High anxiety: What’s driving more teens to seek mental health care?

Two decades ago, when Jenny Britton, LICSW, director of child and family services for Washburn Center for Children, was getting started in her career as a mental health professional, she often felt she had to work undercover.

The teens she saw for common mental health concerns like depression and anxiety usually wanted to keep their relationship with her on the down-low.

“There was so much secrecy and shame,” Britton said. “The attitude from kids back then was, ‘I’m not going to talk to you. I don’t want you to come to my school. And I definitely I don’t want people to know you are my therapist when I see you in the hallway.’”

Today, things are completely different, she said. “Now, when I run into kids when they’re with their friends, most of them are just casual, like, ‘That’s my therapist.’ Of course I always maintain confidentiality, but there is so much less stigma around the relationship. They’re really comfortable letting people know that they’re getting help.”

That growing sense of openness around mental health care may be part of the reason more and more young people are seeking help for their own mental health concerns, Britton said.

“It is being spoken out loud so much more now. The shame and secrecy are so much less than they were in the past.”

And options are opening up, Britton added: “Kids have more language, more avenues for seeking help. We’re better at naming things. There are more people in our schools and communities that can identify and recognize what’s coming up for children.”

Still, the increased demand for mental health services for adolescents can’t simply be chalked up to a more open attitude. Britton and her colleagues think there’s something else going on.

“Is the world today a scary place? Yes,” she said. “Is there an uptake in adolescent mental health diagnoses? We’re absolutely seeing that.”

Some of that uptick may have to do with a keener approach to diagnosis, Britton theorized. “We couldn’t identify anxiety and depression as easily 20 years ago. We know that there were kids with unmet mental health needs back then, and we are better at identifying them now, but that doesn’t explain the numbers of kids with these diagnoses today.”

Washburn Center has responded to this growing need by making health services available to a larger number of families, Brittion said. But more could be done.

“The demand is still there. The needs are still there. Some young members of our community are still suffering because they can’t find help.”

The story is the same at Amherst H. Wilder Foundation in St. Paul. Gael Thompson, LICSW, Wilder’s clinical manager of child and adult outpatient programs, said that counselors at her nonprofit have their hands full managing a growing client base of young people and families seeking assistance for a variety of mental health conditions.

“In the last couple of years, we have seen an increase in the number of teens that are coming to see us,” Thompson said. Part of that increase may be credited to our culture’s growing comfort around issues of mental health, she allowed, but she also believes that there’s more behind the trend.

“I think it is a real thing,” Thompson said, “and it’s something that we’re working hard to address.”

Scary world

Melting ice caps. War. Mass shootings. Political upheaval. This is not an era for the faint of heart.

It’s no surprise that the young people growing up in this shaky world are experiencing record rates of anxiety and depression. Mental health practitioners who work with youth say their clients often cite real-world issues as a major cause for their ailments.

“The world is a scary place right now,” Thompson said. “It doesn’t feel very safe for most people, and I think teens are taking it particularly hard. They are burdened with so many stressors that people their age didn’t have to contend with in the past.”

While everyday teen angst, like worries about getting along with parents, starting high school, passing major exams and getting into a good college, remain a constant, new pressures exist today that most adults never had to contend with. Bullying in some form has always been an issue for young people, but internet-based bullying, with its international reach, can have a larger impact on a teenager’s mental health, Thompson said.

“Cyberbullying continues to be a huge issue. One of my colleagues said that several of her patients experience bullying on the internet — and then become suicidal. That is happening a lot.”

Round-the-clock media access only adds stress to a growing brain in a time that is naturally anxiety filled, Thompson explained. “I think that the teenage years are already so hard. I certainly remember mine. Everything felt huge, traumatic. Your hormones are kicking in and everything feels so big.”

Today, that naturally heightened sense of drama is compounded by nearly constant access to media. “Teens can see the scary things that are going on in real time,” Thompson said. “I don’t know how well anyone — let alone a teen — can feel prepared for that.”

