An adapted excerpt from Behind Closed Doors: A Guide to Help Parents and Teens Navigate Through Life’s Toughest Issues

Worry clouded a mother’s eyes in an exam room with her eight-year-old daughter. Noticeably small in stature, this frail girl with wide blue eyes climbed quietly onto her mother’s lap. Her over-sized, cheerfully perched hair bow created a stark contrast to her somber expression. The family experienced a significant health scare when this cherub was diagnosed with severe immune defi-ciency before her first birthday. A long procession of specialist visits, hospital stays, painful tests, scary nights of high fevers, and many tears overshadowed her first seven years of life before get-ting the good news that she was one of the few who were fortu-nate to outgrow her condition. Her family was guardedly optimis-tic about reentry into a seminormal life after living through years of restrictions.That’s why, this Christmas, the little girl was beyond excited to go to a birthday party at an American Girl store. With eager anticipation, she wore a festive party dress, shiny patent leather shoes, and her trademark impossibly large hair bow. In the middle of the party, as the little girl presented her gift, she started having trouble breathing and it rapidly worsened. Her mother panicked and gave her an asthma rescue inhaler. It helped a little but not enough. A devastated little girl and a horrified mother abruptly left the party to speed to their pediatrician. When they got there, she looked fine. They scratched their heads, worrying about any sign that the immune deficiency was returning. It took years to diagnose. It was . . . anxiety?

The thing you don’t know is this serious little girl is my little girl, and the worried mother is me. Yes, I’m an expert and seasoned pediatric nurse practitioner. But parents, can we agree it’s difficult to be objective with our own kids? Our emotional investment clouds rational thought and we fall into the “you don’t understand, this is my baby” mentality. We intensely fear fatal injuries or debilitating diseases such as cancer. We don’t fear things like depression or anxiety because those seem less scary and, frankly, something we think we can control. It took me two years to realize my daughter was having panic attacks. When we find out it’s not something “serious,” our natural reaction is to feel relieved. When we hear “anxiety,” we think, “Oh, is that all?” There’s often a mixture of doubt and, if we’re honest, annoyance. Our secret inner monologue says, “Is this real? For attention?” We want a rapid anxiety test like a rapid strep test. Then we want a quick fix, like the “pink stuff”!

Today’s teens are experiencing the compounding mental health effects of social isolation, social media, social justice, and social stigma. Even before COVID-19, eight million children had a recognized mental health disorder. One in three high school students felt sad and hopeless most of the time, a 40 percent increase from the previous decade. Only about half of children diagnosed with a mental health condition actually receive treatment. Mental health crises among teens are skyrocketing with increasing emergency room visits for self-harm and suicidal behaviors, prompting an advisory from the US surgeon general. Teens with untreated mental health conditions are more likely to engage in risk-taking behaviors including unhealthy sexual activity, alcohol consumption, drug use, and acts of violence.

When considering your teen’s mental health, it’s important to have an open mind. If your teen voices feelings of anxiety or depression, stop what you’re doing. Listen carefully and respectfully. Resist the urge to be dismissive. Normalize these feelings as indications to see a healthcare provider just as you would if your teen reported a sore throat or fever. Some parents are resistant the moment someone suggests the issue might be related to mental health. They’re even offended. I’ve seen this more times than I can count. Many symptoms of anxiety and depression masquerade as tummy troubles. Families sometimes go down an avoidable road of expensive and invasive testing when a balanced perspective also considers mental health. If your provider suggests this possibility, be open.

If your teen’s ability to daily function and engage in activities they normally love is impaired, you should be concerned. Schedule an appointment with your healthcare provider to discuss further assessment and interventions. In this age of internet searches and information superhighways, it’s tempting to self-diagnose or arm-chair quarterback treatment. Frankly, it’s dangerous. If you identify mental health concerns, seek consultation from a trained health professional. Your teen needs to know you’re their advocate working to connect them to the help they need.

