How To Help Teens Struggling With Mental Health

Anxiety and depression are different but can share some indicators. First, look for some significant changes in a young person’s behavior, such as disinterest in eating or participating in social activities previously enjoyed, altered sleep patterns, or withdrawal from other aspects of life. It is difficult; this behavior can sometimes be normal teenage anxiety. However, a teen in need may express undue worry, hopelessness, or deep sadness, especially for long periods of time.

Whether a teen is dealing with anxiety or a clinical problem “is the $64 million question,” said Stephen Hinshaw, an expert on teen mental health issues at the University of California, Berkeley. The question is about “persistence, interference with blooming, sheer suffering (on her or his part and yours) that can help make this difficult differentiation.”

If the lines become too blurry to tell the difference, it may help to see a pediatrician to find out if there is a clinical problem.

Credit…Annie Flanagan for The New York Times

The advice of experts is resounding: be clear and direct and do not shy away from difficult questions, but also approach these issues with compassion and not accusingly. As challenging as it may seem to talk about these issues, young people often desperately want to be heard. At the same time, it can be difficult to talk to a parent.

“Be gentle, be curious, and over time be persistent but not insistent,” explained Dr. Hinshaw out. “Shame and stigma are a big part of the equation here, and if you’re outraged and judgmental, be prepared for a shutdown.”

“Quite a few ‘teens’ are practically begging you — without telling you so directly — to remain concerned and loving and have a dialogue,” said Dr. hinshaw.

For teens who struggle to open up, try collaborating on a shared hobby or activity without bringing up their mental health. Put them at ease, and in the end they may be more willing to share.

These issues are “usually very difficult for a teen to talk about with their parent or guardian,” said Nicole Nadell, an assistant professor of pediatrics and psychiatry at Mount Sinai. “Be a patient and active listener in the beginning, reflecting back to the teen what they are saying, thinking and feeling.”

If you have suicidal thoughts or are concerned that someone you know may be having these thoughts, call the National Suicide Prevention Lifeline in the United States. 800-273-8255 (TALK)call 911, go to the emergency room, get help from an adult, or go to for a list of additional resources. To go here for sources outside the United States.

It is a sign of strength, not weakness, to seek help.

Research shows that the suicidal impulse passes if it can be delayed. Then the underlying problems can be addressed. Researchers call suicide “a permanent solution to a temporary problem.” Help is needed to get through this period of excruciating pain that leads to suicidal thoughts. Get that help.

Self-harm can include cutting, hitting oneself, burning, or other forms of mutilation. These behaviors may seem to cause pain, but they’re actually meant to redirect or make emotional pain go away, experts say.

Non-suicidal self-injury is “mainly used to re-regulate,” said Emily Pluhar, a child and adolescent psychologist at Harvard Medical School. The behavior, she explained, can release a pain reliever, a natural pain reliever that can provide a sense of relief. “It helps people re-regulate and feel calmer.”

The problem is, such behavior ultimately doesn’t work to fix the underlying problem and can then get worse.

Cutting is often done on the wrists, ankles, or thighs. “Self harm is often hidden from parents and peers through long sleeves and secrecy. If you see evidence, try to argue — even though your teen will probably try to minimize or hide it, out of shame,” Dr. Hinshaw said.

If you see any wounds that appear to endanger a teen, call 911 or go straight to the emergency room.

When cutting is discovered, it is vital that a parent or caregiver respond with concern and compassionate curiosity, not alarm (unless danger is imminent). “Be curious first instead of alarming. The best way to get your teen never to talk to you about an important issue is outraged or moral or judgmental,” said Dr. hinshaw.

Some recommended tactics for starting and fueling a conversation about mental health issues in general include making sure you’re genuine and authentic – admit it if the topic makes you nervous – and creating silence and space for a young person to express oneself. And try a “change of settings,” some experts recommend, such as a car ride or an activity, which can make conversation natural with less eye contact.

Dan: “Validate, validate, validate,” says Dr. Pluhar of Harvard. “You don’t have to agree with their perspective, but you have to validate that their perspective matters and that you understand it.”

The ultimate goal is to help an adolescent find the root of the emotional pain that leads to self-harm. Once your child is ready, a pediatrician or other health professional can help you find a suitable counseling path. Evidence supports several forms of cognitive behavioral therapy, including dialectical behavior therapy to teach coping skills. These skills help people recognize their thinking patterns and reformulate problems in a healthier way.

It’s important to understand that self-harm is not the same as suicidal thoughts, which is a much broader override of the biological instinct for survival. That said, self-harm that lasts for a long time and gets more severe can be a predictor of suicidal behavior.

M, one of many teenagers identified by just a single initial.
Credit…Annie Flanagan for The New York Times

It may be worth suggesting healthy alternatives to self-harm for your child to try. Research shows that the urge can be delayed by removing the object or tool used to cause harm from the home and by using simple methods such as exercise. dr. Nadell of Mount Sinai suggests a few:

dr. Hinshaw recommends several concrete steps:

  • “Ask other parents, or join self-help/advocacy groups, to get a sense of the clinicians in your area with a reputation for careful, state-of-the-art assessments/evaluations, compared to those who are too quick. †

  • “Ask the prospective reviewer: How many evaluations have you done for ADHD or anxiety or depression? How many hours does such an evaluation often take? How many, do you estimate, of those evaluations you do ultimately confirm a diagnosis?”

  • Ask if the provider uses evidence-based rating scales completed by parents and teachers that provide objective measures of how a young person is doing socially and academically. These metrics are important, experts say, because parents can often get a distorted view of how a young person is behaving — for example, the child may seem moody and controversial at home or complain about how difficult school is when, in reality, they are performing well in classes. , have friends and adapt well.

  • Question: “Would you contact the school for additional information? For each condition, do you get a developmental history from the parents, from childhood, of milestones, deficits, strengths, and contexts that seem to accentuate versus help with the problems at hand? Do you have a family history of similar conditions?”

Credit…Annie Flanagan for The New York Times

Psychiatric medications can be powerful and effective. But they can have side effects, risky drug interactions, and withdrawal challenges. So parents should approach the issue of medication with the same clear, thoughtful investigation they would when seeking a therapist, pediatrician, or other counselor to help with mental health issues in general.

“Again,” said Dr. Hinshaw, “Ask around for physicians/psychiatrists of excellent reputation in this sense. And work with a physician/psychiatrist who strives for the lowest possible dose of the correct medication for your teen’s problems.”

Ideally, said Dr. Nadell of Mount Sinai, the prescriber will specialize as a child and adolescent psychiatrist. The challenge in many parts of the country is that specialists are not available or only take out cash or private insurance. That means, experts said, parents should speak to pediatricians or primary care physicians about their experience and make sure they explain the side effects and interactions with other medications, as well as how to tell if the medication is working and how difficult it is to wean the medication. .

Remember that cognitive behavioral therapy or other non-medical techniques are often the best first-line treatment for mental health problems. These strategies provide an adolescent with tools to deal with anxiety, stress, and other challenges. Research shows that when medications are needed, they can be most effective when combined with such therapies.

Experts say there are essential habits to promote mental and physical health. Sleep is huge. Young people, with developing brains, need eight to ten hours of sleep. Lack of sleep can hinder development and can dramatically affect mood and learning. Physical activity is also vital for mental and physical well-being.

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