Josephine Chung, Ph.D., spends a lot of time talking to teenagers and their parents about the everyday stresses of life. A developmental psychologist and parent coach, she works to help teens, parents and schools address problems with anxiety, change, sleep and academic performance. In this high-stress era, Chung’s business is booming.

“I do think there seems to be a rise in awareness about anxiety in teenagers and among our population in general,” she said. “Is that because young people are more willing to talk about their mental health today? Or is it truly that the prevalence of teen anxiety is on the rise? It’s hard to really know.”

What Chung does know is that research backs up what she’s seeing in her work.

“The National Institutes of Health is reporting that one in three adolescents in between the ages of 13 and 18 will experience anxiety disorder,” she said. “To me that’s pretty shocking.”

Chung acknowledges that many of her clients come from well-to-do families that emphasize achievement — in academics and activities. Still, in families of all economic classes, she sees this trend as a shift away from an earlier time, when parents expected kids to do their individual best, but not be better than anyone else.

“I do think that culturally there has been a shift around expectations and this pressure to succeed,” she said. “When I was growing up, it was assumed that if you pursued something you loved, you would likely be successful — but today the expectations around grades, being involved in multiple activities, the stakes for getting into what’s considered a good college, have sifted. It can veer out of control, and kids are paying for that with their mental health.”

Inter- or disconnected?

The internet is often listed as the top reason for the increase in mental illness among American teenagers. The constant comparisons to others, the lack of mental silence, the barrage of disturbing news that social media encourages is the perfect recipe for breeding insecurity and social anxiety.

Many of Chung’s teenage clients tell her that social media feels addicting, even though they can clearly see how it takes a toll on their sense of self-worth.

“I think social media plays a huge role in the way that young people are feeling about themselves and their social standing with their peers,” she said. “Teens are constantly connected. When your self-esteem and the way you view the world becomes connected with something that is not really rooted in reality and instead based on how many followers you have or how many likes you get, it is hard for them not to compare themselves to their peers.”

Teens, like all human beings, need social connections to thrive, but so many of the connections they make online are fictional and manipulated to show an ideal and unobtainable reality, Chung said.

“Those social media connections are not the same as meaningful human connections, and yet so many young people base their sense of self-worth upon their standing in social media.”

She says that her female clients are particularly vulnerable to the negative psychological impact of social media use.

“Many of my female clients have this love-hate relationship with social media. They know it is contributing to their stress and anxiety, but it is hard to resist that hit of dopamine they get when they open it up. It looks like everyone is having a great time, but I try to remind them that it is not the truth. It is the edited image that the individual poster is wanting to get out into the world.”

While Britton clearly acknowledges the dangers presented by social media use, she also sees the internet’s potential for building healing connections among young people who struggle with mental illness.

“Social media has epic downfalls when it comes to children and communities,” she said, “but being able to be connected to someone who feels the same way as you or is concerned about the same things is a positive element of all this media exposure that our children have today.”

When a celebrity — or an ordinary human being for that matter — goes online and speaks openly about their mental health struggles, Britton’s young clients say they feel inspired.

“A young person may find an author or a music artist or an actress that they look up to and see that they’ve been through a similar situation to what they’re experiencing,” she said. “It is important for us to know that we are not the only people who feel the same way as we do. There is a thing that happens in our brain and body when we hear about another person who really gets what we are feeling. For some teens, those connections are made online.”

Britton said that when she was growing up, the shame around talking to others about mental illness was so great that it only happened in times of extreme crisis. Though time spent online researching mental health concerns can seem isolating or disconnecting, in the best circumstances, young people can take what they learn on the internet and use that language to talk about it in real life with adults who are there to help them.

“Making the real-world connections is important,” Britton said, “and in theory, anyway, the internet can speed that up, making the time from private concern to public action that much shorter.”

Mental health is all about connection, Chung believes. And while she knows that she can’t take social media out of her young clients’ hands, she hopes that by working closely with them and their families, she will be able to help strengthen and re-build ties that have been severed by social media. It requires parents to make changes in their own lives.

“What teens seek is real connection with the people who love them and whom they love, Chung said. “Our lives are so busy that oftentimes we miss those moments.” If parents can turn off their own devices and return to some of the basic elements of human connection, “of just communicating to teens that they will be there no matter what, it makes such a great difference for the mental health of any young person.”