Martin Luther King Jr. said, “You don’t have to see the whole staircase, just take the first step.” Many parents have an intense fear of voicing any symptoms of mental health concerns, thinking such a diagnosis will lead to immediate pressure to take medication. That’s not how this should happen. In actuality, the gold standard for treatment of depression and anxiety (the most common teen mental health conditions) is cognitive behavioral therapy (a way to retrain your brain to think differently) and counseling. Evaluation should take a stepwise approach. If your teen has symptoms, your provider will do the following:

Ensure there is no safety threat to self or others
Carefully rule out physical problems
Consider questionnaires to identify mental health concerns
Determine if labs or other tests should be ordered
Decide if the issue can be handled in primary care or if a specialist is needed
Discuss treatment options

For concerns about depression during a healthcare visit, you can expect a behavior rating scale (questionnaire) like the Patient Health Questionnaire-9 (PHQ-9). This is a simple nine-question screening tool about things such as sleeping, eating, or feeling down or hopeless. Scores are ranked from minimal to severe and guide your teen’s care. The General Anxiety Disorder-7 (GAD-7) helps gauge the presence and severity of anxiety symptoms. It asks questions about how often your teen feels restless or irritable. These tools are easily found with an internet search. Taking them at home, however, should never substitute for a professional medical evaluation, but it can help you to know what to expect.

Take every opportunity to increase your comfort in talking about mental health. Conveying to a teen their struggle is a secret conveys shame and builds anxiety. Stigma prevents teens from reaching out and creates reluctance to seek help. Know the facts about mental health disorders and recognize the biological basis as opposed to behavioral choices. Choose your words carefully. Avoid labeling people or using mental health terms casually. People often say things without thinking: “What are you, crazy?” “You’re psychotic.” “Schizo!” (People are not schizophrenic but rather people living with schizophrenia.) The way we lead in our speech influences the attitudes of others. Challenge stereotypes when you hear them. Treat others with dignity and respect. Choose to empower your teen to be confident about any diagnosis they may have, knowing they’re equipped to learn more about their condition and access resources without harboring self-stigma.

Seek counseling or care for yourself if you’re struggling personally or struggling to accept your teen’s mental health condition. Lastly, never see your child’s mental health through the lens of your parenting success or failure. That’s a dangerous trap.

Parents, teens desperately need you to initiate these conversations with confidence and grace while sparing their dignity. A good opening to a conversation is to watch a movie with mental health themes together (A Beautiful Mind, Inside Out, Dear Evan Hansen). Research celebrities who are outspoken about their own mental health struggles. (Chris Evans, Lil Wayne’s conversation with Emmanuel Acho, Kevin Love, Brooke Shields, J. K. Rowling, Dansby Swanson, Demi Levato, Lady Gaga, Olivia Munn, and Sophie Turner—for starters.) Every family is different and has different views on these individuals. Some of you may have an intense aversion to celebrity culture. That’s okay! Many will be well known to your teen and exploring this together can give you opportunities to influence your teen’s views.

Three Questions for Teens:

On a scale of one to ten, with one being terrible and ten being terrific, how would you rate your mental health? What made you choose that number?
Can you describe a time you’ve been concerned about your mental health or the mental health of a friend or family member? How did that make you feel?
What can I do to support your mental health?

Three Questions for Parents:

In the secret spaces of your heart, what are your true feelings about people with mental health conditions?
What language, words, phrases, or attitudes do you use that may be harmful to people with mental health struggles?
How can you make your home a safe space for respectfully discussing issues related to mental health?

You might have a short conversation with your teen or it might open a floodgate you didn’t know existed. Rest assured even if the conversation was ho-hum, your teen is now better prepared to act in the future. Maybe this was a difficult subject to discuss because you or a family member has a diagnosis previously undisclosed to your teen and it brought up difficult emotions. If you’ve never sought help for yourself but are wondering if maybe you should, the answer is unequivocally yes. Reach out to someone who loves you and take steps to seek professional resources.

The good news is that Gen Z teens are ready and willing to have conversation around mental health in a way no previous generation has been willing to engage. In our generation as parents, Mr. Rogers said:

Anything that’s human is mentionable, and anything that’s mentionable is manageable. When we talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.

Taken from Behind Closed Doors by Jessica L. Peck. Copyright 2022 by Jessica L. Peck. Used by permission of Thomas Nelson Publishing. www.harpercollinschristian.com

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