During my husband’s late-morning computer class, chatter unexpectedly drifted towards mental health one day. One of his students mentioned the food served in the ‘mental hospital.’ “Were you a visitor there?” a fellow classmate asked her. “No, I was a patient,” she replied. Upon seeing their puzzled face, she added: “for suicidal tendencies.” An awkward pause followed and then her seat mate piped up, “I hope you are feeling better now!” The lesson wrapped up before the lunch bell, but I wondered, how many more students would suffer silently? To whom do they turn for help?
Hiding Behind a Smile
While the openness of this pre-teen was surprising at the time, the student thankfully did not choose to bury her feelings. I know the pain of loved ones struggling with depression, and the anxiety and isolation this can bring. It was often masked with laughter and a false bravado. “Anyone can hide behind a smile,” they told me. For a while the typical smile disappeared. And I remember the relief of seeing it return like a ray of sunshine after a long storm. I wonder, in this ongoing pandemic, how many more are hiding their struggles. As my college friend of mine once did. Sadly, she took her life a few months after a fun weekend visit with her. We had talked and laughed late into the night – and I had no idea of her deep depression!
It took years of trying to put on a happy face and pushing through my pain to develop a real heart for hurting people. Feelings were not always talked about when I was growing up. Perhaps this was a trend in my parent’s generation, when many new citizens traded their war-torn homelands for a new start in America. For years I dismissed my endless ruminating and rejected the label of anxiety. I considered it a sign of weakness, or a lack of Christian character. With all the comforts of home, what did I have to worry about?
The Rise of Mental Health Disorders
Today students have plenty to worry about. They face the typical angst of fitting in with peers and feeling different or bullied, excelling in school, choosing colleges and careers, navigating friendships and romance. And now teens are tackling social justice issues, from climate change and gun control to Covid protocols and political choices.
Social media has brought a whole new level of stress, with 24-7 exposure to drama. Children often lack the emotional maturity to manage it all. And they miss out on valuable in-person connections due to increasing cell phone and online screen use. (A ParentsTogether survey reported that nearly half of children spend six or more hours a day on devices, a 500% increase from 2019.) Also, when many of their activities are structured, they lack the free time for creative expression and self-care, to help stay grounded. Fortunately, teens are surprisingly resilient and motivated for the most part.
But it is small wonder that the Center for Disease Control statistics show that anxiety, depression and mental disorders are now the leading cause of illness and disability among young people today. (LBTQ communities are especially at-risk.) The World Health Organization, in an article on global adolescent mental health, reported that 1 in 7 teens and ‘tweens experience mental health conditions. Yet these remain largely unrecognized and untreated. When those we love are in a crisis, what can we do?
Normal Teen Angst or a Mental Health Disorder?
In a May 10, 2022 article in UK Healthcare, psychologist Dr. Alissa Briggs gives us some helpful pointers to distinguish between the routine teen angst and mental health issues.
• A temporary overreaction to triggering incidents versus a consistent irritability • Morning fatigue and sleeping in on weekends, versus not getting out of bed or sleeping all the time • Grade drops during transition years or in certain subjects, versus a steady decline in all subjects • Difference in food preferences, versus change in eating habits- over-eating or under-eating • Change in interests, versus a drop in all activities, including those that gave joy before • Comments or evidence relating to self-harm or death versus occasional malaise
Other Symptoms to Look For
Here are a few warning sings from NAMI (National Alliance on Mental Illness)
- Excessive worrying or fear or feeling excessively sad or low
- Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
- Persistent feelings of irritability or anger
- Confused thinking or problems concentrating and learning
- Avoiding friends and social activities
- Difficulties understanding or relating to other people
- Feelings of tired and low energy
- Altered eating habits such as increased hunger or lack of appetite
- Changes in sex drive
- Difficulty perceiving reality
- Inability to perceive changes in one’s own feelings, behavior or personality
- Overuse of substances like alcohol or drugs
- Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
- Thoughts about suicide
- Inability to carry out daily activities or handle daily problems and stress
- An intense fear of weight gain or concern with appearance
Early Warning Signs
Mental health conditions can also begin to develop in very young children. Because they are still learning how to identify and talk about thoughts and emotions, their most obvious symptoms are behavioral. Symptoms in children may include the following:
- Changes in school performance
- Excessive worry or anxiety, for instance fighting to avoid going to bed or school
- Hyperactive behavior
- Frequent nightmares
- Consistent disobedience or aggression
- Increased temper tantrums
• Engage in active listening with full eye contact, and summarize what you think they are saying. Grab moments for connection, no matter how brief, inopportune or inconvenient. Keep it positive.
