How To Talk — And Listen — To A Teen With Mental Health Struggles

"It just is really sad to see what was supposed to be the best years of your life, like, go down the tubes."

That's how E., a 16-year-old who lives in Alexandria, Va., described her state of mind right now. E. is among many teenagers who have struggled during the pandemic with the loss of routines and milestones. (We're not using her name to protect her privacy.) When school went remote last spring, she started staying up late into the night. Once a cross-country runner, she became less physically active. Her grades slipped from A's and B's to F's. She lost friendships and felt lonely. She compared living with her mother to being "in solitary confinement."

Not sleeping, failing classes, and expressing severe pain and turmoil — these are all what Dr. Khadijah Booth Watkins, a psychiatrist and associate director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, calls a "loss of function." They could be indicators of a serious mental health problem.

There's not much solid data on this, but some clinicians, like Dr. Booth Watkins and Elisa Nebolsine, a cognitive behavioral therapist in Falls Church, Va., say that the levels of distress, including suicidality, in their adolescent patients is among the highest they've seen in their careers. Nebolsine says that's because the pandemic is making it hard for teenagers to meet basic developmental needs. "I mean, their brain is wired for new experiences, for new learning, for social connection, for romantic connection, for status and hierarchy and all these different developmental tasks that they are not getting access to."

If you are worried about a teenager you care about, here's how to start the conversation and when to get professional help.

Spot the red flags

Beyond loss of function, which could include sudden and severe changes in eating, sleeping, or even basic hygiene, red flags could include language about wanting to hurt yourself or not wanting to be around anymore. (If you have any questions about talking to a young person who may be suicidal, our mental health reporter Rhitu Chatterjee did a whole article about that.)

Nebolsine, the therapist in Falls Church, Va., adds that depression manifests itself in talk that is PPP — personal, pervasive and permanent. Personal, meaning they're internalizing whatever's going wrong and experiencing it as a personal flaw. Pervasive, meaning the bad feelings cross many areas of their lives from school to socializing. And permanent, like E., who told us, "Everything is hard because there's no end to it."

Validating and modeling

"The biggest tool in the toolbox of a parent is being able to model," says Dr. Booth Watkins. "So being able to model resilience, being able to model self-compassion, being able to model mindfulness." Of course, this means parents need their own support system and self-care practices in place if they want to help their children thrive.

Modeling self-compassion includes what Dr. Booth Watkins calls "the best friend test." "Would you tell your best friend, 'that was stupid'?" Probably not, she says, and we should ask our teens not to talk to themselves that way either.

Modeling resilience doesn't mean belittling or downplaying our children's concerns. Dr. Booth Watkins says we need to validate and empathize with their feelings about missing a birthday party or a baseball season, even if it seems small in the grand scheme of things. Only then can you move to trying to creatively problem-solve with them.

Getting help

After having one of these conversations, you might want to seek out help from a professional. Teletherapy has made therapy more accessible during the pandemic. Here are some resources and ideas:

• Google for "sliding scale therapy" in your location to find clinicians who accept lower fees based on patients' income.
• Check with a local graduate school to see if they have student therapists available. Check in with your teen's school for resources.
• Open Path Collective is a nonprofit committed to affordable therapy
• Teencounseling.com is an online platform for teens created by the company BetterHelp. (BetterHelp is an NPR sponsor. A full list of NPR podcast sponsors is available here.)

With help from a therapist and medication, E. pulled her grades up from F's to C's. And she was excited to return to school in person this month.

The podcast version of this episode was produced by Audrey Nguyen.

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