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IT鈥橲 a tough time to be a teen, with cyberbullying, exam stress and a selfie culture that piles on the pressure to always look good.

Perhaps it is little wonder newspaper headlines talk about a burgeoning crisis in our children鈥檚 mental health. Self-harm and depression are reported to be soaring. A survey by the UK鈥檚 National Union of Students found eight out of 10 people in higher education say they have had .

Similar fears are being voiced in other countries, including the US and Australia. This is surprising, considering that, by some measures, Western teenagers are living less turbulent lives than at any other time in history. They are less likely to take drugs and get drunk than they used to, and teen pregnancies have been falling for many decades.

So is there an underlying rise in rates of depression in teens? Or is something more subtle at play?

There are signs the rise is real, even if the size of the change is being overstated, says Simon Wessely, the past president of the UK鈥檚 Royal College of Psychiatrists. 鈥淐learly, something is happening,鈥� he says. 鈥淭here is a change.鈥�

For instance, the UK鈥檚 , which uses an interview and questionnaire to clinically assess mental health and is repeated every few years, found that among 16 to 24-year-old females, depression and anxiety rose from 21 to 26 per cent between 2007 and 2014. Other studies have also shown a rise in problems among teen girls. This is undoubtedly cause for concern 鈥� but it is nowhere near the eight-in-10 numbers that make the headlines.

Indeed, not all the evidence points to a crisis. Among the under-30s, rates of suicide, which would seem to be an important measure of serious distress, , according to the UK鈥檚 Office for National Statistics. This is telling, says , who helped write a previous version of US psychiatrists鈥� main textbook, the Diagnostic and Statistical Manual of Mental Disorders. 鈥淗uman nature is very stable. The way of measuring rates of mental disorder is remarkably unstable and subject to bias depending on the methods used.鈥�

鈥淚t鈥檚 important to distinguish between normal sadness and clinical depression鈥�

Still, there are other signs of an increase in problems. Teenagers seem to be self-harming more. The number of 13 to 16-year-olds seeing their doctor for this reason rose by nearly 70 per cent between 2011 and 2014, according to a UK study published last month.

鈥淲e can鈥檛 really explain this possible rapid increase in self-harm among girls,鈥� says Nav Kapur at the University of Manchester, UK, who led the work. It might reflect a real rise in psychological problems, but could also be due to better awareness or recording of self-harm, he says.

One frequently cited explanation for the uptick is constant exposure to social media and the cyberbullying this enables. For example, Jeremy Hunt, the UK鈥檚 chief government minister for health, tweeted the self-harming figures with the reaction: 鈥溾��.

So is social media responsible? Cyberbullying is often painted as a uniquely dangerous threat. Yet this is contradicted by a recent study of over 100,000 English teens, which found there were more incidences of face-to-face bullying than internet abuse, and the former was .

鈥淸Social media] is a new channel but it鈥檚 nothing different from traditional bullying,鈥� says at the University of Oxford, who took part in the research. He thinks parents and teachers are more nervous of bullying involving social media simply because they didn鈥檛 grow up with it 鈥� and that the dangers are exaggerated by firms selling cyberbullying training. 鈥淭here has been a huge amount of hype,鈥� says co-author , also at the University of Oxford.

Nuance needed

Further, even a rise in self-harming may not indicate a rise in distress. 鈥淭here seems to be more self-harm happening, but it鈥檚 not completely clear this is due to a greater level of underlying distress,鈥� says Max Davie, a paediatrician in London who treats children with this behaviour. 鈥淚t may be becoming a more culturally acceptable way to show your distress.鈥�

The same could be true for depression. People are now more likely to pay attention to negative emotions because of wider awareness of mental health issues due to public health campaigns, as well as celebrities speaking out about their own problems.

鈥淧eople are probably a bit more aware of their negative feelings,鈥� says Stephen Scott at King鈥檚 College London. 鈥淭here鈥檚 much more emotional education in schools now.鈥�

But that doesn鈥檛 ring true to at the University of Liverpool, UK. The stigma around mental health still remains, she says, and 鈥渋t鈥檚 not reduced by much鈥�.

This disagreement is more than academic 鈥� it is crucial to understand why these figures are rising if we are to properly treat teen mental health, as exaggerating the problem could actually be making things worse. For example, getting schools to do mental health 鈥渃heck-ups鈥� is a helpful-sounding proposal that has the potential for harm. There is no easy way to diagnose mental illness with a simple questionnaire 鈥� all such screening tools give a high rate of false positives. In other words, people are wrongly labelled as having depression or anxiety when they are in short-term distress. That can lead them to panic, and confuse short-lived feelings with conditions serious enough to warrant a diagnosis of depression or anxiety, says . 鈥淚t鈥檚 important to distinguish between normal sadness and clinical depression.鈥�

Failing to do so carries a real risk, says Frances. 鈥淏y putting the normal experience of being a teenager into mental illness terminology it reduces kids鈥� resilience,鈥� he says. 鈥淭hey change from thinking 鈥榯his is part of life and I鈥檓 going to cope with it鈥� to 鈥榯his is a mental illness and I鈥檓 going to need treatment for it鈥�.鈥�

鈥淭here is a real crisis in teenage mental health, and it is the lack of treatment available鈥�

Similarly, the mental health awareness campaigns often proposed to combat perceived problems can be surprisingly counter-productive, says Wessely. They can cause a run on already overstretched mental health services, .

One thing about teenage mental health is not disputed: clinical depression in the UK is certainly not being treated effectively. There is a real crisis in teenage mental health, and it is the lack of treatment for people with diagnosed problems.

The UK鈥檚 National Health Service has undergone successive rounds of cuts since the global recession began a decade ago, and children鈥檚 specialist mental health services are being stretched particularly thinly. Teenagers in acute need are having to wait weeks or even months before they get to see a psychiatrist. There are so few hospital places that they may have to stay in a clinic hundreds of kilometres from their home, cut off from family and friends.

Long waiting times

In August, a judge if the NHS continued to delay finding an inpatient bed for a 17-year-old girl who had tried to kill herself several times. After his intervention, a bed was found.

Just last week, the watchdog released a report warning that children with mental health problems are waiting up to 18 months for treatment. 鈥淲e should put our efforts into getting more resources, because if we put them into increasing awareness we just increase wait times and burn out our staff,鈥� says Wessely.

Newer interventions are being trialled in schools, such as training in mindfulness, resilience and anti-bullying programmes. But it is essential that any interventions are tested in randomised trials before being widely implemented. Given the widespread perception of crisis, it can be tempting for politicians to roll out new interventions before the evidence is in, says Scott.

Wessely agrees it is vital we don鈥檛 act too hastily. 鈥淪omething is changing. The first thing we should do is take a deep breath and find out what鈥檚 going on,鈥� he says. 鈥淧eople say we can鈥檛 afford to wait that long. I say we can鈥檛 afford to not wait.鈥�

This article appeared in print under the headline 鈥淚s life today bad for teens?鈥