Mental disorder and mental health interventions for children and youth: the cases of non-suicidal self-harm and unruly behaviour A philosophical inquiry

This dissertation is a contribution to the philosophy of mental disorder with a focus on children and youth and questions about what interventions they need.

I start by asking whether non-suicidal self-harm in youth is a mental disorder. Non-suicidal self-harm involves someone causing themselves harm with no intent to try to kill themselves. Young people cutting themselves alone and when with peers may be viewed as destructive, abnormal and irrational. Yet, I argue that non-suicidal self-harm in youth is never a mental disorder in its own right. Although non-suicidal self-harm in youth is not a disordered behaviour, that does not imply that it never merits intervention.

This leads to the question of what criteria should be applied when deciding whether to offer mental health interventions. I claim that whether one has a mental disorder should not determine whether one is offered a mental health intervention. The argument is made through considering the cases of non-suicidal self-harm in youth and unruly behaviour in children and youth. Unruly behaviour includes a wailing toddler, a child deliberately breaking items and a youth crossing police lines when protesting.

Unruly behaviour is another interesting case. In some instances, there is a high likelihood of negative outcomes for some children and youth who are behaving in an unruly way. However, unruly behaviour may also be part of a passing phase and helpful for development. Furthermore, in some cases, unruly behaviour may be praiseworthy, and encouraging unruliness may advance an individual’s welfare. The case of unruly behaviour, then, raises the question of when mental health clinicians should intervene.

The cases of non-suicidal self-harm and unruly behaviour help make my central claims. I say that behaviours and thoughts that are usually part of a passing phase and produce goods appropriate to that phase of life are not mental disorders; that managing life in the best way one can with the abilities available at a particular stage of life is not disordered; and, furthermore, that whether one has a mental disorder should not determine whether one is offered a mental health intervention. Finally, I say that, rather than depending on whether a person has a mental disorder, interventions should be offered only when they will advance the welfare of the service user.

My dissertation will appeal to philosophers. I also hope that youth, parents, teachers, clinicians, policy makers and similar will be interested in the contents. This is because important practical questions are asked that challenge common views, and that guide policies and clinical practice to improve the welfare and service outcomes for children and youth.