Dr. Jaspar Khawaja: Let’s stop being reactive and start meeting the psychological needs of children and young people

The mental health of children and young people is a major issue.

Longitudinal studies suggest that recorded mental health problems in adolescents have increased over recent times and in 2022, 18 per cent of children aged 7 to 16 years and 22.0 per cent of young people aged 17 to 24 years had a probable mental disorder. 

Data on reported self-harm shows a large increase over time for females and in 2014 with 20 per cent of young women reporting that they had self-harmed, three times higher than in 2000. Diagnostic prevalence rates are a limited measure and do not capture the nuance or lived experience of children and young people. That said, whilst it is difficult to make strong claims around the relative pervasiveness of mental health problems over time due to methodological issues and data limitations, on balance, evidence indicates that there have been increases in anxiety, depression, and self-harm in teenagers, particularly for young women. So far, the discussion around mental health has been dominated by talk of reducing waiting times and increasing the availability of support, rather than addressing the causes of distress.  

Fundamental psychological needs

Based on dozens of research studies, with people of a wide range of ages, Self-Determination Theory reveals how human beings must perceive that their actions can impact their lives and that the mental health of all of us depends on our ability to satisfy three basic psychological needs—the need for autonomy, competence, and relatedness. To feel in charge of our life and to feel we can manage the challenges of life, we must feel a sense of choice over our behaviour and decisions (autonomy); feel effective and capable in the activities that are important to us (competence); and have meaningful, stable connections with other people in our lives (relatedness).

So how do children, and adults, meet these psychological needs? We do so through play and other self-chosen, activities. According to an article in The Journal of Paediatrics, play and other self-directed activities are, by definition, autonomous; for children such experiences build competence in activities that they care about and that prepare them for adulthood, and such activities are the primary means by which children build friendships (relatedness). However, importantly, these needs do not develop in isolation and require certain social environments to allow them to be fostered.

What constitutes play? 

"Play is the ultimate expression of freedom for its own sake" pronounced the late anthropologist David Graeber, while Peter Gray in his book ‘Free to Learn’ outlined the characteristics of play. 

The first is that play has to do with one’s motivation, not behaviour. For example, two people could be writing a story, one might be playing while the other is not, due to their differing motivations for that activity. The second characteristic of play is that play does not have to be all or nothing. Play can blend with other attitudes and motivations, and it is useful to understand the extent of play on a scale ranging from 0 per cent to 100 per cent. Therefore, one can still be playful in the most mundane of activities. 

For some people, school/work might be around 30 per cent play, mostly involving repetitive, dull tasks but also containing opportunities to joke with friends, which they enjoy. For others, school/work may be 70 per cent play as they contain tasks that they find meaningful and are good at, and which they have some freedom over, although there are some boring aspects that are necessary. 

The third characteristic outlines certain principles that research has found increase the chances that an experience will be play when: 

1. play is self-directed

2. play is an endeavour where the means are valued more than the ends;

3. the structure and rules of play stem from the players;

4. play is imaginative and in some way removed from ‘real’, ‘serious’ life

5. play involves an active, alert and non-stressed state of mind, which also aligns with research on how we learn best.  

How does play support mental health? 

"The opposite of play is not work - the opposite of play is depression."- Brian Sutton-Smith.

The immediate effects of play on children’s moods are often clear to see, as it is when they’re at their happiest. Children know this and when asked to depict or describe activities that make them happy, often depict or describe scenes of play. Children also consider play to be an activity that they initiate and control. Part of the joy of play comes from being free from the control of others.

Play does not only promote immediate joy, it also provides the conditions whereby mental capacities and attitudes are formed that support future well-being. Research highlights that people who have a strong belief that they can solve problems that arise and impact their surroundings (a high internal locus of control) are less likely to develop anxiety and depression than someone with opposing beliefs (a weak internal locus of control).

However, Gray questions how one can develop a high internal locus of control when they are forever monitored and controlled by others and lack experiences of being in control themselves. This theory can also explain how the lack of control adults have in their lives (e.g., poor or temporary housing conditions, little autonomy in their job) will impact negatively on their mental health.  

There is also research indicating that the amount of time children have for self-directed activities is predictive of future skills and well-being. For example, significant positive correlations were found between the amount of self-structured time (mostly free play) young children have and (i) executive functioning (the ability to develop and follow a plan to solve problems); (ii) scores of emotional control and social ability; and (iii) later self-regulation.

 Evidence also indicates that children deliberately placing themselves in moderately risky situations (e.g., climbing a tree) can reduce the likelihood of future phobias and anxiety as they are confident in their ability to manage dangerous situations. Play provides conditions for managing social interactions, conflict, challenges, and  putting yourself in someone else’s shoes, as well as knowing when situations are risky or damaging and acting in your own best interest.   

What has happened to children’s play? 

Gray, Lancy and Bjorklund document how the decline of play has coincided with the deterioration in the mental health of children and young people over the last 50 years in the US. Whilst the long-term data for these trends is not available in the UK, the underpinning causes that they cite can also be found here. Primarily, the school system and societal attitudes. 