• Outline expectations and limits for the important areas like safety and be flexible little things. Expect them to check in with you.
• Show interest in what is important to them- even it it’s not your taste- and know who their friends are.
• Take care our own mental health/nervous system so we do not overreact to what kids do. Teach empathy: towards each other and towards others.
• Provide opportunities for kids to become productive and competent, or redefine success.
From my work with teenagers, I have discovered it is important to create an atmosphere where teens: feel safe and valued, are trusted with independence, and engage in group activities. (No wonder how much they resist, they like to be included!) Students need guidance to develop coping strategies for dealing with stress. And they benefit from unstructured pauses in their daily schedule in order to unwind. Thankfully some schools still offer mental health breaks during the day. It also helps when adults engage in joint projects or hobbies, and show in interest in their world without overly prying.
When the Amygdala Goes Awry
The more we prod about school performance, sexual identity, or friend choices, the more teens might push the boundaries. It does not help that the less inhibited part of the brain, which controls emotional reactions (the amygdala), develops first. And then the decision-making and rational behavior part of the brain (the prefrontal cortex) kicks in. This does not fully develop until the late twenties. Thus teens may start to develop notions of consequence but will still seek instant gratification. Thus, they may wolf down that beef burger they know they are allergic to. Or do that risky prank or shoplift dare, even if gets them into trouble.
Teens just like to be heard, validated and accepted, regardless of the questionable choices they sometimes make. They do not want to be judged for who they are. Or seen as a problem to be solved or a project that an adult is trying to turn them into. Knowing what I know now, working with teens and tweens, I would parent my children differently today. If only babies came with instruction manuals! When my friend learned she was pregnant, the first gift she requested was a book on raising teens- thankfully her son turned out fine.
The important thing to know is that these concerning risky endeavors, whether walking down a live train track, or trying out a new strain of marijuana, is not always an act of rebellion. They are still learning to regulate their actions. Or, these risky acts can be a cry for help, according to teen expert Dr Lynn Ponton in the Romance of Risk: Why Teenagers Do the Things They Do.
Teachers, Parents or Therapists?
A May, 2022 article in The Tampa Bay Times recorded that several states like Florida, in the wake of the Parkland High School shooting, invested heavily in mental health. They made a push to identify mental health needs before problems got out of control. But even with 69 million dollars invested in this area, new bills and legislation offered little to no mention of suicide prevention. Districts initially submitted detailed plans to incorporate social emotional learning into classrooms. However, those same governors and allies now suggest that this responsibility rests with parents. Florida’s Department of Education now resists textbooks that incorporate social-emotional learning.
One teacher California teacher shared similar concerns with me about where the burden of responsibility lies. She lamented the lack of emotional fortitude of students today and the additional demands placed on teachers to address issues that parents once managed. Often parents today are trying to keep their heads above water as well, managing the family finances, their careers, or other family members. Teachers end up taking on more of the load, doubling up as instructor, counselor and parent. Despite the best intentions of adults, students must also want to help themselves and find their own path.
If students do not self-advocate, school counsellors are often the first line of defense. A drop in performance or attendance is often a first clue. If red flags arise, a teacher might notify a counsellor or social worker. But this is an under-resourced position and caseloads are heavy and often shared between multiple schools. Sometimes concerned teachers will be the ones who alert parents of a health concern; a middle school gym teacher was the first to inform me when my son faced a crisis.
Social Emotional Issues and Privacy
How much can schools be expected to go beyond required curriculum to cover empathy, healthy relationships, and goal setting? And how do we help young people in sensitive matters while protecting their privacy? Does safety trump privacy?
