Supporting Youth Mental Health

Recommended Listening: 

How to help a child at risk of suicide | NPR's Life Kit

Websites: 

Culture and Health Promotion of Minority Youth & Families Lab

The Child and Adolescent Mental Health Project

Articles:

“‘It’s Life or Death’: The Mental Health Crisis Among U.S. Teens” from the New York Times

“The kids are not all right. The CDC finds mental health among teens has declined” from NPR

Asian American parents’ experiences of stress, discrimination, and mental health during COVID-19 by Cindy Y Huang and William Tsai

Joe Riina-Ferrie: Listeners should be advised that this episode includes discussion of suicide. If you or anyone you know is at risk for suicidal behavior please call the National Suicide Prevention Hotline at 988. That’s 988.

Cindy Huang: As a parent of three children during the pandemic, one of whom was just an infant still when the pandemic hit, it was just sort of like everything colliding and making me fully realize, wait, this is what I research. Now I'm living this, I'm living and experiencing the stress and the risk factors that I talk about. 

Jen Lee: Hey, everyone. Welcome to How's School, a new podcast from the Digital Futures Institute hosted by myself, Jen Lee and my co-host, Joe Riina-Ferrie.

Joe: Hey, Jen.

Jen: Hey, Joe.

Joe: Hey, everyone. How's School? is a podcast about the issues that impact young people, for the people who care about them and want to be able to ask better questions to connect than, "How's school?"

Jen: And that need for connection has never felt more urgent than it does right now, in the context of what has been described as a current youth mental health crisis. And to help us navigate this difficult topic, we've invited Teachers College professor Cindy Huang. Her recent work has looked at the impact of the COVID-19 pandemic and rising racism on the mental health of Asian American parents. And she studies mental health issues for immigrant and ethnic minority youth. Thanks for joining us, Cindy.

Cindy Huang: Hi, Joe. Hi, Jen. Thanks for having me.

Jen: Thanks for being here. All right, let's dive in. I'm just going to be real here, right off the top and say that as a parent, navigating the mental and emotional health of my family and finding support has been a big part of the last few years. And I know I'm not alone. Both the CDC and the office of the Surgeon General have each released reports within this past year describing a crisis in youth mental health.

Joe: So this crisis was already underway before the pandemic, but studies have suggested the pandemic has exacerbated the situation. Young people dealing with serious mental health issues and teen suicide have been showing significant increases. And Cindy, your own work has shown that while the impact of worsening mental health and the pandemic is felt across youth identity categories, some youth are facing higher risk based on things like their identity or immigration status. For example, Asian American youth and their families have dealt with an increase in racism and racial violence and the sense of fear that goes along with it. So are we understanding this correctly? Is that how you would frame the problem? Or would you put it a different way?

Cindy Huang: No, I think that perfectly captures the complexity of youth mental health. I think so much of what you just said is true, where mental health issues were always present.  But I think what the pandemic has done is it's brought it to the forefront, whereas people, maybe parents, before wanted to - maybe weren't aware of how prevalent things were, or maybe weren't aware of what some signs may be. I think now it's being talked about, it's being discussed at schools, by teachers and just in the media. And so people are now realizing how prevalent it is. And even beyond that, I think there are certain populations and certain risk factors that place people at heightened risk for mental health issues coming to the surface. And a lot of those have to do with race and, or immigration status.

And so as you said, COVID brought to light the discrimination or racism that exists for say Asian American populations. Certainly with COVID, in the pandemic earlier days, it being called names like the China Virus by the US government, those certainly have exacerbated anti-Asian hate crimes that we saw rising across the country and really even the world. So if you take that, really, those stories brought to light some of the experiences that are everyday for a lot of Asian Americans that were experiencing them. 

And I think part of the issue has also been that people are now getting language on how to talk about mental health issues, how to talk about these contextual factors that are risk factors for mental health. So for example, we know there is lots of research saying experiencing discrimination and racism has links to not just mental health, but also physical health problems. Chronic experiences of discrimination is actually linked with increased heart disease, hypertension, chronic stress. And so what this is really doing is giving people the language, giving media the language. And I think to take that back to youth, parents now have this language and are thinking about themselves and their experiences with their own mental health, maybe as a result of the pandemic, maybe it was there before. But now then seeing and thinking about its impact on their own children.

Joe: Yeah, yeah. I really appreciate that, in your work and in the work of others, just examining how some of these social factors that aren't necessarily always named in sort of like individual psychological things that people are facing, is now being included in that discourse around our individual mental health. Do you think this framing of it being a crisis is an accurate way to describe what's going on with youth mental health? I mean, we're taking these words from, like a- New York Times did a big article about it, that we came across when we were researching for this episode and other pieces as well, including those reports from the CDC, and the Surgeon General. What do you think about framing?

