How Do We Solve Britain’s Rising Youth Mental Health Crisis?

Exploring the bidirectional link between youth unemployment and mental health outcomes

Nine million people in the UK are locked out of the economy. Our latest ONS statistics show that one in every 15 people who are of working age in the UK are off work because of long-term sickness. This is 69% higher than in Germany and more than twice the level seen in Italy, creating an all-time high in the UK. It may be surprising to some, but the sharpest rise in economically inactive people has been seen among 16–24-year-olds. This trend coincides with well-documented increases in common mental health disorders (particularly anxiety, depression, and stress-related conditions) among young adults.

In response, the BMJ recently explored not only the scale of the problem, but the more difficult question of how to reverse it: how to re-engage a generation and get them back into the workplace while addressing the psychological burdens they carry.

A Noble Question

In society, raising this issue often carries a reputational risk. Discussions that link health, particularly mental health, with employment outcomes are often perceived as stigmatising and accusing the young of being ‘weak’ or wanting everything ‘served on a golden plate’. There can be little doubt that these reductionistic takes do nothing to help and empower the group that will be the future of this country.

Yet avoiding the conversation does little to address the underlying reality. We are of a similar opinion to Andrew Marr, who stated in the New Statesman: “There is nothing progressive, nothing socialist and nothing social democratic in being content witnessing large swathes of your adult population withering away on sickness benefits.”

Empirically, the relationship is clear. There is a strong association between economic inactivity and common mental health disorders in young people. Prior to the pandemic, the UK performed comparatively well, with lower inactivity rates than many similar economies. Since then, however, recovery has lagged behind its G7 peers. The question is not simply what is happening, but why the UK appears to be an outlier.

The ‘Passive’ UK Approach

Part of the answer may lie in how mental health conditions are treated within the UK’s welfare and healthcare systems. In countries such as the United States or Germany, mental health support is more often embedded within “active” labour market policies. These are frameworks that assume work, in some capacity, is a fundamental part of recovery. By contrast, the UK model remains comparatively “passive,” frequently requiring individuals to reach a threshold of wellness before being considered work-ready.

This approach is intuitively appealing, but it overlooks the evidence that work itself (when appropriately structured, of course) can provide routine, social integration, and a general sense of agency.

The government have also long known that intervening early is crucial by targeting struggling young people before they disengage completely, and campaigns and charities that continue to provide targeted support to those who need it will remain crucial.

The relationship between work and mental health is, of course, bidirectional. Poor health can limit an individual’s ability to work, but prolonged absence from the workforce can equally impact psychological well-being. The BMJ is right to emphasise the protective effects of good-quality work. However, the claim that job quality alone explains the UK’s divergence doesn’t seem to have good evidence supporting it. Comparable economies such as France and Germany have not experienced the same post-pandemic levels of inactivity, suggesting that other structural or cultural factors are at play, rather than just job quality.

Are We Missing Something?

One under-explored factor may be the erosion of early-career social support networks. The transition from education to employment has historically been eased by things such as in-person mentorship, learning from colleagues, and the support system of nearby friends and family.

The rise of remote-first entry-level roles and thus fewer chances for guidance and support, combined with more people having to move away from social networks for first-time jobs, may have created an additional layer of stressors in early adulthood. And this is not to even touch on the harms that social media can bring, with studies showing that those who spend more than three hours a day on social media are at greatest risk of mental health problems. Social media seems to have this unique ability that’s never been seen before to tap into and manipulate our psychology and neural networks.

Yes, every generation had it’s unique set of challenges and cultivating the strength needed to overcome these challenges is pertinent, but we won’t do this by avoiding the conversation entirely.

To Be Practical or To Follow the Passions?

Application season may be drawing to a close, but the question surrounding what medical career is the right fit for us goes on. It’s such an important question, isn’t it? Most of us have tussled with this question and either arrived at a fulfilling answer or conceded that such a question can never be answered in a satisfactory manner.

We are often told to follow our passion in medicine by looking at our personality traits and trying to align them to a speciality. For example: Do you like working with your hands? If so, then a procedural speciality may be for you. Are you more of an extroverted person who enjoys significant patient contact? Maybe don’t pick pathology. Do you enjoy diagnostic work? Perhaps consider specialities like radiology and GP.

But there are some questions that we are quick to dismiss in medicine when it comes to picking our careers, and those are the practical considerations: How do you want your life to look like? What things are important to you in life, and how will they change as you age? These practical considerations are crucial, as one may say that ‘falling in love’ with a speciality is overrated.

Some believe that it can be incredibly easy to ‘fall in love’ with a speciality once you begin doing it. Does motivational psychology not tell us that in the self-determination theory, one of the 3 core pillars needed to feel satisfaction is competence? When you get good at a task, you satisfy that need for competence, which in turn provides the satisfaction that is needed for a fulfilling career.

Half-Time Rule Change: The Case of the Unfortunate IMGs

What options do IMGs have now that the rules have changed?

This piece isn’t about moralising over the recent UKGP legislation. The On-Call team has already shared its views in previous posts. But regardless of where you stand on the matter, it’s not hard to see why many IMGs have been left feeling deeply aggrieved.