According to the Education Debate, since 1979, the UK has been subject to an ever-increasing marketised, competitive model of education, in which we have seen the development of centralised accountability systems such as Ofsted, league tables, and an increased focus on exams as a measure of outcomes. This has led to an increasingly pressured, rigid school environment where children have few opportunities to play or engage in self-directed activities and do large amounts of homework when not in school. 

Research has shown break times in England have shortened over the last two decades, with older pupils losing more than an hour a week as lessons increasingly replace lunch and playtime. Lead researcher Ed Baines states, “children barely have enough time to queue up and to eat their lunch, let alone have time for other things like socialising, physical exercise, or exploring self-chosen activities.” Some schools have stopped unsupervised break and lunchtimes completely, in attempts to reduce bullying. 

Not only does the school system thwart the playful instincts of children, but it also places them in highly pressured, competitive conditions that are harmful. The Children’s Society reported a consistent decrease in children’s happiness with life and with school since 2009. While Edge Foundation recently surveyed 10,000 young people and almost half reported that school is ‘not an enjoyable or meaningful experience’, and is something they feel they need to “get through” because of its bearing on their futures. Participatory action research from States of Mind elicited the factors that make school distressing from the perspective of young people. 

The Children’s Society reported that the school climate often means young people do not feel heard, or that their views are considered. The responses of students across these studies may provide some explanation for the Oxwell study data that found one-third of young people felt increased wellbeing at home, during lockdown. In school environments that inhibit opportunities for play and autonomy whilst simultaneously creating stressful conditions where children feel unheard, it is not surprising that psychological distress arises as an unintended consequence.  

Those who argue that high-stakes exams are good for developing resilience in young people and prepare them for the future are not only wrong but are stuck in paradoxical thinking. In reality, the more pressure exerted on children and young people by the school system, the less equipped they are to manage difficult situations in the future. The conditions that actually prepare children for the future are playful and unstructured, where children can learn to make choices, manage conflict and develop connections independently. 

Well-meaning changes in societal attitudes of childhood can also explain the reduction in play. Outside of school, childhood time increasingly gets spent in adult-directed, school-like activities, such as formal sports and lessons. Research in England has also shown huge drops in children’s independence. The permission to walk home alone from primary school dropped from 86 per cent in 1971 to 35 per cent in 1990 and 25 per cent in 2010, and permission to use public buses alone dropped from 48 per cent in 1971 to 15 per cent in 1990 to 12 per cent in 2010. 

A report commissioned by the National Trust found time spent playing outside has also declined by 50 per cent in a generation. 

Surveys have indicated that parents reducing opportunities for children’s independence largely stems from fears of crime and traffic.

Research also indicates that children’s play is impacted by their social background. Street play is particularly important for disadvantaged children as a consequence of having less space, however opportunities for this have decreased due to local development and community ‘policing’.

What can we do? 

Sone quick, small changes are likely to have a positive impact. 

Research shows that small increases in breaks and lunchtimes can improve children’s emotional well-being. Statutory requirements for the proportion of the schooltime required for free play could also be introduced to guarantee that there are opportunities to play at school. Peter Gray’s intervention in the US schools has involved play clubs which offer an hour of play before or after typical hours of school with the only rules being don’t hurt anyone and don’t break anything valuable. This could easily be implemented in schools in the UK, as a progression of breakfast/after school clubs that already exist. And simply highlighting the importance of play will hopefully allow parents to recognise the value of supervising children playing with each other, and only intervening when necessary. And, when playing with children, letting them guide that activity and play.

In the medium term, investment in playgrounds and parks is vital and could be designed in innovative ways alongside children to maximise creative play. Further, investment in libraries and neighbourhoods should also take place using strategies led by local communities to reduce barriers and co-create environments for child independence. Delaying the age which children start formal schooling (which is currently the earliest age in Europe) and extending the Early Years curriculum, which is already largely centred around play, is a sensible step forward. Exploring ways to reduce high-stakes exams and school accountability is likely to reduce the external pressure placed upon both teachers and students.

In the longer term, we should consider wider reforms to education to maximise opportunities for play and self-directed learning. Derry Hannam proposed all state-funded schools, both primary and secondary, allocate 20 per cent of curriculum time to be negotiated around the interests, concerns and questions of the students. The 20 per cent would be used for individual or collaborative self-directed learning, with teachers available as facilitators or ‘experts’ if their services are requested by students. He also suggested that staff could use the time to pursue their own research questions and interests to demonstrate lifelong learning. This seems like a good proposal to me.

Other models of schooling are already being implemented in England, and around the world which can be learned from.

One final point. I do not want to place a lack of play as the singular cause of mental health problems in children and young people. Addressing complex societal issues would make a significant difference to the well-being of children, such as reducing child poverty, providing secure, good-quality housing and ensuring that all children have their basic physical needs met. However, the importance of play is increasingly recognised as essential to meeting our psychological needs.