Ask Dr. Christine: Youth Mental Health

How do I start the conversation about mental health with my child?

We all know that parenting can be challenging, especially when we need to have conversations with our children that could be uncomfortable. However, as parents, we must find opportunities to lean into conversations about mental health, no matter how uncomfortable those conversations may be.

Prior to initiating a discussion, it is important for you to reflect on your own childhood experiences with your family. This is particularly important for those raised in families in which talking about mental health was taboo or frowned upon; reflect on how that environment made you feel. Use this reflection to modify your approach or avoid any potential pitfalls that could have negative consequences for your child. When it comes to parenting, we often do what we’re familiar with (based on our childhood experiences) so use this conversation as an attempt to reshape the narrative around how mental health is discussed within your family.

Once you’re ready to have the conversation:

Start off by modeling an approach for discussing mental health, which will help to normalize the discussion. It will also give your child permission to be open and vulnerable with you. One way to do this is by sharing your feelings and strategies that you use to cope. Share what it is that you have been experiencing. For example, you could say, “Daddy has been feeling really worried and scared lately about things, and I’ve been spending more time at the gym to feel better. How have you been feeling these days? What are things that you do to help you feel better?” Starting with an open-ended question will allow for your child to share more freely.

Asking your child how they have been feeling and how they cope will provide an opportunity for you to learn about strategies your child uses to manage intense emotions. Inquire about where they learned some of those strategies: was it from social media, school or from their friends? That way you can assess if they have reliable sources of mental health information. Learning this information from your child can also help provide you some insight on how you can best support them when they are experiencing mental health symptoms.

Make sure to communicate that you are a safe person for them to talk to about their mental health. Avoid jumping to conclusions, making assumptions or minimizing your child’s experiences. Be open and willing to listen — set the stage for the conversation and let your child take the lead.

How do I know if my child needs help?

As parents, we often feel like we know our children best. However, it can often come as a surprise to many parents when they learn that their child is experiencing a mental health issue, especially when the parent happens to find out from someone other than their child. Questions often arise from parents such as, “How could I have missed this? Everything seemed ok,” which is why it is helpful to know some of the warning signs that your child may need some additional support.

While determining whether your child needs help, assess their overall level of functioning. Are they able to go to school and keep up with all the academic demands? Do they get along with their peers and family members without significant difficulty? Have there been any changes to their sleep patterns, appetite and mood that have lasted multiple, consecutive days? If you notice that their mood and behavior are interfering with their ability to function academically and socially, then that is a sign that your child would benefit from some help.

What is the best approach to checking in with my child about their mental health?

Checking in with your child is a critical step to ensure that there are open lines of communication about their mental health. It could be helpful to establish a common language around your mental health check ins and to embed that into your routine as a family. For example, while sitting at the dinner table, you can have “check-in time” or start the “feelings chat.” It’s essential that all members of the family share in order to model the importance of the discussion.

It is also ok to check in with your child outside of the usual routine times for such a discussion. It is important to lead with what behaviors you are noticing rather than jumping in and making assumptions about why they are behaving a certain way. State that you are curious about some changes in their behavior and ask them what they believe is behind some of those changes. This approach of coming from a place of curiosity should increase the likelihood that your child may feel more willing to disclose their true emotional state.

What is the first step in getting my child help?

Once you have identified that your child has a mental health issue and needs further support, you’ll need to communicate your concerns and assess if your child has the same level of concern. This will hopefully generate an opportunity to ask them what their thoughts are about how best to move forward. Also, ask how they feel about speaking to a stranger about their symptoms. This will allow them to share worries or fears they may have about receiving mental health treatment, so you can address those concerns prior to speaking with a mental health professional.

If your child is resistant to getting help, validate their concerns and let them know that it is ok to feel scared. I recommend that parents reach out to their child’s pediatrician as a first step. The pediatrician has a longstanding relationship with your child, and hearing from a trusted professional can help your child understand why mental health treatment would be beneficial. Additionally, a pediatrician can provide medication if needed, and they can point you in the right direction to establishing care with a therapist or psychiatrist.
 

Christine Crawford, M.D., MPH, is the Associate Medical Director at NAMI.

Note: This article was originally published in the Spring 2022 issue of Advocate