Covid has added a whole new level of complexity and strain to mental health and physical concerns. Many mental health programs are underfunded and understaffed. Providers may not be fully covered by insurance, or their practices are bursting at the seams. This area is especially concerning when students turn 18, where parents lose the right to access their children’s medical records or make decisions about their care.) Students need to sign medical release forms in advance in order for parents to be kept informed of health emergencies, or parents can obtain a power of attorney. Here is a helpful article to consider for your college-bound youth: : https://money.com/hipaa-medical-forms-college-health-insurance/
While doctors are now expected to screen for mental health issues, parents rarely receive adequate and must pursue their own research.
Mental Health Resources
There are national groups, and also each state has different levels of investment in the area of mental health. In California, we have various programs at the state and local level that address mental health needs.
NAMI is the nation’s largest grassroots organization dedicated to mental health, and started as a group of parents gathered around the kitchen table. It is made of families, members, 600 affiliates and 49 state partners to assist families impacted by mental health issues. One can call the NAMI HelpLine to find out what services and supports are available in your community.
YMCA’s Reach And Rise program matches children and teens with trained adult mentors who will spend one to three hours a week with them doing activities in the community: providing help to 10,000 neighborhoods nationwide.
United Parents: Parents Helping Parents. This group provides support, educational/caregiver advocacy and respite care for parents of children facing mental health, emotional, and behavioral disorders.
SAMHSA (National Helpline mental and substance use disorders) www.samhsa.gov
National PAL Youth Leadership Program: A national program serving at risk youth ages 8-17 to provide positive role models, build leadership and community service opportunities. PAL, Mountain View, CA.
A search of Youth Emergency Services will also provide additional contacts in your area.
Parents Helping Parents. (PHP) A nonprofit service to help children and adults with mental, physical or learning disabilities to receive the support they need, and training to support families.
Help-One-Child is another parent-centered group that partners with community agencies and churches. They provide support for foster and adopted children, at-risk youth, and their parents.
Heart for Youth USA. A non profit, dedicated to mentoring “at-promise”youth and pairing them with adult mentors. Other states have similar programs such as DREAM in Nebraska and Missouri.
ASPIRE (After-School Program Interventions and Resiliency education) is an intensive outpatient Program at El Camino Hospital in Mountain View, CA that supports children, adolescents and young adults with mental health issues such as anxiety and depression. Most health plans are accepted.
CHAD (Community Health Awareness Council) They partner with local organizations, schools and the community of Santa Clara County, CA. Cost-effective services to children, adolescents and adults are provided by Master’s and Doctoral candidates in training, who are supervised by licensed clinicians.
CharlieHealth.com An intensive zoom based therapy approach offering evidence-based solutions for teens and young adults (age 11-32) facing mental health challenges. They have sessions that include CBT-based trauma counseling and substance therapy, and DBT. Therapists are specialized in many areas, including LBGTQ populations and are in-network for most major medical groups. They advertise “no wait lists!”
And of course if someone you know needs helps now, you should immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911.
Troubled Teen Industry
More extreme approaches towards mental and behavioral health intervention include remote boot camps and wilderness camps. Some youth advocates refer to this as The Troubled Teen Industry, a 1.2 billion dollar industry with over 50,000 (often unwilling) participants a year. When local resources and therapists cannot adequately address the mental health issues affecting their children, concerned parents sometimes send their children to credited or non-credited therapeutic boarding schools and wilderness camps in hopes of providing a safe structured environment. Sadly, investigations have shown that these “tough love” approaches can sometimes become abusive.
Parents should not take these decisions lightly, as these schools may not be regulated or licensed, and the success rate is mixed at best. For as many teens who feel an alternative program helped save them, there are many who also who felt it made no difference or it made them feel worse, with lasting harm. I know people who credit one of these schools to turning their lives around, and those who continued to struggle. Regardless, family relationships need healing after such difficult choices.
Victims of trauma, like Edon Hebron of Florida received help through a California treatment center. When local resources failed to stem the mental health crisis that arose after witnessing a mass shooting at her school, her parents turned to out-of-state help. Later she transitioned to a group home, returned to her home state, and started a college degree. She wonders what those with fewer resources would have done. Carter Barnhart shared similar concerns after attending Newport Academy in CA, where she recovered from a sexual assault in her early teens. Eventually she co-founded CharlieHealth to help provide high-quality, evidence-based treatment for struggling youths and young adults.