Cindy Huang: That's such a great question, because even as you're asking me now, I'm thinking, wait, it's not a one time thing. This has been actually, the trends for youth mental health has been trending upward for decades. So there are studies that have looked at generational differences in depression and mental health and stress. And we know that today's generation compared to the generations from decades ago have higher rates of depression. And I think for many years, people have been trying to figure out why. So I wouldn't say that it's a crisis, more that it's hit a point where you can't look away anymore.

I also want to add to that though, that there is a real - despite what I said about it being a trend, there were real things about the pandemic that exacerbated these risk factors. So yes, the discrimination and hate crimes against Asian Americans was one of them. But that's not all. We know from research that youth, maybe who had predispositions for mental health problems, by being isolated and locked at home and not being able to go out and socialize, for some that really exacerbated the problem and brought to the surface mental health problems that maybe wouldn't have come up to the surface until much later or if at all.

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Jen: Yeah. And I think part of why this topic can feel overwhelming, is just, it's easy to feel fear about the young people in our life when they're struggling and to have worry and concern. I think I felt a big mix of emotions as I was reading about how other families were experiencing these challenges too. I feel like the part of me that worried that it was maybe a personal failing of my own as a parent, that part was almost relieved. Like, okay, maybe I'm not the only one. But then immediately the reality of how many families and young people were struggling, just also brought a lot of sorrow close behind it.

Joe: Yeah.

Cindy Huang: Yeah.

Jen: How about you, Joe?

Joe: I mean, I can relate to how challenging it can be, even as an adult, to have conversations with my own parents about mental health. I'm not a parent myself, but just for me as a person, there's just a deep feeling that I want my parents, my family to see me as being okay, for them not to worry about me, even if it's not something serious. But maybe even, especially when it is something serious, there's that sense around that. 

And then broadly, when I think about the issue of youth mental health, I feel a sense of anger and fear about just how completely we're failing to care for young people right now. So that said, I guess we want to know how you're feeling, Cindy, when you think about this crisis in mental health, what emotions does it bring up for you?

Cindy Huang: Yeah. I mean, I really echo with both of what you're saying. I think as an adult, as a psychologist, I'm of course, self-aware and can deal with mental health issues when they hit. And when the pandemic hit and we were all shut down for what feels like still, parts of it is still happening. As a parent of three children during the pandemic, one of whom was just an infant still when the pandemic hit, it was just sort of like everything colliding and making me fully realize, wait, this is what I research. And now I'm living this, I'm living and experiencing the stress and the risk factors that I talk about. And just to share on a personal level, it was really hard.

I had two kids who were old enough to be in elementary school, but young enough, kindergarten and first grade, where they were still learning how to read. There I was on maternity leave with an infant and also suddenly helping facilitate school for my kids.

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That is also then compounded with the stress of not knowing what the heck Coronavirus is, especially those of us in New York City, we were just locked down and it was scary. You hear sirens, you couldn't go outside. So then it's no wonder that you see mental health issues in kids. It's not mental health issues in the way that kids are coming to you and saying, "I have anxiety or I'm depressed." Not all kids, even teens have that type of language. There's the awareness that needs to happen, the self-awareness, but then there's also the language that goes along with that. And I think oftentimes that's what is missing, is that language. But they feel something. And whether that's something is being felt from us as parents, giving off an uncertainty, because I think that was one of the biggest exacerbators of stress among parents, is, is school going to be open? Are they going to be closed? We're in school, is there going to be exposure. And then next week, at any given point, they're staying home, right? And completely just kills any kind of control you feel like you have in your life, whether it's things we took for granted pre-pandemic, like I can set my own deadlines and meet this deadline. And I think so much of what I feel is actually first recognizing that I've gotten desensitized to it because we have had to live with a level of uncertainty and ambiguity. 

When I stop to really think about how I feel, I do get angry about it. And I don't think that it's necessarily, because I feel like we're failing kids. But this anger in general of people wanting to just move forward from the pandemic, like things are normal. And I think maybe that's where it relates to youth mental health and where I do appreciate the attention that the CDC, that the Attorney General, and all the media has then labeled this moment as a crisis. Because it is a crisis in the sense that we can't ignore it. But by labeling it, we are giving the language for all of us to be able to talk about it as an issue, we can't deny it being a problem. And I think that makes all the difference in the world.

