What are some of the most serious mental health challenges facing our young people today? And how can we create the support that they really need?

On this episode of School’s In, hosts Dan Schwartz and Denise Pope welcome Dr. Steven Adelsheim, clinical professor of psychiatry and behavioral sciences at Stanford School of Medicine, as they discuss how the pandemic affected students’ mental health. Steven works on several facets of youth mental health, including:

• What’s behind rising rates of anxiety, depression, other mental health issues
• The development of statewide mental health systems, including those focused on schools
• Early detection and intervention programs for young people both in school and in primary care
• Supporting community behavioral health partnerships locally and at scale

Clinical Professor Steven Adelsheim is a child/adolescent and adult psychiatrist and the director of the Stanford Center for Youth Mental Health and Wellbeing in the Department of Psychiatry. His work focuses on early mental health intervention for young people, integrated health care models and decreasing stigma surrounding mental health issues. To learn more about his research, visit his faculty profile.

If you or someone you know is struggling with their emotional health, the National Institute of Mental Health lists resources on their webpage.

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Presented by Stanford Graduate School of Education (GSE), School’s In is hosted by GSE Dean Dan Schwartz and Senior Lecturer Denise Pope. 

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So a peer specialist is like a 15-year-old, like a kid?

No, no. The peer specialists that are there, generally people with lived experience who are employed and work there. But at the same time, one of the things that's interesting Denise, as you say, is that we're finding that actually many of our youth advisors, as they're progressing through their maybe year or two of leadership training and development of the youth advisors, a number of them are actually taking jobs as peer support specialists in these different allcove settings. And we're seeing it become almost beginning of a behavioral health workforce in terms of seeing those roles happen.

Well, that's good because I know we are desperado for more people to go into this, right? We don't have the adults employed to cover the need of all the kids who need clinicians and therapists, right?

Absolutely. And one of the things that also has been happening is we see young people, and I would say the generation of youth, we have now quite a bit more comfortable talking about mental health issues. The stigma issues are much less for them than for many of us in our generations. And so we're seeing a lot of peers interested in supporting each other as well. So we're seeing frankly at many of the high schools in California and in programs across the country, the development of peer-to-peer opportunities. And this is for that 15, 16, 17-year-old student you were talking about, to get skills to learn how to support themselves and support their friends and have those conversations. So we've also been working with a group of young people as well to develop a peer-to-peer curriculum so that youth can start then supporting other youth directly, allcove centers as potential places where then that training and support can also happen down the road.

Can I ask a slightly tangential question?

Sure.

So a couple years ago, I'm at a dinner and a very senior famous psychologist professor asked me about my feelings and I say, "I don't really like to talk about my feelings." Is this a generational shift? This sort of willingness to talk about one's mental contents?

I think there's more of an acknowledgement that all of us as human beings have these issues. I think culturally, we see a real difference. I think for young people from very diverse cultures, there was quite a bit of stigma and taboo in many cultural groups around talking outside of the immediate family about mental health challenges. And I think for many of our young people, there's more of a willingness to acknowledge it. We see it in our famous American athletes now breaking down that stigma. And for many others, it's becoming more comfortable just to acknowledge that this is part of our lives.

Just like any other medical condition, we have mental health conditions as well. And so I do think at least there's some more honesty about it. We will encourage parents to be more honest with their own kids about their own challenges, their own failures, their own struggles. So their parents don't often come across as sort of perfect beings that never had a problem in their lives. And then their kids thinking, well, what am I doing with all these issues? My parents are so perfect. So we're trying to build that intergenerational conversation, but it's the young people who were more comfortable with it, frankly right now.

Okay, a cynic... And I'm not a cynic, but a cynic might say, is this too much? Because now you've got kids who are sort of self diagnosing as depressed when they're not. Everything is now elevated. I'm having a mental health crisis. We see some reports saying maybe we're doing too much. I am not this person. I'm just asking you as a potential cynic might say. How would you react, Steve?

I still feel like we have a long way to go to be doing enough, to be quite honest with you. I think it's great that young people are getting more sensitized to these issues. I am grateful that we're creating opportunities to develop resiliency skills potentially in some school settings. We had a youth mental health crisis before the COVID epidemic, and it's only been accentuated over time. And so even if you look nationally at the rates of young people with serious depression, anxiety, higher rates of not only suicide attempts, but at times suicide rates going up in our young people, we do need to acknowledge we have serious challenges in terms of really creating the mental health support that our young people need.

So if you are a parent or an educator, what are some things to look for? Because I think we miss a lot, right? What are some things to look for?