Alternative Education Programs
Education is always a huge concern with mental health issues. Alternative education programs cater to kids with different emotional and educational needs. There are also private and public charter schools, some of which use hands-on teaching approaches. Students can complete courses in a self-paced style, online or in person, or even one-on-one. Or, they can receive a combination of home schooling and in-class instruction.
While some private schools cater to learning and emotional disorders, they may still have a one size fits all approach to education due to limited resources. Kids can be exposed to the same struggles and temptations, but typically enjoy smaller class sizes. Regardless of whether students attend private or public school, they are entitled to emotional /educational/personality testing at their local public schools. Keeping good documentation is especially important for obtaining mental health accommodations.
Other high schools options include middle college programs held on college campuses, for bright students who benefit from more flexible schedules, smaller class sizes, counseling and more individualized support. Not to mention, a cost savings! Some students even earn a community college associates degree while in high school. This level of support does not always translate to the college level, but it is an excellent way to expose students to the college, and improve chances of transferring to a strong 4-year college in their home state.
High schools do not always promote community colleges, but they need not be viewed as second best! Often they have excellent instructors who truly love teaching. The other advantage to community colleges is the STEM program- Science, Technology, Engineering and Math. My son embarked on an interesting and full-time tech career as the result of this opportunity. They also offer special services to support students with learning or physical disabilities and mental health conditions.
The Pressure of College Expectations
This is a topic in and of itself. Not every student should be expected to attend a prominent 4-year college. Working in high schools, I see students excitedly share what schools they have “committed” to. (In Europe students are expected to commit to certain education tracks and school programs as early as the 6th grade!) Many students cram for college-admission exams at a young age, as if this is the only path to success. Parents hire costly tutors and enroll their children in college-prep programs, in order to receive acceptance letters to top universities. I taught one such student in a summer program, who was sent to California from Singapore to fine-tune his English skills. He whined to me, “If I have to study once more for the TOEFL (English Language Proficiency test), I will want to kill myself!”
In the push to promote honors and Advanced Placement (AP) courses, some schools offer fewer practical hands-on courses and vocational technology courses than in the past. Students feel pressured by peers and parents to pursue 4-year colleges and take advanced placement in high school courses to boost their GPAs. In the hopes of getting a competitive edge in their college application process. I have administered such tests and have observed the stress they induce.
Fortunately schools offer choices: with both self-paced or a hybrid of virtual/in person learning environments. School districts occasionally have alternative learning sites or pull-out classes, where students with special needs can meet for smaller class sizes, or they can be mainstreamed into regular classes. There are also private schools that offer fully accredited high school programs for those with different learning styles and emotional needs, such as Mid-Peninsula High School in Menlo Park California. Public charter schools occasionally foster a more hands-on learning approach as well.
Obtaining a Diagnosis
Finding an accurate diagnosis is often the most important piece towards starting a treatment plan. Often an undiagnosed learning disability or neurological and developmental disorder can affect mental health. Untreated medical conditions such as Celiac disease or other food sensitivities can also impact mental health and cognitive function, as the gut and brain are so connected.
Psychologists Mitch Prinstein and Kathleen Ethier believe that the current mental health infrastructure in the U.S. is geared towards adults, mostly established during the era of returning war veterans in the 1940s. They argue that severe emotional problems existed ten years before the pandemic. “Failure to address this mental health crisis will result in not only the distress of millions of youth in the U.S. today, but a change in the productivity, success, and well-being of U.S. citizens-at-large as this generation matures.”
In pursuing optimal education and work opportunities for your loved ones with emotional and behavioral health issues, learning all you can about protecting the brain and modeling good mental health strategies is an important first step. And reaching out to others who you know need support. Of course, also contact your health insurance plan, primary care doctor and state and county mental health authorities if you suspect your loved ones need help. The NAMI HelpLine can also provide information about what services are available in your community. You never know when you might help save a life!