Regularly reviled by the press, vilified as ‘hoodies’ or ‘lager swilling louts’ who terrorise law abiding citizens, teenagers are often presented as ‘the enemy within’. Sadly, recent events in the news seem to confirm this negative image. The murder in Warrington of a father, carried out by a group of young people in front of his own family, marked a very sad day; made more poignant given the account of his efforts to work with local police to address antisocial behaviour in his neighbourhood. This tragic event appears to support the idea of lawlessness on Britain's streets and a growing fear of young people as volatile and violent. Government strategies such as the Anti-Social Behaviour Order (ASBO) have failed dismally and rather created a pseudo ‘badge of honour’ among a disaffected group of marginalised young people, often living unsupported by a family or close social network.
Make no mistake, this article is no apologia for unacceptable behaviour which threatens or harms innocent others who may fall prey to a teenager's actions. But, as in any other exploration of human behaviour, the underlying dynamics are always more complex than a superficial description of an event might suggest. Not so far from Warrington, in the market town of Chorley, a 15-year-old girl was recently brutally stabbed in an apparently frenzied knife attack. This event reflects the statistic that teenagers are more likely to be the victims of crime rather than the perpetrators. This is not a fact the tabloid media are keen to present since it compromises their view of teenagers as ‘evil’ and ‘out of control’.
In contrast, the children's tsar, Sir Al Aynsley Green, revealed that research carried out by the Office for the Children's Commissioner, showed that young people's number one fear was violence, in public places.1 Nor is the home a haven for many youngsters. Given that fatal abuse of children is still at the rate of one death every 10 days at the hands of a parent or guardian2 it would seem that for many young people there is no safe place anywhere.
The galling truth is that the behaviour of a society's young people reflects the behaviour of the adults towards those for whom they are responsible. Despite their fierce desire for independence and relentless challenging of boundaries (and to this I speak with heartfelt experience …) young people need the engaged attention of their families. They also need professionals who work with them, largely teachers but also primary healthcare practitioners, to acknowledge their potential vulnerability. One in 10 of 5–17 year olds experiences a mental health disorder.3 Antisocial behaviour, which can also be labelled a conduct disorder, may well conceal an underlying emotional problem, particularly in boys.
John Major once famously said ‘Understand less, punish more’. While he exposed his emotional illiteracy with this profoundly ignorant epitaph, sadly, as a society, we seem to have made little progress. The recent news that excessive corporal punishment is used regularly to contain or intimidate children held in detention centres, often the most vulnerable of our society, is evidence of our disregard for some children's emotional fragility.
Only 25% of all children and young people who are experiencing emotional distress significantly disruptive to be classified as depression, according to DSM criteria, are ever diagnosed.4 The other 75% muddle along often in extremely difficult and hostile social situations. A number of them will present in our surgeries for dermatological or respiratory problems, with no mention of their sadness, unless we recognise their distress and begin a dialogue. It is often a difficult interaction and primary healthcare workers may well feel ill-equipped or ill-prepared for the contents or direction of the encounter. But we have a moral and professional responsibility to address this unmet need which, if ignored, will continue to create havoc in the lives of the young people themselves and within the communities of which we are all part.
- © British Journal of General Practice, 2008.