Newspapers and social media feeds are full of stories about the current mental health crisis, especially how it is affecting children and youth. Parents and caregivers may want to talk to their children about mental health, but are unsure about how to broach the topic.
Yesenia Marroquin, PhD, a clinical psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia, offers these tips.
When to take immediate action
First a note: If your child expresses suicidality, intense depression symptoms or other severe mental health concerns, it’s important to reach out to the child’s primary care provider or, if they have one established, the child’s mental health team. Those are the people to turn to when there are immediate concerns.
If the young person is actively suicidal or is in danger of injuring themselves or those around them, and is not able to stay safely at home, it’s important to seek out crisis emergency services. Alternatively, if their current mental health team has a plan in place to address these concerns, follow the plan.
Talking about mental health won’t trigger an issue
Some parents may think that if they talk about a mental or behavioral health problem — like depression, anxiety, suicidality or impulsive behaviors — it will somehow result in their child developing these symptoms. In reality, opening up parent-child communication around mental health has several positive factors:
- It can reduce the fear of experiencing mental health symptoms.
- It can reduce the stigma of seeking care for mental health.
- It is a step toward transparency, helping your child feel more comfortable raising any concerns they may have about their own mental health or that of a friend.
When we refuse to talk about mental health, the young person will keep their concerns to themselves, and things may get worse before they seek help. Without treatment, a smaller problem could grow into a bigger one that is more difficult to address.
Consider your own judgments
Parents should think about how they talk about other people — a neighbor, a family member, a friend — who had or are currently experiencing a mental health challenge. Take a step back to consider: Are you communicating any judgment? Have you said how the person with mental health challenges is “hurting” their family or is “crazy” (or another derogatory term)?
A more helpful model would be to be sympathetic, while not going into details that could invade the person’s privacy. You could say, “I’m so glad that this person is getting help” or “Just like people get physically sick, sometimes they have a mental health condition.”
It’s possible that when you begin to talk about mental health generally, your child or teen may open up about their own challenges or those of their friends. It’s important for parents to be an effective sponge at first. Listen without judgment.
Let the young person steer the conversion, not the parent. If your child is sharing their own difficulties, parents or caregivers will want to avoid any blaming statements or feedback that damages the flow of conversation. Avoid statements such as, “How could you do this to me?” or “How could you feel this way when [a religious figure] loves you so much?”
If the child seems hesitant to talk, parents can ask open-ended questions that encourage the child to open up, such as, “How long have you been feeling this way? Or “Can you tell me more about the things you’re worried/anxious about?” Assure them that you’re ready to listen, which means turning off your cell phone or pausing work — or even going for a drive or a walk — so you’re truly available.
Give the young person the opportunity to finish their thoughts and resist the urge to problem-solve. Instead, fully recognize and validate the emotion that the kid is expressing. A parent could say, “Would you like me to just listen? Or could I share some ideas I have?” That gives the child a choice.
Sometimes, out of defensiveness or their own distress, parents or caregivers may not “get it” and may even say to their child, “What are you talking about? You’re not unhappy/anxious/compulsive.”
Trust that if your kid is telling you that you don’t get it, you don’t. Don’t try to convince them that you do understand. Return to active listening, setting it up by saying, “Right now, you’re experiencing that I’m not getting it. I’ll just listen to give you the space to make your point. Perhaps that will help me understand.”
If your child has shared about their own challenges, offer them the opportunity to talk to a mental health professional, therapist or counselor. “I’m always here to listen; but if you want more input, we can find a counselor for you to talk to.”
The reality is the need for mental healthcare for young people is greater than the current capacity to help. Call your primary care provider as they may have resources that can bring a measure of relief sooner. Also, ask the PCP and your health insurance company for referrals and get on the waiting list for mental health providers in your community.
In the meantime, to gain insight into the depth of the problem, rely on what you already know. As parents and caregivers, you know your child’s patterns of behavior, such as how they are on a good day or a tough day. Clues to observe include: Are they withdrawing more? Are they declining invitations they used to accept or backing out of commitments? Are they more/less hungry? What are their sleep patterns like? How frequent are these behaviors? This type of information can be helpful for a mental health provider to better understand your child.
You can also model ways to ask for help that is honest and nonjudgmental. Communicate compassion for yourself and for other people, even naming the emotions that you’re having. You could say, “I’m so grateful that you brought this up to me. If I seem sad, it’s because you are one of the most important people in my life, and I see that you are hurting. I’m so sorry that you’ve had to go through this on your own until now. We’ll be able to figure this out together. We’re on the same team.”
It can also be helpful to engaging in activities as a family in the interim. It could be some sort of physical activity, a game night or going to the movies. Considering connecting with others in the community through volunteering as a family. All these activities can help combat isolation and loneliness, which are important risk factors.
It’s best to refrain from comparisons; instead talk about common situations, along the lines of: “There are people who have gone through this and there are ways to solve it.” You would not want to say: “So-and-so had this treatment, but it doesn’t sound like you have it as bad.”
Unless your child asks, don’t compare your own mental health journey with that of the child’s. If they do ask if you’ve ever been depressed, for example, or how you handle anxiety, you should note that everyone reacts differently, but you could share strategies that worked for you. You could say, “This was really helpful for me at your age when I was having a rough time.”
Also, try to refrain from interpreting or determining the “cause” of your child’s feelings. Thinking that “they are like this because they broke up with their significant other” or “her friends are making her act like this” isn’t helpful and could cloud the situation.
It’s OK to talk about another young person in the parent’s sphere — such as a co-worker’s child, for example — who experienced a mental health problem and is seeking help. However, speak in general terms: “I got off the phone with a friend, and I’m glad I was able to support her as her child is going through some tough situations. It’s important to reach out for support.”
Parents need to manage their own reactions
Parents may experience their own intense emotions when hearing about their child’s mental health challenges. Look for trusted friends or relatives who can support you as you help your child work through their difficulties. It’s a balancing act for parents to get the support they need while still preserving the young person’s privacy as much as possible. If the parent shares details of the child’s struggles with a family member and word gets back to the child, that could damage the trust between the parent and child.
If it’s a trusted person, it’s helpful to frame it as, “My child just talked to me about challenges they’re going through. I need to get what I’m feeling and thinking off my chest.” Keep the discussion about emotions that are coming up for yourself, whether it’s blame or distress about your own mental health experience. Focus on how what was discussed is impacting you as the parent, not all the details of what the young person shared.
If the young person has expressed suicidality or talked about plans to hurt themselves, it’s important for the parent or caregiver to remember that their child may have gone to that place because they want to solve the problem of emotional despair and suffering. They may feel hopeless. They’re not making these statements because they want to cause their parent pain; they may actually believe that other people may be better off without them.
Parents should try to keep the focus on the child and not assume the child’s words are meant to hurt you. Dismiss the myth that suicidality is selfish. It’s not helpful to dwell on thoughts such as, “How can they do this to me? How can they hurt me so much?”
Primary care provider is your partner
Remember that your child’s primary care provider can help with mental health conditions just as they help with physical health conditions. Mental health is health.
More and more primary care providers have taken training in screening for and treating mental and behavioral concerns. They have strategies, resources and tools to help families facing common concerns as the first step toward relieving your child’s emotional distress.