The youth mental health crisis requires healing for parents as well as children, a new book argues

No child or young person should receive psychotherapy without their parents or caregivers also receiving support, according to a new book that calls for a “sea change” in youth mental healthcare.

Rather than treating distressed children or those with behavioural challenges as isolated cases, the book – by a Cambridge University-based child psychotherapist, Alix Hearn – argues that the care systems should actively support their parents as well.

Hearn calls for children and young people to be thought of as part of an “ecological system”: a web of relationships that also includes their families, communities and wider culture, but is often overlooked by overstretched children’s services. Addressing record levels of youth mental health difficulties, she suggests, means moving beyond simply seeing the problem as medical, and recognising that young people’s wellbeing is also shaped by their wider circumstances and environment.

Her argument draws extensively from attachment theory: the principle that children have an evolutionary need for a secure emotional base, which is usually provided by parents and carers. While it is widely accepted that children are more likely to struggle when that support is absent, Hearn points out that adults’ parenting styles are themselves influenced by how they, in turn, were parented.

As a result, families are partially defined by “ghostly attachments” – learned behaviours that are passed down, often unconsciously, through the generations. Hearn argues that every family has “unremembered hauntings” that affect behaviours such as how they express, manage, or shut down emotions.

“At the moment, many services working with children and young people still focus on treating a child as an individual who needs fixing, curing or improving,” Hearn said. “In fact, children are often receptacles for adults’ unprocessed feelings.”

“When a child is referred for therapy, it may be that their parent or carer also needs help. In an ideal world, no child would be seen unless they – the parents – were also part of the process.”

Hearn is a teaching associate at Cambridge’s Faculty of Education with 15 years of clinical experience. Her book, Places of Safety, will be launched at an event in London on Tuesday, 2 June.

Based both on her own professional experience and that of colleagues, she argues that youth mental health referrals often involve unmet attachment needs. Children who are withdrawn, aggressive or at risk of self-harming, for example, may be responding to a lack of emotional support or comfort.

Parents’ capacity to meet those needs, however, is often influenced by their own childhood. Part of the task for psychotherapists, Hearn writes, is to identify and unpick the ghostly attachments that may lie behind a referral.

Young people’s behaviour may, for instance, be shaped by episodes that they cannot remember from early life, or by how their parents have processed – or not processed – aspects of their own upbringing. The most profound examples, which the book highlights, include cases where responses to mass traumas such as the Holocaust or other genocides, have been passed down within families.

Hearn said that she was particularly affected by current wars in the Middle East and Ukraine while researching the book’s sections on ghostly attachments and epigenetics – the ways in which genes can be ‘switched on’ or ‘silenced’ by environmental stress.

“The horror of these conflicts is not just about what’s happening now,” she said. “For children who survive, there will be echoes that affect their children and grandchildren. More attention needs to be paid to how we anticipate those intergenerational consequences.”

Places of Safety also links the youth mental health crisis to a wider sense that “the world is burning”. Climate change and global instability, she argues, are compromising children’s sense of safety – an anxiety often absorbed from the adults around them.

Drawing partly on evidence produced by The Lancet Psychiatry Commission on Youth Mental Health, Hearn says that climate change and the wider ‘polycrisis’ of global shocks is eroding people’s collective sense of safety. As with other anxieties, adults are liable to unconsciously pass this unease on to their children.

She encourages a form of “green care”, suggesting that the environment can be treated as an attachment figure with its own therapeutic value. The book argues that increasing disconnection from the natural world perpetuates division and “othering” in the psyches of children, young people and families.

“Young people are growing up in a world that feels really unsafe,” she added. “When adults say, ‘I don’t understand why children are struggling – in my day we just carried on,’ one answer is that we live in a field of collective anxiety about the future. If the world is on fire, nothing matters. If nothing matters, what is there for us to attach to?”

Places of Safety is published by Karnac Books, and is available to purchase via their website - www.karnacbooks.com