The Success Mask: When Achievement Hides Mental Health Struggles
Mental health struggles are not always visible. Some young people continue to excel academically and fulfil their responsibilities while experiencing significant psychological pressure. This gap between outward functioning and internal wellbeing can make mental health difficulties harder to recognise. Achievement and productivity are often viewed as indicators of success, resilience and wellbeing, yet they do not necessarily reflect how a person is coping. A compound of academic pressure, perfectionistic expectations, and social stigma actively encourages youth to conceal their internal state. Consequently, society's emphasis on visible success makes some difficulties harder to identify and address.
Several factors can contribute to concealed mental health struggles. Academic pressure can cause young people to associate their performance with their sense of self-worth. A 2023 systematic review of 52 studies found that 48 reported a positive association between academic pressure and at least one adolescent mental health outcome.1 However, achievement itself is not necessarily harmful. Research distinguishes between perfectionistic striving and perfectionistic concerns, with the latter showing stronger associations with anxiety and depression symptoms among young people.2 Social expectations to be strong and resilient can discourage vulnerability. Stigma, embarrassment and a preference for dealing with problems alone may further prevent people from seeking professional support. A systematic review of 52 studies found that individual and social barriers were common among young people who did not seek mental health support.3 These factors can make it easier for someone to appear successful while struggling privately.
Mental health difficulties among young people are a significant concern in Aotearoa New Zealand. The Youth19 Rangatahi Smart Survey identified five distinct profiles of mental health needs among secondary school students, based on measures including wellbeing, depression and anxiety symptoms. Only 40.31% of participants
1 Thomas Steare et al., “The Association between Academic Pressure and Adolescent Mental Health Problems: A Systematic Review,” Journal of Affective Disorders 339 (2023): 302–317, https://doi.org/10.1016/j.jad.2023.07.028.
2 Sara Curran et al., "Associations between Perfectionism and Symptoms of Anxiety, Obsessive-Compulsive Disorder and Depression in Young People: A Meta-Analysis," Clinical Psychology Review 103 (2023): 102300, https://doi.org/10.1016/j.cpr.2023.102300. 3 J. Radez et al., "Why Do Children and Adolescents (Not) Seek and Access Professional Help for Their Mental Health Problems? A Systematic Review of Quantitative and Qualitative Studies," European Child & Adolescent Psychiatry 30, no. 2 (2021): 183–211,
https://doi.org/10.1007/s00787-019-01469-4
were classified in the healthy group, while the rest experienced varying levels of mental health need.4 This demonstrates that mental health difficulties cannot always be identified through outward behaviour. This is particularly important when considering high-achieving students. Good grades, busy schedules and participation in activities may show that a student is functioning, but they do not necessarily show that the student is doing well mentally. Relying on these visible signs alone could mean that some young people do not receive support when they need it.
Hidden mental health struggles can have significant consequences when individuals do not receive appropriate support. Young people may delay seeking help because they do not recognise their experiences as serious, fear judgement or believe they should manage their difficulties independently. Radez et al. found that 96% of studies in their systematic review reported individual barriers to help-seeking, while 92% identified social barriers such as stigma and embarrassment.³ Gulliver et al. similarly identified stigma, difficulty recognising symptoms and self-reliance as important barriers for young people.5 Combined with pressure to appear successful, these barriers may prevent young people from speaking up. Friends, teachers and family members may also fail to recognise the problem because the person continues attending school, completing work and participating in everyday activities. Mental health awareness requires more than recognising visible distress.
Mental health, however, should not be viewed solely as an individual responsibility. A study of 9,699 New Zealand secondary school students found that 82% of students with significant mental health problems had not sought help from a general practitioner.6 This suggests that improving mental health support requires more than expecting individuals to speak up. Schools have an important role in creating environments where students can access support without fear of judgement, while families and policymakers can help ensure that appropriate services are available and accessible. Schools should also recognise that academic performance is not a reliable measure of wellbeing. At the same time, individuals still have a role in recognising their difficulties and seeking support. Mental wellbeing is therefore a shared responsibility between young people, their families, schools and wider communities.
Moving beyond surface-level awareness requires us to change what we consider evidence of wellbeing. Schools can provide accessible mental health support and education that reduces stigma, while families can create spaces where young people
4 T. J. Fleming et al., "Distinct Profiles of Mental Health Need and High Need Overall among New Zealand Adolescents: Cluster Analysis of Population Survey Data," BMC Public Health 24, no. 1 (2024): 635, https://doi.org/10.1186/s12889-024-18045-8
5 Amelia Gulliver et al., "Perceived Barriers and Facilitators to Mental Health Help-Seeking in Young People: A Systematic Review," BMC Psychiatry 10, no. 113 (2010),
https://doi.org/10.1186/1471-244X-10-113.
6 Kimberley R. Mariu et al., "Seeking Professional Help for Mental Health Problems, among New Zealand Secondary School Students," Clinical Child Psychology and Psychiatry 17, no. 2 (2012): 284–297, https://doi.org/10.1177/1359104511404176
Bibliography
Curran, Sara, et al. “Associations between Perfectionism and Symptoms of Anxiety, Obsessive-Compulsive Disorder and Depression in Young People: A Meta-Analysis.” Clinical Psychology Review (2023).
Fleming, T. J., et al. “Distinct Profiles of Mental Health Need and High Need Overall among New Zealand Adolescents: Cluster Analysis of Population Survey Data.” BMC Public Health 24 (2024).
Gulliver, Amelia, Kathleen M. Griffiths, and Helen Christensen. “Perceived Barriers and Facilitators to Mental Health Help-Seeking in Young People: A Systematic Review.” BMC Psychiatry 10, no. 113 (2010).
https://doi.org/10.1186/1471-244X-10-113.
Mariu, Kimberley R., Sally N. Merry, Elizabeth M. Robinson, and Peter D. Watson. “Seeking Professional Help for Mental Health Problems, among New Zealand Secondary School Students.” Clinical Child Psychology and Psychiatry 17, no. 2 (2012): 284–297. https://doi.org/10.1177/1359104511404176.
Radez, J., et al. “Why Do Children and Adolescents (Not) Seek and Access Professional Help for Their Mental Health Problems? A Systematic Review of Quantitative and Qualitative Studies.” European Child & Adolescent Psychiatry 30 (2021): 183–211.
Steare, Thomas, Carolina Gutiérrez Muñoz, Alice Sullivan, and Gemma Lewis. “The Association between Academic Pressure and Adolescent Mental Health Problems: A Systematic Review.” Journal of Affective Disorders 339 (2023): 302–317. https://doi.org/10.1016/j.jad.2023.07.028.