence for a rise in the problems of children and adolescents.
In Sweden ten percent of children and adolescents are judged to have mental health problems. They suffer from depression, anxiety or disorders related to aggressive behaviour, have difficulty concentrating; or have eating disorders. Another five-to-ten percent of children and young people have minor forms of mental health problems. The starting age for depressive disorders has decreased and more young people are suffering adverse effects of depression.
The prevalence of suicide in Sweden has declined by 30 percent for the total population over the past 20 years, but less so for the 15 – 24 age-group, where it is the second most important cause of death.
Self-reported health is a common self-assessment measure. It has a predictive value for future illness and death[7, 8]. Swedish national surveys show that self-reported symptoms of nervousness, anxiety, sleeping problems and tiredness have increased for the total population. However, the largest increase has been in the younger age groups, where e.g. adults of 18 – 29 years doubled and in some cases tripled their symptom ratings between 1988 and 2002. In 1988/89, 4.6 percent of young men reported that they felt nervousness and/or anxiety and in 2002 this figure had increased to 14.9 percent. For women, the corresponding increase was from 8.9 percent to 28.2 percent, while sleeping problems rose among men from 7.1 percent to 20.0 and among women from 10.5 percent to 27.4 percent. Tiredness tripled for young men from 3.4 percent to 10.3 percent and doubled for young women from 8.4 percent to 16.4 percent. Other international, national and regional surveys for the past decade show the same tendencies [10–12].
The prescription of hypnotic drugs for all age groups increased by more than 100 percent from 1991 to 2004. Young women in the 15 – 19 age group had the largest increase, i.e. their purchased prescriptions rose from 0.2 to 1.8 defined daily doses (DDD)/1000 inhabitants a day. Women aged 20 – 24 years increased their purchases from 1 to 7.5 DDD/1000 inhabitants a day. The most dramatic rise is seen for prescription of antidepressant drugs, where young women aged 20 – 24 increased their purchase from 2 to 45 DDD/1000 inhabitants a day between 1991 and 2004.
The Swedish national action plan for the health-care system emphasizes the need to offer young people adequate help in the early stages of mental health problems. The plan also points out the need for greater cooperation in outpatient care for adults and young people. In recent years, several county councils have established special counselling units with easily accessible help for those aged 16 – 24 years.
A mental health offer for young people
In 1999, five counselling psychotherapists from the St. Lukas Foundation in Stockholm started a counselling programme for young adults aged 18 – 29 years with minor mental health problems, e.g. nervousness, worry and sleeping problems, but not psychiatric diagnoses. The therapists each had 15 – 20 years experience of psychodynamic psychotherapy with young and adult people. The target group was recruited through advertisements in a free magazine and clients were invited to attend four counselling sessions after a wait of no longer than two weeks. No client was refused, but a few were referred to other care providers. The National Institute of Public Health sponsored the programme entitled Four-sessions-at-most, and the cost to the client of each session was low for Swedish circumstances, about 7 GBP.
The counselling method
The counselling method employed was developed at the Young People's Counselling Service, Tavistock Clinic, London as an offer for the "cautious and the curious; cautious about commitment but curious about themselves ." The method has proved applicable and useful for young adults in college settings whose problems have not become permanent.
This concept of brief intervention has been practised in Stockholm since 1993 at the Institute of Psychotherapy, which introduced the present counselling technique at St. Lukas. The criteria for acceptance are that the client should:
be actively seeking help,
be prepared to understand his/her own participation concerning the actual problem,
be aware of the relatively short-term nature of the contact and accept the limitation of four sessions.
And the therapist should
focus on the counsellee's actual situation and difficulties,
activate the counsellee's ability to reflect on her/his situation,
try to catch the core problem emerging from the counsellee's behaviour during the meeting,
reduce the counsellee's regression by forming links with external reality.
Aim of the present study
Since the method had been in use for a period, it needed to be evaluated. The overall aim of the present evaluation was to study the appropriateness of the method of brief intervention for public health settings and for preventing mental illness. There was also an interest in whether a short contact of four, sometimes only three, meetings could help young people to solve their problems.