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Jen: Totally. And one thing I heard you mention before was the way that sometimes the challenge is that were missing language or vocabulary to describe how we're feeling. And also, another one I'm thinking about is that sometimes the process of decline in how we're doing is so gradual that we actually don't feel it happening. And we don't realize how far we've drifted from our own baseline. And so I know a lot of us would love to hear from you if there are any risk factors or signs that you can think of that maybe the young people in our lives are struggling, that we can be on the lookout for? What should we be watching for or noticing?

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Cindy Huang: My big thing that I always talk about, in terms of mental health signs, is to look at behaviors. Behaviors are the first signs of mental health problems. And what's nice about understanding and looking at behaviors, is they're right in front of you. You don't need the words. For example, symptoms of depression could be things like extreme fatigue, sleeping more than usual, sleeping less than usual, just to add in the complicated matters of mental health, depends on the person. Appetite, decrease or increase in appetite. And we're talking about significant changes, but even incremental changes can also be a sign of something. It's actually not as common to have somebody immediately go from, who's depressed to go from perfectly healthy habits to suddenly not. That's not typical. What you usually would see is a gradual change over time. We're talking about a couple weeks to a few months. But the big thing is pay attention to the patterns and themes of your own signs, but also those of your children and the people around you..

Joe: I was just going to say that you made it sound challenging in that unfortunately, these symptoms, aren't making it easy for us in the sense that they're gradual like that. But it sounds like what you're saying is to look for patterns that continue over a period of say a couple of weeks or so. And then if you notice that there's a change in someone's basic routines over that amount of time, maybe it's-

Cindy Huang: Or I would say even longer. If we're talking about diagnostic criteria, it's kind of like a minimum of two weeks. I would say two weeks is not that much time. Most people, most kids are showing signs over time.

Jen: Part of the point of this entire podcast is for us to learn how to ask better questions when we speak to young people, besides just the standard “how's school?” Which is everyone's often go-to. So what advice would you give about how to bring up the topic of their mental health with the kids and the teens? It seems like it could be kind of awkward to be from like, "How's your day?" To like, you know what I mean?

Cindy Huang: Yeah - it is really awkward. It starts as simply as making the attempt. So I think making the attempt to talk to them. Even before that - You can watch and observe behaviors and behaviors can go really far. So let's say you're noticing your child is more withdrawn than usual. So you start noticing your child is more withdrawn and then comes the asking, how do you ask? Sure, you can start with, "How's school?" But I always like to tell parents, specific questions will elicit specific answers. Who questions, what questions. What are you learning in blank? "You mentioned this friend, how are they doing? Have you been talking to them lately?"  And then listening. Parents can do so much by just listening to what their kids are saying. And I'm totally guilty of this myself. You can't help it when your kids give you an answer, you feel like you have to teach everything, Feels like you're supposed to be teaching them something. Or they said something with an attitude and you're supposed to tell them, "Hey, watch it, watch that tone." And it's not to say you don't do that. It's to say that, give yourself a few moments where you let certain things go, like the tone that you don't like, or the attitude, the gloominess that they're showing you. But look at what they're doing. Maybe your kid is gloomy, but they're staying in the room and answering your questions. That's a sign, they're engaged in this conversation, even if they're not smiling about it. Those are the moments then to keep it light and just keep it going. Kids, especially teens, shut down when they feel or fear judgment, punishment, some thing, nagging, whatever may be, that's when they shut down. 

Maybe they're not feeling so great. They don't have the words to articulate, "I don't feel so great." It takes a very conscientious young person to say, "Mom, I don't feel good." It also takes a certain level of not feeling good to then go to your parent and say, "I don't feel good." Because we all know how to explain away our physical symptoms. "Oh, my tummy hurts." You have no problem telling your parent, your tummy hurts, your head hurts, your arm hurts. But this kind of non-existent discomfort that's associated with anxiety or depression or just scary thoughts, scary experiences, just social experiences, social interactions are some of the biggest ways that kids feel, especially teens feel like, let's say they're being bullied or somebody was harassing them or they experienced discrimination. But they didn't have the words to say, "Oh, this is discrimination." Whatever it may be. They may feel alone. They may feel ashamed. And that shame is such a big piece of what keeps kids from communicating. And so as the adults in their lives, we have to recognize that and understand that there are lots of reasons why people may not share, maybe they don’t know how to share, and just give them and create the opportunities for them to share.

Jen: Okay. So just to recap on the individual personal side, some tips you've given us are to pay attention to behaviors and to ask concrete, specific questions, to engage and then listen. And those are all really great tips.