I think some of the key things really to be looking for are a change in a young person. And that can often be whether or not they're struggling to get out of bed to go to school, but also less interest in social activities, more time spent at home alone in their room not interacting or socializing with friends. Often tearfulness, for many young people there are also increasing somatic complaints. So what I mean by that is sometimes kids will have more stomach aches or more headaches or more physical complaints or saying, I don't feel well. I can't go do whatever my regular activity might be as well. So all of those things can be signs of the potential of an early mental health challenge, which at least it's important to check in well with our kids and see how they're doing.

And we usually tell people, if you're at all worried, you go talk to a pediatrician, talk to the school counselor, but don't just ignore it. Parents are like, oh, teenagers will be teenagers. They're moody, they're sulky, they have outbursts, right? But it's better to catch this early. Is that right, Steve?

Well, like any other medical condition, early intervention has really shown for all mental health issues to be really beneficial as it is for anything else. And so the earlier we can link young people to the supports they need as well as their families, the better outcomes people have. Not only short-term, but long term as well.

What's an example of an early intervention to help?

In a school setting, it would frankly be a young person telling their friend that maybe they're feeling like they don't want to go out with their friends anymore, they're feeling sad, or they're feeling like they don't have the motivation anymore to do their work. And they tell their friend and their friend actually convinces them to go with them to talk to the counselor at school in very simple terms. Or if they refuse to go to that friend, maybe even telling their parent, I'm worried about my friend here and I just want you to know that this is going on. And then having that family member taking it seriously. And then really, like Denise said, maybe calling up the pediatrician and asking for that early guidance.

So the kid goes to the counselor and then what happens?

The truth is, I think it really varies in terms of our school settings and our counselors. Right now in California, as we're seeing the broader potential for school mental health professionals to be more involved directly in therapy, I think there are more opportunities for young people to get that supported school, often, as I mentioned, working in school-based health centers. We have community providers also in school where even that school counselor can say, let's go talk to that person from the neighborhood mental health organization who's at our wellness center. And let's have an initial conversation with them and see what kind of support you need.

And then it might be some kind of talking through with that young person what's been going on, helping them maybe in a few sessions sorted out. Or maybe that young person says, "I don't want to talk to someone at school."

And then the counselor can help make that call or connection to the allcove center down the street to be able to help that young person get over there for a first visit as well. Or maybe talk to the family with that young person and get them to the allcove center for early support.

This has been so helpful. I have one question that I know people will probably have on their mind, which is early prevention. What can I do as a mom to really support mental health? I mean, should we take the phones away? Should we prevent them from ever going to parties? People are just grabbing at things because they're so nervous about this suicide rate going up and the levels of depression and anxiety. What do you think?

Yeah, I think we're seeing a lot of things about the dangers of social media, but I have to say that from the work that I and our center teams have been doing, I think we feel like there's some real benefits for young people around social media. And what's important is they get support to think about how to use it safely. Our young group of advisors through a good for media program, our young people that are mentoring other youth and how to use social media in ways that support their mental health, they put out a guide for parents on how to talk to your kids about using social media.

They provide support for young people and how to think about what to turn on and what to turn off for it to be safe. I think for parents, what's really important I think, is to find those ways to check in and to listen to young person and to be able to do that in informal ways, to do it in a non-judgmental way. And I think our young people are getting pretty good at sort of having a sense of what they need. And I think being able to trust that without us really sort of telling them necessarily all the time what they need in terms of some of those issues.

We hear you Stephen. We definitely want to equip everyone with the right tools to succeed. So thank you so much for sharing your insights today. The work you're doing to support youth mental health is crucial. It's innovative, it's making a difference, and it's going to help us face these ongoing challenges.

I completely agree. I completely agree, Dan. And now it's time to talk takeaways and I will kick us off this time. I think the biggest one for me is really the importance of early intervention. Catching mental health issues early seems to make all the difference. And I think having community-based resources like the allcove centers also really helps make support more accessible for our kids. It gets them in there and we know that they're getting the help that they need.

And for the parents and educators, the thing that stood out to me is remember to stay engaged and watch for changes in behavior that might signal something more serious. And of course, just continue to encourage conversation as much as we can.

That's right. We've got to show up for the kids. So keep your eyes and ears peeled for those opportunities. So Steven, thank you so, so much. We learned so much today. Thank you for this really important discussion and thank all of you for joining us on this episode of School's In. Remember to subscribe to our show on Spotify, Apple Podcasts, or wherever you tune in. I'm Denise Pope.

And I continue to be Dan Schwartz.