Tackling Tough Teen Mental Health Issues

Most children transition into adolescence without major bumps in the road. But for some teens, the 11- to 18-year-old period of life can present difficult challenges to navigate and increase the likelihood of risky behavior. In recent years, certain mental health issues – including anxiety disorders, depression, marijuana use and suicide – seem to be on the rise among youth. Here are suggestions for dealing with serious mental health topics that teens may face:
What should I look for in my teen to distinguish between typical teen behavior and signs of mental distress?
Mood changes in teens are a normal part of adolescence, as are intermittent problems sleeping and occasional “bad days.” But for some teens, these behaviors can become more severe, pervasive and prolonged and could be caused by something more serious, like depression.
If you notice that your teen has been feeling down for at least two weeks, is having trouble concentrating, is more irritable than usual, is fatigued, has changes in appetite, or no longer enjoys or cares about things she or he once did, she or he may be depressed. If these symptoms don’t go away and interfere with the ability to function normally, it is important to get help. Start by reaching out to your teen’s guidance counselor at school or your primary care provider who is equipped to provide support and referrals to additional care as needed.
What should I do if I am concerned that my teen or one of her peers is considering suicide?
The first step is to ask your teen directly if they are thinking about ending their life. Mention what you’ve noticed that has made you worried about them. Raising the question about thoughts of suicide does not plant the idea, but rather creates an opportunity for you to offer support. Having open, ongoing conversations with your teen about mental health will allow you to ask the tough questions when you think she might be at risk.
If you are concerned about your child’s friend, have a conversation with their parent if you know them or bring it up to another trusted adult at school. You can do this confidentially. The most important thing to remember is that you do not need to go about this alone. You can empower those who the youth trusts to make sure they have the help they need to overcome depression with professional treatment – be it an adult, her friends or her school, which is equipped with protocols for the best ways to care for their students.
If you are afraid that someone is in immediate danger of harming themselves, call 911. You may also call one of the emergency numbers below, which offer support 24/7:

  • California Youth Crisis Line: 1-800-843-5200
  • National Suicide Prevention Lifeline: 1-800-273-TALK
  • Crisis Text Line: Text START to 741-741
  • Stanford’s Child and Adolescent Psychiatry Clinics: 650-723-5511

Project Safety Net at psnpaloalto.com provides a hub of resources and education for anyone in the Bay Area needing mental health support.
I have seen a lot of discussion online about the Netflix series 13 Reasons Why and its focus on suicide, sexual assault and bullying. Should I be concerned if my teen has watched the show?
The series 13 Reasons Why portrays several disturbing themes, including suicide, in a way that is not in accordance with the national recommendations for suicide depiction. The series’ representations of sexual assault and bullying may trigger emotional reactions among viewers, and some teens may take away a disturbing message that presents suicide as an acceptable option to deal with their problems.
If you are concerned that teens in your community are watching 13 Reasons Why, the most important thing you can do is to watch it as well. Ask your teens what they know about the show and then discuss it together to help them safely process the difficult topics and images presented. Now is a good time to have these conversations with your teen, as a second season is to be released soon. The American Foundation for Suicide Prevention has created tips to help guide your conversations about the series, available here: afsp.org/wp-content/uploads/2017/05/TipsForParents_2017.pdf.
I worry that there is a stigma associated with discussing mental health issues that is preventing my teen from opening up with me about the support he may need. How can we work to break through this?
It is true that there is a societal stigma around mental illness, among teens and parents alike. The best way for us to decrease this stigma is by talking openly about mental health issues. With your teen, approach this one conversation at a time. The more we talk about mental health, the easier it gets for teenagers to be attuned to it as they go about their lives.
The stigma surrounding mental health can be even more difficult to break through because of certain cultural barriers, particularly among immigrant families. The Stanford Department of Psychiatry and Behavioral Sciences produced a series of educational videos available on YouTube to help Asian-American families understand the challenges faced by both parents and their adolescents and the impact of cultural expectations about success and mental health. Watch the videos for advice on how to approach conversations about mental health with your own teens: youtube.com/watch?v=8kdC7KulnoA&t.
Stanford’s 2018 Adolescent Mental Wellness Conference, Overcoming Cultural Barriers to Access, will focus heavily on this theme. See the sidebar below and learn more at adolescentConference.stanfordchildrens.org.
I am concerned that substance abuse issues among teens will increase with the recent legalization of marijuana in California. What should I do as a parent to educate my teen about the potential dangers?
Chances are your teen is hearing about the legalization of marijuana in the media and among peers. As a parent, the best thing you can do is to keep the conversation going. Look for everyday opportunities to discuss it, perhaps when you drive past an advertisement or a dispensary. Start by asking open-ended questions without judgment, such as “What do you think about that ad? How do you feel about legalization?” Include the topic of marijuana in talks you may already be having about teen drinking. You can also ask your school district and school board what they are doing to combat the dangers of drug use among teens. There are several effective school-based programs, including the New Leaf Curriculum, that may benefit your teen’s school if they have not already implemented one. nltc.com/wp-content/themes/newleaf/images/New_Leaf_Curriculum.pdf.
Shashank V. Joshi is director of training in child and adolescent psychiatry at Lucile Packard Children’s Hospital Stanford and an associate professor at Stanford University School of Medicine. Advice is not intended to take the place of an exam or diagnosis by a physician.
Families welcome at Stanford’s Teen Mental Health Convention
Stanford’s 2018 teen mental wellness conference hopes to break down the cultural barriers to mental health for youth.
Parents, teens, teachers, counselors and clinicians are invited to the conference April 27 to 28 at the Santa Clara Convention Center with the aim of sharing strategies for overcoming the roadblocks to mental health care for specific demographic groups and for youth as a whole.
Sessions include “When to Worry: Typical Teen Behavior Versus Signs of Mental Distress,” “My Parents Don’t Get It,” “Supporting the Mental Health Needs of Diverse Communities,” “Working with Gender Expansive Youth,” and more. Topics range from suicide and drug abuse prevention, to digital safety to the use of art and faith toward mental wellness.    
The event features mental health experts from around the country as well as from conference hosts, The Lucile Packard Children’s Hospital Stanford and the Stanford Department of Psychiatry’s Center for Youth Mental Health and Wellbeing, and from the event sponsor, El Camino Hospital.
The fee is $100 per day, $25 for students and youth age 25 and under. Scholarships are available. The convention center is at 5001 Great America Parkway, Santa Clara. More information is at adolescentConference.stanfordchildrens.org.
Mental Health Resources for Youth
If your teen is struggling, you can get support from the following sources:
School and student partnerships:

