Children and young people across Europe and globally are facing a growing mental health crisis. In a world where change, particularly in the digital sphere, is happening at a rapid pace, constant exposure to an endless stream of news, much of it negative, poses a challenge even for adults. It is no surprise, then, that young people are finding it increasingly difficult to cope.
According to the World Health Organization’s report on youth mental health in Europe published last year, one in seven children and adolescents is living with a mental health condition. Girls aged 15 to 19 are particularly vulnerable, with one in four experiencing mental health difficulties. The report also confirms that suicide remains the leading cause of death among young people aged 15 to 29. This is also reflected in rising psychiatric hospital admissions. Some countries reported a 28 percent increase in pediatric psychiatric hospitalisations and a 43 percent rise in emergency department visits related to self-harm following the COVID-19 pandemic.
Why is this happening?
The European study ‘Insights into youth mental health and well-being: existing practices and new trends’ points to four main factors behind the decline in young people’s mental health: socioeconomic instability, global crises, digital technologies and influence of social media and artificial intelligence. It is important to remember, however, that young people are not a homogeneous group, and these factors can affect them in different ways.
Psychologists working with young people recognise many of these factors in their everyday practice. One of them is Sophie Landmann, a Doctor of Counselling Psychology who collaborates with the Munich-based organisation Mental Health Crowd alongside her private practice. She believes social media plays a major role in many of the challenges young people face, offering them endless ideas about who they should be.
‘As adults who know who we are, we can more easily disregard things or say „This isn’t for me. I don’t care what this person thinks“. But for young people, that’s much harder,’ says Sophie.
Photo: Sophie Landmann, © RED NOSES International – Miloš Vučićević
Young people she works with often seek help because of stress, mood swings, self-doubt and anxiety caused by the unrealistic expectations they place on themselves. Many also struggle with body image issues, which can affect their relationship with food.
But, at the same time, she has noticed a positive shift. Young people today are more willing to seek professional support and are generally more self-aware than adults.
‘They are better at naming their emotions and already have more tools. Whether they use them is another question, but they do have more knowledge. Many of them follow accounts or watch series that talk about mental health or mental illness.’
Many who come to see her do not have a mental illness. They seek support simply because they want to prevent problems from developing. However, Sophie points out that when young people do seek help after a mental illness has developed, they are often in a much worse condition than adults.
Meeting the challenge with a holistic approach
Mental health difficulties that can lead to hospitalisation and seriously affect a person’s wellbeing often have multiple causes and are rarely straightforward. That is why no single approach to treatment can be expected to work for everyone, and there is no magic solution in the form of a single type of therapy. The best outcomes are often achieved by combining different methods. Schools, mental health organisations, psychologists, psychotherapists, doctors, artists, nutritionists–they all have a role to play. By working together, they can help young people facing what may be the greatest challenges of their lives feel supported and empowered.
Unfortunately, there is still not enough funding or commitment to tackle the need for a multidisciplinary approach to mental health. The World Health Organization’s data reflects this reality. While the prevalence of mental health conditions among children and adolescents up to the age of 19 has increased by one third over the past 15 years, services have not kept pace with the growing demand.
Across Europe, one in four countries lacks community-based mental health services for young people, one in five has no dedicated policy addressing their mental health needs, and there is only one psychiatrist for every 76,000 children and adolescents.
Sophie is a strong advocate of a multidisciplinary approach and of finding what works best for each individual. She says she has seen outstanding art therapists who, for some people, were more helpful than talk therapy or medication.
‘We’re all so different and what works for one person doesn’t necessarily work for the next. But I’ve seen art, especially movement, drawing and crafts, make a huge difference, especially for younger people.’
The potential of culture and the arts to shape the way young people see themselves and the world around them is also highlighted in the comprehensive report ‘Youth, mental health and culture’ by Voices of Culture, a dialogue platform that connects the European Commission and the cultural sector. The report brings together examples from 53 organisations across 23 countries working in the fields of culture, health, education and social services. It describes that their impact is multifactorial, affecting physical, psychological, emotional and social wellbeing. As the report notes, creative arts and culture bring joy and relief and can be transformational.
