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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Helping Adolescents Thrive at Home, at School and in the Community

September 26, 2018 | Suicide and Addiction | Comments
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Children are the living messages we send to a time we will not see. – Neil Postman

My friend and colleague, Harold Koplewicz, M.D., founding president of the Child Mind Institute, doesn’t mince words.

“Mental disorders in children and teens are real, common and treatable, and it’s dangerous to ignore them,” he told me. We recently spoke to Harold and to Michael Birnbaum, M.D., director of the Early Treatment Program at Northwell Health, about adolescent mental health.

Harold noted that we will lose 5,000 young people ages 14 to 24 to suicide this year, and 600,000 more will end up in emergency departments after a suicide attempt – that’s more than one suicide attempt every minute. Nine in 10 of these young people have a psychiatric disorder.

The developing brain is susceptible to both positive and negative influences, making adolescence a risky time of life. One in five teens and young adults lives with a mental health condition. Half of them develop the condition by age 14 and three-quarters by age 24. Mental illnesses disrupt the normal developmental milestones related to school, work and relationships, Michael pointed out. 

I’m here to sound the alarm that we can’t ignore the mental health of our young people, but I’m also here to offer some commonsense solutions that we can begin implementing today. We haven’t a moment to lose.

Involve Parents

Adolescent angst is real, so it can sometimes be difficult to differentiate between a “stage” and real mental health problems. Parents are the first line of defense. You don’t have to be an expert on mental health problems to be an expert on your own child. “Any significant changes in behavior that last longer than two weeks should raise a red flag,” Harold said. Perhaps your son or daughter is eating or sleeping more, having trouble concentrating or is isolating themselves from their friends. The key, Michael told me, is for parents to have “honest, open and regular communication” with their teens. Because some young people may not be comfortable discussing their struggles, it’s up to us to notice. That’s the impetus behind our #SaidNoTeenEver public service campaign

Intervene Early

Early intervention reaps rewards. The National Institute of Mental Health’s Recovery After an Initial Schizophrenia Episode (RAISE) project found evidence for the effectiveness of an intervention called Coordinated Specialty Care (CSC) for first-episode psychosis. CSC is a team-based, collaborative, recovery-oriented approach that emphasizes outreach, low-dosage medications, cognitive and behavioral skills training, case management and family psychoeducation.

Compared to usual community care, individuals served by CSC programs stay in treatment longer and experience greater improvements in their symptoms, interpersonal relationships and quality of life. They are more involved in work or school, and CSC is cost-effective. That’s a win-win! Though CSC is specific to schizophrenia, its underlying principles are broadly applicable, Michael pointed out.

Engage Teens

Teens are chatting, talking and texting about mental health in record numbers, but few receive evidence-based treatments for their mental health problems. Perhaps the most important thing we can do is engage teens themselves, and there are a number of ways to do so.

First, we can make effective use of technology, including social media. “Teens are so plugged in; this is where they live,” Michael said. “We have to meet them where they are.” Though excessive social media use has been linked to increases in anxiety and depression among teens, positive messages like those in the Child Mind Institute’s #MyYoungerSelf campaign can help teens emerge with a more positive attitude about their potential and about asking for help. While face-to-face treatment is always the goal, Michael noted, teens may be more comfortable texting or videoconferencing with a provider at first, and that’s an important entrée into care. Used judiciously, he believes, “technology can help us identify mental health problems, engage patients and improve the delivery of care.”

Second, we can educate teens about the science of mental health, including information about the developing brain. Recently, New York and Virginia became the first two states in the nation requiring mental health education in schools. But education doesn’t have to be formal. The Child Mind Institute publishes a series of conversation starters for talking to teens about the brain, behavior and risk.

Third, we can help understand what’s important to teens and how they make decisions to help activate their own motivation to engage in treatment. Shared decision-making and motivational interviewing are two interventions that can help teens take a more active role in decisions concerning their care. Both help teens focus on their goals and their expectations for treatment. Motivational interviewing has proved to be effective in teens with anxiety and depression, as well as substance use.

Mobilize Communities

Teens interact with a host of social programs, including community libraries and recreation centers, Boys & Girls Clubs, Boy Scouts, Girl Scouts and others. Around the country, these and similar programs are helping young people grow up healthy in healthy communities. Now the National Council wants to take these efforts to scale.

Recently, we announced a two-year learning opportunity to reduce the impact of anxiety, depression and suicide among underserved youth ages 10 to 24. The goal is to create better supports for young people experiencing mental health challenges, while also empowering youth to engage in meaningful community change. And we are looking for you to join us. You can get connected to coaches, mentors and subject matter experts who can help you adopt and sustain leading-edge mental health supports in your organization. You needn’t be a mental health agency or National Council member to participate. Visit the Youth Mental Health Call for Applications to learn more.

Create Positive Relationships

The common thread in working with adolescents is the need to create positive relationships between teens, their families, the providers and organizations that serve them and their communities. And all it takes is one person to reach out and extend a helping hand. That’s what Mental Health First Aid is all about.

Mental Health First Aid for Youth teaches people who interact with teens how to recognize the signs of a mental health or addiction crisis, initiate a conversation and connect young people to professional help and community resources. Everyone can #BetheDifference for someone who is struggling with a mental health or substance use problem if they know what to say and what to do.

The mental health of our young people is too precious to squander. We need to understand the signs of distress, engage youth in treatment and replicate best practices. Let’s start today!

What is your organization doing about adolescent mental health? Respond to this post or write to me at I read every message!