Helping strategies

In response to the demand for adolescent mental health services, mental health professionals are working to increase their services.

Wilder, for instance, has placed therapists in 24 St. Paul public schools, Thompson said. Similar initiatives are happening statewide. The idea is that if mental health services are available in a place the spend the majority of their days, more kids will seek them out.

“It is really easy for kids to access this resource when it is right there at their school,” Thompson said.

Families play an important role in this initiative, she added. School administrators have been advised to let parents know that the counselors are available to their children. This is an important step, because even though the larger culture may be shifting toward greater acceptance of mental health care, many immigrant communities still view this sort of treatment with distrust.

“I think that parents should realize that there’s help out there,” Thompson said. “It is never too early or too late to ask for help. Asking for help is a sign of strength. It is not about being weak.”

At Washburn center, Britton said that many therapists emphasize to their young clients the power of open acknowledgment of their mental health diagnoses.

“There is this idea called, ‘Name it to tame it,’” she explained. “If we can name what is bothering us, like, ‘I’m experiencing this thing in my body,’ or, ‘I’m experiencing this thing emotionally,’ being able to sift through what is happening is the fundamental part of growth and healing.”

That sifting often takes the form of conversations with a trained and objective adult.

“Research says that if kids have one other person who is not their parent or caregiver who can see and understand them as an individual, that their biggest resilience factor,” Britton said. “Parents and caregivers are important, but being able to be understood by another adult is transformative, even beautiful. A teen should have someone they can say something to like, “I need to be check out this thing that happened with my mom. Should I be mad at her or not? How can I share my feelings with her?’”

In her one-on-one sessions with clients, and in her group mindfulness-based stress-reduction seminars for teens, Chung often plays the role as the objective observer. She teaches her young clients the basic concepts of meditation, mindful breathing and non-judgmental self-compassion — and encourages them to build these skills into their own lives.

“I take an integrative approach that looks at lifestyle changes, everything from mindful moments, having it accessible in way that they don’t have to sit in a 30-minute meditation trying to achieve a quiet mind,” she said. “It is thinking, ‘How can I be present in this moment, pay attention, be focused on my breath so I’m not having intrusive thoughts about the past or fast forwarding to the future.”

Chung also encourages teens to keep a “gratitude journal.” She explains that each night, right before going to sleep, they should write down three things — big or small — that they are thankful for.

“They all leave my office with a journal,” Chung said. “I ask them to keep it by their bed so it’s the last thing they’re thinking about as they go to sleep. That way, when they are closing their eyes, they can make the shift toward gratitude and engaging in mindful breathing.”

‘Wind-down’ rituals

Many teens complain of stress-related sleep disturbances. Chung’s approach harkens back to the nighttime “wind-down” rituals of early childhood.

A teen wind-down starts with a shutdown of electronic devices. “Disengage with the phone an hour prior to bedtime,” Chung said. “Leave it out of the bedroom and charging downstairs.”

Though picture books and lullabies are a thing of the past, teens and their parents and caregivers can extend the nighttime ritual with simple stress-busting routines, Chung said. “Maybe it’s sitting with Mom or Dad and having a nice cup of tea and decompressing, letting go of the day. What you are doing is telling your body it is time to let down, time to go to sleep.”

Sometimes, when her pre-teen daughter is feeling particularly stressed, Chung admits to turning on Pachelbel’s Canon, a tune she played to lull her to sleep when she was an infant.

“Within a minute, she’s out, because her body is conditioned to respond in a way that she just lets go and relaxes,” Chung laughed. “Pavlov was brilliant.”

Using techniques like that might not work for most teens, but any loving connection a family can make is important in building a young person’s sense of security and mental health, Britton said.

“Fundamentally I think there’s been a shift in the depth and breadth of understanding that mental health is for everyone. I think how that plays out for teens today is through more exposure to people sharing their stories, and being connected through those stories. One of the biggest places of healing and growth is in connection and relationships, especially relationships with family. That’s where so many young people get their mental health support.”