How to have the conversation about kids’ mental health

Awareness around kids’ mental health is increasing, which is great news. When it comes to helping though, the best way to go about it isn’t always clear. Dr. Dimal Shah, child and adolescent psychiatrist, answers some key questions to help get the conversation going and address concerns when they arise.

How can adults approach the subject with children if they think they’re struggling with mental health concerns?

Mental health concerns can seem like a challenging topic to address with children. It can be just as nerve racking as the “birds and the bees” conversation. However, the sooner you start talking about mental health and the more times it’s discussed in an open and nonjudgmental way, the easier it will be for both adults and children.

It is important to start when children are toddlers by helping them recognize their emotions and use their words to tell adults how they’re feeling. Toddlers don’t understand the concept of time. Asking a question like “How did you feel yesterday?” is a hard ask. It’s more effective to address it in the moment.  “You’re crying. It looks like you are upset because you lost your toy.” Small repeated interactions like this will help kids learn they can come to their caretakers with their emotions.

As children age, they’ll be exposed to the world around them – school, daycare, playground, family events, parties and social media, as well as local, national and world events. This will lead to difficult conversations and questions, some of which have no good answers. First, process your own emotions and thoughts privately or with other adults. Then, you’ll be better prepared for age-appropriate conversations led by children’s questions and curiosities. At the end, let them know they can always come back to ask more questions. This open invitation provides permission for children to seek guidance from a trusted individual in the future. If caretakers aren’t willing to have these conversations, kids will turn to other sources – peers and social media – for answers. One way or another, their curiosities will be answered – it just depends by whom and with what accuracy.

These ongoing, open, nonjudgmental communications about mental health from a young age will help de-stigmatize mental health conditions. In turn, it will make addressing mental health concerns less challenging.

What if kids don’t want to talk about mental health?

Take a moment and put yourself in their shoes.

• What barriers and challenges do you see in talking about mental health concerns?
• Is there an environment that fosters open and non-stigmatizing dialogue about mental health and wellbeing?
• Can they express their thoughts and feelings without being punished or judged?
• Are their friends supportive of their mental health concerns and needs?
• Do they have a good support system with trusting adults who care for them?

If there are obstacles help reduce or eliminate them. Create the nurturing environment that makes it easier for children to talk about their thoughts and feelings. Let them know you’re always there to listen or provide guidance when they need it. It helps to remind them you love them unconditionally and want to keep them safe in hopes they have a bright and fulfilling future.

What are some ways adults can support kids’ and teens’ mental health on an ongoing basis?

If children express thoughts, feelings or concerns, please don’t dismiss them. Acknowledge and validate what they share. Ask them to elaborate or explain their thought process to understand their struggles. This time now will provide rewards immediately and during ongoing struggles.

Children afflicted with mental health conditions are going through a lot. Most of the time, the public can’t see it, which is difficult. It can be easier to provide sympathy and a helping hand to a child with a broken leg and on crutches trying to get ready for school than a child with depression trying to do the same task – though it shouldn’t be.

Children with mental health conditions aren’t trying to be “bad.” Many want to be “good” and are seeking love, affection and praise from their caretakers and schoolteachers. It’s just harder sometimes.  If adults adjust our mindset that kids are trying their best, it may be easier to connect with the children and find effective ways to help and advocate for them.

What if a teenager expresses concerns about a friend’s mental health?

This is a very hard situation! Teenagers should seek advice from trusted adults rather than trying to tackle this on their own. The challenge is the teen wants to keep the friend’s trust while being concerned about their safety and wellbeing. Ultimately, safety and wellbeing are paramount.

If there’s a life-threatening emergency or immediate safety risk, call 9-1-1 to get Emergency Medical Services to the friend’s location immediately. Every second counts, especially in suicide attempts.

For non-life-threatening situations, encourage the friend to talk to their caretakers or trusted adults who have vested interests in their wellbeing. This may include grandparents, uncles, aunts, schoolteachers, counselors, therapists, pediatricians and psychiatrists. It can be scary asking for help during such a dark time, but it doesn’t have to be done alone. You and your teen can be present when the friend shares their mental health concerns with parents or caregivers. Sometimes, it helps if someone else starts the conversation.

Everyone should have the phone numbers to the Suicide & Crisis Lifeline (three-digit dialing code 988 or 800-273-8255) and the Crisis Text Line (text “HOME” to 741741) saved into their phones. These numbers connect the caller or texter to a live trained specialist who can help in crises.

When is it time to seek help from a professional pediatric mental health care provider?

If a child is an imminent danger to oneself or others, call 9-1-1 or take them to the nearest emergency room.

It’s definitely time to address a child’s mental health concerns with mental health clinicians and primary care physicians when the child expresses thoughts of suicide, violence or aggression toward others; engages in self-injurious behaviors; has a rapid decline in demeanor, outlook on life or school performance; or shows a sudden and unexpected loss of enjoyment from hobbies and interests.

Preventative measures can help curb the negative impacts of significant events such as neglect; physical, sexual or emotional abuse; experiencing or witnessing domestic violence; parental separation or divorce; loss of a loved one; disaster or trauma within the community; or receiving a debilitating diagnosis for a loved one or the child themselves. A mental health clinician can help them process the situation in an age-appropriate manner, while monitoring for the development of psychiatric illnesses.

Caretakers are often faced with the challenge of determining if what their child is experiencing is part of childhood development or a psychiatric illness. A mental health clinician can help in these situations as well.

You know your child best. If you’re concerned, seek help. You’re not in this alone.

View more mental health articles and information from our Virginia Treatment Center for Children.

Find out how our Cameron K. Gallagher Mental Health Resource Center can help your family navigate and access services for your child’s mental health needs.