NAMI (The National Alliance on Mental Illness), the nation's largest grassroots mental health organization, has developed a program called Ending the Silence. The goal is to raise awareness and change perceptions about mental health and to start that conversation with middle school and high school students.

BY JANET HAAG

Every good parent wants their child – their children – to be healthy and happy. We go to great lengths to find the right pediatricians, to make sure our kids' immunizations are up to date, that we get them the right care when they are sick, and sometimes we forget that what is going on in their minds is as important to their health as what goes on in their bodies. Mental health and physical health go hand in hand.

Let's start by looking at a few statistics, according to the Substance Abuse and Mental Health Administration (SAMSHA), 1 in 5 Americans has a diagnosable mental health condition. 50% of these conditions show up by age 14; 75% by age 24, so it should come as no surprise that 1 in 5 youth ages 13-18 lives with significant mental health challenges, depression and anxiety topping this list. The statistic, however, that should be of greatest concern to us is that less than 20% get the help they need.

Often, the reason why treatment is not adequately pursued can be attributed to the shame, blame, silence, and misunderstanding that surrounds mental health challenges. This is particularly problematic because early intervention is critical—the earlier treatment is received, the better the outcome. In the absence of treatment, we see more acute and prolonged illnesses, increased substance abuse, higher school dropout rates, greater involvement in the criminal justice system, and higher rates of suicide. 

It is normal for children and teens to experience various types of emotional distress as they grow and develop, and the truth is that it can be hard to know when certain behaviors are cause for concern and when they are simply part of normal phases of development. However, when the emotions are extreme and/or the distress is persistent, significantly interfering with daily activities – these CAN BE signs children are struggling with their mental health. Not all of these struggles will lead to a diagnosable mental health condition, but we need to pay attention, talk to our kids about how they are feeling and what they are thinking, and provide the support and assistance they need. Creating "space" for children and teens to express their feelings and concerns helps them develop emotional intelligence and strengthen their mental health.

Mental health challenges are not anyone's fault. Abnormalities or injury to the brain, as well as chemical imbalances can be the root cause. Genes, passed from one generation to the next, and family history can interact with other factors and increase susceptibility to specific mental health conditions. In addition, poverty, social isolation, abuse and loss influence one's ability to cope. Often, we underestimate the effect that upsetting social/cultural/historical experiences can have on kids. Some prime examples are 9/11, war, or gun violence. The latter is an issue that we are grappling with in our schools in a BIG way right now.

Because no two people experience an event or situation in exactly the same way, what is traumatic for one child may not be for another. Trauma is, in fact, more common than we might think and often misunderstood. It can happen like a "bolt out of the blue," triggered by an unexpected death in the family, a sudden injury—or it can develop over time through intense pressure precipitated by living in a crime-ridden neighborhood, ongoing neglect or abuse, or encountering a series of losses. The common denominator in any traumatic experience is the feeling of utter helplessness that it generates. When any of us are triggered, we experience a rush of adrenaline that can set off a chain reaction of emotions and behaviors that may seem out of proportion to the situation.

Trauma can be at the root of certain mental health struggles and If we suspect a child has been traumatized, the first thing we want to do is to let him/her know he/she is not to blame, either for the trauma, or his/her response to it. If childhood trauma goes untreated, it can carry over to adult hood and set the stage for further trauma.

It is important for us to remember that children need time to work though their emotions – some children may want to talk, others may not talk but might express themselves in other ways such as drawing or engaging in physical activity. No matter what, children need a calming presence.

Sometimes, the best we can do is to be that presence and wait until later to figure out what actually happened. Sometimes, asking children how they think a sibling or friend is handling a particular situation can help to relieve the pressure they are feeling and encourage them to open up. Most of all, we need to reassure them that we can work through problems and issues. There are solutions and alternatives and ultimately, we'll work things out. We will be OK.

Talking with a child's pediatrician can be a start on the path to seeking mental health treatment but we have to remember he/she is not a mental health specialist. Putting together the right team of mental health professionals will not be quick or easy. The most effective treatment usually involves a team, and a combination of treatment modalities. This may include finding the right medication or combination of medications, therapy, and home and school behavioral plans. The goal is to put together a plan that works well for everyone. Children, parents, school personnel, and mental health professionals should all be active participants in setting treatment goals.

Medication is not magic. There are many different kinds and dosages and it can be challenging "to get it right." Prior to taking medication to treat a mental health condition, there should be an evaluation that includes a description of presenting concerns and symptoms, health history, information about the child's development, education, social interactions and possibly laboratory studies (like blood tests, x-rays etc.) Because medication is involved –medical training and expertise is needed emotional distress as they grow and develop. However, when the –hence the need for a psychiatrist or advanced practice nurse and ongoing medication monitoring. Lots of people are confused by a psychiatrist's role in treatment because they are not always as involved in therapy as people expect them to be. However, it is actually a therapist's primary job to build rapport with a child and help them find healthy ways to cope. We have to remember that if, over time, a particular mode of treatment isn't working, or a particular therapist isn't connecting with our child, it is perfectly OK to make a change. We also need to work closely with the school. Teachers spend a lot of time with our children. We want to partner with them and take advantage of whatever school services are available.

Mental health treatment is a process, so it takes time, and trial and error are to be expected. Patience is essential. We might see ten steps forward and nine steps backward, but even small improvements suggest progress. As parents/caregivers, we should not underes timate the importance of finding other people who can understand what we are going through, with whom we can share our frustrations and hopes. There is something to be said for collective wisdom. We also need to take care of ourselves by eating healthy, getting enough sleep, exercising, and managing our own stress.

Effectively modeling self-care tells our children what they should be doing, louder than our words ever can.

Finally, what can we do about stigma to promote earlier intervention and treatment? Often, people, including kids, look at those with mental health challenges and that's all they see. They label them and treat them unfairly as a result. If we are going to change this for the better, we have to change people's minds and hearts. We have to start with a conversation.

We have to recognize that mental health challenges are no different than any other challenge. We have to see people for who they are – with all their strengths and hopes and dreams, as well as their challenges.

NAMI (The National Alliance on Mental Illness), the nation's largest grassroots mental health organization, has developed a program called Ending the Silence. The goal is to raise awareness and change perceptions about mental health and to start that conversation with middle school and high school students. NAMI Mercer, a robust local affiliate of NAMI ( namimercer.org) is offering this program throughout the greater Mercer County area. Ending the Silence. presentations include a lead presenter who provides gen eral information about mental health, a young adult who shares their journey of recovery, and an opportunity for interaction. There are three tracks – one for School Staff, one for Families and one for Students. Those who have experienced the program have said it made a real difference. Ending the Silence. can be booked by contacting NAMI Mercer.

For parents/caregivers who are interested in connecting with others who share their experiences and concerns around their kids' mental health, check out the Parent Support Network of Central New Jersey, a collaborative venture between The Youth Mental Health Project ( ymhproject.org) and NAMI Mercer. This is a group for caregivers of children under the age of 24 to help each other find better resources, and better understand and advocate for their children's mental health.

If we ever get over the stigma associated with mental health conditions–we might start to talk more freely about what works and doesn't work, where we can find help, and how much hope we can have for a happy, healthy future for all our kids! •

Acknowledgements: Special thanks to NAMI ( nami.org) and to the Youth Mental Health Project ( ymhproject.org) for providing substantive content for this article.

ABOUT THE AUTHOR: Janet haag is Executive director, naMi (the national alliance on Mental illness) Mercer.