In Denmark, we see an increasing number of young people and children experiencing a decline in well-being in school and a steady increase in mental dissatisfaction. A 2020 study shows that 15 percent of all Danish children aged 18 have been diagnosed with a psychiatric disorder. Among 16 to 24-year-olds, one in three women and one in five men report unhappiness, stress, anxiety, and loneliness – severe conditions that put pressure on the welfare system. But the psychiatric system struggles to keep up with rising demand due to a lack of staff, beds, and resources and years of political under-prioritization.

Striving for a future where young people thrive requires attention to and understanding the psychiatric system as part of the exploration towards something better.

What is the common denominator between the crisis of well-being and the decline of the psychiatric system? How can we rethink the current approach, and what actions are needed? We spoke with two psychiatry insiders: Anna Juul, author, screenwriter, and a longtime psychiatric patient, and Sara Kærn Linstow, a physician in the child and adolescent psychiatric emergency department.

A multi-diagnosed psychiatric system

Anna Juul and Sara Kærn Linstow share their deep understanding of psychiatry and willingness to highlight the urgent need for immediate and long-term change in the field. Sara expressed her candid views in a controversial column titled ‘I’m the sleepy doctor who abandons my patients’ and shared her insights in the Danish news podcast Genstart. Anna has written several books about her experience with psychiatric illness, including her most recent work, ‘Superskurk,’ and actively participates in political debates. Anna is also a Danish Psychiatry Foundation board member, but she speaks on her behalf in this interview.

Sara, you receive these young people with severe mental health issues such as anxiety, depression, and suicide threats. You have doubts about the psychiatric system’s ability to meet these patients’ critical and often life-altering needs. What is your experience of a typical day in the psychiatric ward?

“I experience a psychiatric system with many diagnoses, which is ironic. But what I experience most is that there is often too little time and resources to help young people who need psychiatric help effectively. That leads to a tendency to rush treatment and do things halfway,” Sara explains.

She continues: “To do my job, I have to do it 100 percent, which means, among other things, that I have a lot more time to screen and treat my patients and walk them to the door when they are ready.”

Accepting the difficult paths in life

Finding a link between the heavily burdened psychiatry and the increasing dissatisfaction among young people can be a delicate balancing act. Nevertheless, the fact remains that more and more young people are reporting unhappiness and seeking psychiatric help at an alarming rate. That begs the question: What underlying factors contribute to both issues and how can we address them effectively?

“Of course, it’s important to distinguish between mental illness and dissatisfaction, but I see a clear pattern in society. We’re too obsessed with performing and making a positive contribution,” says Anna Juul, explaining that she sees a clear link between the increasing mental dissatisfaction among young people and the general and collective feeling of not being allowed to feel and show the negative and challenging emotions and aspects of life.  It’s ingrained in society, politics, our institutions, often in friendships, that we should always feel happy and satisfied. Expressing one’s true feelings and thoughts is still not widely accepted, and this reluctance is detrimental to both the field of psychiatry and our collective, especially younger generations’ sense of well-being.”

Empathy is the essence

The decision-makers at Christiansborg promise ten-year plans, systemic interventions, and actions to achieve much-needed positive change in the psychiatric system. However, it needs to be clarified how effective future interventions will be given our current societal norms and views. How can we create the best method for those who need help? 

“We cannot solve the problem without the politicians. We need them to listen and provide sufficient funding to improve the psychiatric system. If they could raise the money during the Covid 19 crisis, they can certainly do it now if they prioritize it enough. Privatizing everything is not the answer because that would only exacerbate social inequality,” says Anna Juul.

“Nurses and many physicians should strive to improve their patient interaction skills, including the cultivation of ‘bedside manners’ and attentiveness to patient needs. It’s not to say that these skills don’t already exist; they do. But there is a pressing need to focus more on developing and maintaining these key human skills. Perhaps medical education institutions should consider introducing empathy as a subject to address this aspect even more,” Anna suggests.

Sara emphasizes the importance of empathy and humanism in psychiatry and stresses the need for new creative approaches to design a more compassionate and accommodating psychiatric system.

“Introducing empathy and ‘learning bedside manners’ in medical school is an excellent idea,” Sara says. “As a student, I would have appreciated it. However, we need to recognize that our current working conditions are a major contributor to this problem, and we need a new framework to support the practices,” Anna highlights.

In our ‘Imagine if we…’- workshops, we spent a lot of time debating how to shift the overall responsibility for well-being from the individual to the community, from treating symptoms to more preventive initiatives. Anna, how can we redesign the system to reduce the number of young people feeling lonely, depressed, and anxious?

“I truly empathize with the unhappiness of young people today. With wars, the massive climate crisis, and just coming out of a pandemic, there is no shortage of bad news. However, we must talk openly about these difficult topics and find a safe space for them. I often wonder why we don’t use existing places in the society like churches to facilitate these critical conversations for young people without any religious context.”

“We should also introduce a new subject in public school that covers all aspects of being human, including difficult topics such as loss and anxiety. By creating an environment that supports and accommodates these challenges, we may prevent more young people from needing psychiatric help from doctors like Sara.”