The last-minute changes to the application cycle after money and time had been invested in courses, examinations and portfolio building are regrettable. And yet, as uncomfortable as it is, this kind of last-minute disruption is not new in medicine. Many doctors will remember taking on intercalated degrees during medical school, only for their value in foundation applications to later be removed. Portfolio requirements for higher training shift year by year, often with little warning. The goalposts, as many will recognise, have a habit of moving.

The ‘Unlucky’ Winners

What feels different this time is the visibility of the impact. Whilst the majority of offers went to UK graduates, even when accounting for applicants relatively, across social media, we’ve seen examples of non-prioritised IMG doctors achieving exceptional scores and rankings, only to be excluded from speciality posts. Regardless of one’s stance on the legislation, it’s hard not to feel a degree of empathy.

And here is the key point: It is entirely possible to view these changes as a necessary response to workforce pressures, while also acknowledging that they come at a real cost to individuals. Both things can be true at once.

But what options remain for IMGs in light of the proposed five-year experience cut-off from the BMA, something that may well be adopted more widely, given the ongoing pressure of competition ratios?

The Uncomfortable Truth

We know that without significant expansion of training posts, any intervention that prioritises or includes experience cut-offs will inevitably create losers. Many of our IMG colleagues are aware of this, but what option do IMGs have?

One option is to remain in trust-grade roles. Doctors may choose to stay in these posts until they meet the five-year eligibility criteria for speciality training, or instead pursue progression via the CESR or ‘Portfolio Pathway’ route (We will stick with CESR as it seems to be more commonly used).

It’s likely that we’ll see a growing number of doctors taking the CESR route, despite the well-known challenges of long and unpredictable timelines, inconsistent support from departments and trusts, and a process that can feel a bit opaque. That said, attitudes toward CESR have shifted noticeably over the past decade. There is increasing recognition of its legitimacy, and a gradual move toward parity with those on traditional training pathways. Some variability of course still exists and won’t be found on any departmental websites or Royal College announcements. Some specialities, departments and hospitals may be less receptive to CESR candidates, which is not ideal given that the process is heavily contingent on departmental support.

Career Planning

The On-Call team have been paying close attention to what IMG advocacy groups have been recommending in light of the bill. One piece of advice that may be prudent is to continue strengthening one’s portfolio through membership exams relevant to one’s chosen speciality (MRCP/MRCS) to not only improve competitiveness when it comes to applying to trust-grade roles, but can also help position IMGs more strongly for future applications.

For those yet to come to the UK, the decision now requires particularly careful thought. The landscape has shifted, and expectations need to reflect that reality. Increasingly, prominent IMG voices are advising colleagues to reconsider the traditional route of PLAB, and instead explore countries with clearer, more structured residency pathways—or even opportunities within their home systems.

Against this backdrop, those selling PLAB courses continue to fervently advertise their courses, and as of April 1st, the GMC will be increasing PLAB test fees.

IMGs now face important decisions about the future of their careers. These choices will require careful consideration of not only the clinical aspects, but also the social and financial factors that shape their lives.

“Seeing some doctors with amazing rankings talking about rejecting the posts they were offered, as it wasn’t in their ideal location. Interesting that these doctors will be added to the ‘didn’t get into training’ statistics next year. This is why statistics alone will never tell the full story.”

“What is everyones go to night shift snack? So far, the contenders are grapes, the classic NHS biscuit selection, fruit or a greek yoghurt pot.”

“Having previously worked in a big teaching centre, in hyper-specialised trusts, I’ve realised the politics, funding issues, and managerial-related stressors are simply not worth it. I moved to a trust close to my family home and realised peace of mind and happiness are priceless.”

“The sheer amount of work that a GP has to chase up without an SHO/F1 to help them was only made apparent to me when I started GP training.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

In what is being described as the biggest haul for the GMC in decades, the government is introducing reforms to make it easier for doctors who are found to have engaged in racist or antisemitic conduct to be dismissed. Here is the full report in The Independent.

The BMJ covered the growing crisis in the number of economically inactive young people this week. Studies show an increase in common mental health disorders amongst these young people who are out of work. The youth of our country will be the future of tomorrow, so what options do we have to help them? Here is the full piece from the BMJ. 

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The Consultant Trap: Why High Income Doesn’t Equal High Wealth

Admit it… One of the primary reasons why becoming a Consultant excites you is the opportunity for higher pay. There is nothing ignoble about this; highly skilled workers deserve fair remuneration. But what if the On-Call team were to tell you that high income is grossly irrelevant; it’s what you do with that income that matters. High income doesn’t automatically equate to high wealth.

For some, the moment the Consultant contract arrives, the life upgrades soon follow: the "26 plate" BMW parked outside, the house with two spare bedrooms "just in case," and the private school fees. The income rises, but because of lifestyle inflation, wealth doesn’t. We don't want a profession where our most senior, highly skilled doctors are effectively living paycheck-to-paycheck because their earnings never find the time to be funnelled into income-producing assets.

Yes, the NHS pension is a great start and is no doubt one of the most generous parts of our pay package, but it is what is called ‘illiquid’. You can’t use it to fund a sabbatical, a career change or a retirement before 67 (or whatever the retirement age becomes once we get there). In the meantime, you need to resist the urge of lifestyle inflation and instead funnel your hard-earned money into alternative investments. We, of course, know that life is for living, but like most things in life, it’s a balance.