  • Sources of Strength, an evidence-supported peer-to-peer wellness and suicide prevention program between students and mentoring adults in local schools. sourcesofstrength.org.
  • School Counselors and on-campus wellness centers. Stanford Children’s Health has partnered with schools throughout the Bay Area to provide consultation to school staff and leaders and/or direct clinical services to students. Students and parents can reach out to their guidance counselor or drop in to the Wellness Center during school hours for immediate support or referral to appropriate care.
  • For K to 8 students in East Palo Alto, Stanford Children’s Health and the Sonima Foundation are providing stress reduction through yoga and mindfulness in the Ravenswood City School District.

Community partnerships:

  • Project Safety Net provides a hub of information, resources and education for anyone in the Bay Area needing mental health support. psnpaloalto.com.
  • The Healthcare Alliance in Response to Adolescent Depression (HEARD Alliance) includes a vetted and searchable directory of area mental health care providers, a prevention toolkit and list of local resources. heardalliance.org.
  • The Stanford Center for Youth Mental Health and Wellbeing includes early mental health support and clinical care, educational and community partnerships and a mental health technology program. med.stanford.edu/psychiatry/special-initiatives/youthwellbeing.html.

Clinical care:

  • Your child’s pediatrician is an excellent point of contact to inquire about mental health support. Once a diagnosis is provided, a treatment plan will be developed, tailored to the unique needs of your child and family.
  • If a young person’s mental health condition is life-threatening, the pediatric psychiatry team in the Stanford Health Care/Lucile Packard Children’s Hospital Emergency Department immediately evaluates, provides psycho education and triages young people to the appropriate care. stanfordchildrens.org/en/service/emergency-department.
  • Mental health assessment and treatment for children and teens is also available through clinics and care centers around the Bay Area. They include: Children’s Health Council. chconline.org; Sutter Health. sutterhealth.org; Bay Area Children’s Association. baca.rocks; and the ASPIRE program at El Camino Hospital. elcaminohospital.org/services/mental-health/specialty-programs/aspire.
  • Many county and community agencies accept Medi-Cal. Those who don’t have insurance can seek free health clinics at freeclinics.com/sta/california.
  • Participation in a child psychiatry research program is another way to access mental health care. To participate, sign up for Stanford’s Brain and Behavior Research Registry. med.stanford.edu/childpsychiatry/BrainandBehaviorRegistry.html.



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