For most people struggling to cope with life in their 20s, the answer is 'skills not just pills', says clinical psychologist Meg Jay.
"That means getting into a better job, getting into a better relationship, learning how to be a friend or make a friend, cooking more, moving more, braving intimacy, learning how to make difficult decisions," she tells Jesse Mulligan.
Photo: Devin Avery
Clinical psychologist and author Meg Jay Photo: Supplied
Meg Jay has specialised in the mental health of 20-somethings for 25 years. Her latest book is The Twentysomething Treatment: A Revolutionary Remedy for an Uncertain Age.
The years between 20 and 30 are when people are most likely to feel anxious, depressed and struggle with substances, Jay says, and this is largely because it's a time of great uncertainty.
"They're trying to adjust to their first jobs or their first relationships, or first cross-country moves, their first years at university and all that can be very stressful ... They've got problems they're trying to solve like who am I going to be? Where am I going to work? Is anyone going to love me?
"Career isn't defined, partnership isn't defined, self isn't defined, where you're going to live isn't defined. And we know that uncertainty makes people feel anxious and stressed.
"There's a lot of uncertainty, the brain interprets that as danger so it makes people feel very uncomfortable. But that doesn't mean that there's something wrong with young adults ... It's normal to struggle, it's common to struggle.
"That's something that they have to learn to figure out is what do I do with all this uncertainty? How do I manage my feelings? And how do I start to create my own structure for my life?"
Jay encourages her therapy clients to replace the word 'anxiety' with 'uncertainty' when thinking about themselves or their situation.
"What if you think of it as social uncertainty that you're unsure about whether this person is your friend? ... When you do that, it begs the question of 'What are the experiences that you need? What are the skills that you need so that you can feel more certain, so that you can feel more sure of yourself or more sure of your relationships?'
"It leaves an opening for growth and change. Rather than this label 'I'm anxious and that's why I'm doing this versus' versus 'I'm feeling uncertain and what do I need to feel more confident or competent?'"
Although young adults can easily meet the diagnostic criteria for mental health disorders, most people tend to feel better by their 30s, Jay says, especially if they're focusing on skills, not just pills.
Often young adults think medication and/or or a therapist is what they need when a lot of what they're struggling with is actually situational and normal.
"We need to give them hope and let them know that it's very common to struggle in your 20s. But by and large mental health improves, as we go about life, as we get better at life, as life gets better, mental health also gets better."
While for some people medication is a "lifesaver" she says, but there are no mental health disorders for which pills alone are all people need.
Therapy is not affordable and accessible for most young people, Jay says, and even for those in therapy, the biggest driver of change is what they do to build skills outside the therapy room.
"I spend a lot of time in my office with very lovely young adults who want the right answer to 'Which job should I take? Which person should I be with? Which city should I move to?'
"Part of moving into adulthood is realising that most big decisions, most big questions, don't have right or wrong answers, they just have your answers, meaning what's right or wrong for you."
The Twentysomething Treatment: A Revolutionary Remedy for an Uncertain Age book cover Photo: Simon and Schuster
Jay encourages 20-somethings to tune into their priorities, values and goals and accept that there is not really a right or wrong when it comes to decision-making.
"We basically make the best decision that we can based on what we know, but that there will never be a right answer. The good news is there's never a wrong answer either."
To parents of 20-somethings, she says overprotection - doing everything for them - isn't actually supportive in the long run.
"Are they living at home as an adult, sharing the labour, the cooking, the laundry ... are they sharing the load or are they living at home like a teenager where they're still sitting down for meals and having their laundry folded?
"That's not helpful to 20-somethings. It may or may not feel good in the moment, but it definitely does not help people feel more confident and more competent and more sure of themselves.
"Ultimately, we can't make the world a certain place. But we can feel more sure of ourselves and our ability to get out there and create a life and have a job and be a friend and be a partner and find a partner. And we don't learn that sense of confidence and competence if other people keep doing things for us."
When a young adult is struggling, it's more useful to help them build self-assurance instead of offering the "short-lasting drug" of reassurance, Jay says.
"I've heard many, many times over 25 years of doing this that it's actually frustrating to young adults when everybody says 'Oh, it's fine. It'll all work out, you have all the time in the world' ... Maybe it works for a second, but it's not really satisfying and it doesn't even satisfy them.
"Rather than do that, what I do is take 20-something concerns seriously. I ask the person 'What are you worried about?' and let's see if we can take that up as a serious problem that we're trying to solve.
"I ask them what feels right about this decision to you and walk them through how they came to the decision that they made or why they took this job in the first place and sort of help them feel good within themselves instead of looking to other people for evidence."
In The Twentysomething Treatment, Jay says she's delivering a message of good news, that life - according to all the data - tends to get better in our 30s, 40s and 50s.
"if you think about it, that's the way it should be. I say to my clients, if your 20s turned out to be the best years of your life, something went terribly wrong, life should get better as you go along."