This is also echoed in the CultureForHealth report, which states that arts and cultural activities play an important role in promoting positive mental health and wellbeing, both individually and collectively. It further notes that the interdisciplinary, accessible and person-centred approach of arts-based and cultural activities can have significant health benefits.
Healthcare clowns as part of care
To support a more holistic approach to mental health care, healthcare clowns from across Europe came together in May this year through the ClowNexus project, led by RED NOSES International. Over the next three years, nine healthcare clown organisations and one research partner will develop practical tools and collaborate with healthcare professionals to integrate humour and play into the recovery process in youth psychiatric settings.
Guided by the belief that a stay in a psychiatric ward is only one chapter in the lives that lie ahead of these young people, the ClowNexus artists aim to offer genuine human connection and bring moments of joy to those going through difficult periods.
‘These are people who are fighting maybe one of the biggest challenges of their lives and we would like to be together with them. Our mission is to connect, to find best methods, to be aware and raise awareness about their needs of art, health and connection,’ said Viltaute Žemelytė, Head of International Programmes Department at RED NOSES International.
Photo: Viltaute Žemelytė, © RED NOSES International – Miloš Vučićević
One of the artists taking part in the project is Ľubica Šulíková from the Slovak RED NOSES organisation. She has been visiting hospitals as a healthcare clown for the past 14 years and, from the very beginning, has also worked in youth psychiatric wards. Once a week, she visits the hospital in Nitra, and occasionally the one in Bratislava. Her organisation also works in five other hospitals with psychiatric departments across Slovakia.
‘I am a support and artistic coordinator, so I also communicate with the management, staff and clowns, with whom we are looking for a way to bring humor and play to this department.’
For Ľubica, it was essential to better understand psychiatric diagnoses and improve communication with doctors and other staff. Building trust, she says, helps healthcare clowns show that they genuinely care and can make a real difference to the atmosphere on the ward and to the wellbeing of young patients. Over the years, she realised that some of the methods had to be adapted to better suit this setting. Throughout that process, she has shared experiences with colleagues and learned from them. This is precisely what the ClowNexus project is built on. Through a series of workshops, method development and testing, it will refine the most effective approaches for working with this audience.
The outcomes will also be evaluated by the Cultural Welfare Centre, an Italian partner organisation specialising in research on the effects of culture and the arts on health. Annalisa Cicerchia, the organisation’s Vice President, believes one of the greatest strengths of healthcare clowning is that it is already an established practice in hospitals. Her organisation is currently developing the methodology that will be used to assess the impact of the ClowNexus, and she speaks with optimism about its potential.
‘The relief that comes from being able to communicate, open up and express what you carry inside is incredibly powerful. Just think about the relief that laughter can bring, how liberating it is when you’re given the chance to laugh, not just once, but again and again.’
Unlike screens, art invites movement and engages the body and the hands. In the past, children had more opportunities to spend time outdoors and explore the world around them through all their senses. Today, both children and adults do that far less. Perhaps that is precisely where art’s healing power lies, Sophie believes.
‘Maybe art, movement, theatre and clowning are getting us back in touch with the idea that „Hey, there’s something more out there than just a screen. Moving my body feels good, and I want to do more of that!“’
Healthcare clowns know there are limits to what they can do. Their mission is not to treat or cure, but to make the difficult days a little easier for young people in psychiatric wards. A break from the struggle does not mean giving up. It means finding the strength to keep going. And perhaps that is what so many recovery journeys need most–hope .
Follow the ClowNexus journey: https://clownexus.eu/
The consortium is composed of nine healthcare clowning organisations and one research organisation: RED NOSES International, Cultural Welfare Center (IT), CZERWONE NOSKI – Klown w Szpitalu (PL), ČERVENÝ NOS Clowndoctors (SK), CRVENI NOSOVI Klaunovidoktori (HR), PIROS ORR Bohócdoktorok (HU), Pallapupas (ES), RAUDONOS NOSYS Gydytojai Klounai (LT), Sairaalaklovnit ry (FI), ZDRAVOTNÍ KLAUN (CZ)
Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor the granting authority can be held responsible for them.
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