Cindy Huang: Yeah. And I just want to add to some of those things. One of the things that you can think about for parents to look for, especially in younger children, but also, there's a cultural component to it, we call it somatic symptoms. Certain people experience their mental health issues physically. Could be stomach pain, I think anxiety and then stomach issues go hand in hand or headaches because of tension. And if you're wondering about something and you're feeling like my instincts are telling me something's not right, it's better to ask your child, a doctor, someone, it's better to ask than to brush it aside. 

Joe: I really appreciate your advice for how we can get some tools to do this interpersonally. And I'm wondering also though, since we are seeing this as a trend. And your work also brings in factors that are beyond the family relationship, which as you mentioned, these closer relationships are big factors. But how can we look, collectively, as a society, although I don't know if I can say as a society, but together, how can we do this together? Considering that it's happening across, not just in individual units. But collectively, we're facing this problem. How can we collectively look to work on it, to improve the situation for young people?

Cindy Huang: Yeah. And that's, I think, the greatest question of all. Because there if you stop to think about all the influences, all the things that contribute to youth mental health, it does go so much bigger than just the parents and even teachers. One of the biggest things we can do is to help understand these other risk factors, understand the experiences of others, because inevitably, those people's experiences impact our children's experiences and vice versa. Like this is your friend, your friend is of this particular race. They may experience this. These are things that they have to worry about. These are things that you don't have to worry about. And these are things that you do have to worry about. So just having that language and understanding, appreciation of differences is one way that we can help our own kids to eliminate discrimination, for example, since we talked about that earlier on. If we're compassionate for other people and teach our kids to be compassionate towards other people and themselves, we create a totally different society. We create a totally different world. And I think that sounds really like rainbows and unicorns and all of that. But there's ways that we can do that. We can make individual experiences easier for our children by learning the language, learning the experiences of other people, helping our children learn the language around their own experiences, their friends experiences, being compassionate. So it seems small, but you can start these things at the individual level to hopefully, one day see larger change. 

Joe: two of the things that I heard were that it's helpful to give people the language to name things when it comes to our individual experiences. We talked about that earlier in the conversation, and I know I've experienced that myself when it comes to mental health. And it's also helpful to give people the language to name things that might not be about their experience, but are about these broader issues in society that they may or may not be facing themselves, whether it comes to racism and discrimination that they might not personally face or other identity categories, gender, sexuality, right?

Cindy Huang: Sure, gender identity. Absolutely, absolutely. And I think ultimately, the things that we're talking about, the things that we can do is to help kids become more self-aware. As adults, we can learn to be more self-aware and then for kids to become more self-aware because what does it really mean to be aware of other people's experiences? Well, it's awareness that these experiences exist. And the fact that you're aware of it, when you do see it happening or you experience it yourself, it won't feel as isolating. It won't feel as shameful. You will have better ability to know that you haven't done anything. You can talk to other people about it because you are not alone. And ultimately, that's going to improve mental health.

Jen: We both appreciate you so much today, Cindy, thanks for being with us, for being in the conversation. And sharing with us how you're feeling, so much about your own experience and some really practical tips too.

Joe: Yeah, thank you.

Cindy Huang: Well, thank you. I know we could talk so much longer. But there's always too much to say about this.

Jen: Totally.

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Jen: Thanks for listening. You can find a link to Cindy's lab at Teachers College, as well as a transcript on the episode page linked in our show notes. 

This episode talked about youth mental health more broadly, but if you have a young person in your life who is at risk of suicide, we’re including a link to a great episode of NPR’s Life Kit in our show notes as well: How to help a child at risk of suicide. We recommend listening to learn more. You can also call the 988 Suicide & Crisis Lifeline for to receive support for yourself or someone you care about. It’s available 24/7 by dialing 9-8-8.
  
On next week’s episode we talk to Sonya Douglass about the attacks on school districts and teachers in the name of “critical race theory”, and a groundbreaking new PreK-12, interdisciplinary Black Studies curriculum for New York City Public Schools.

Sonya Douglass: I didn't know exactly what it would look like at the time, but I knew that there was a need to really bring together people who were researchers who were passionate about Black education, of connecting the scholarship of our elders, right and those who've kind of been toiling in the margins and bringing that work more into the mainstream to help inform education research more broadly. And I feel like things have coalesced nicely in this moment to where, there is a hunger and desire for better understanding of Black education, of understanding issues of race and racism and how they show up in schools and what we can do about it 

Joe: Follow How’s School wherever you podcast, and leave a rating and review to support the show. How’s School is created, hosted and produced by myself, Joe Riina-Ferrie and Jen Lee with audio production and original music by Billy Collins. How’s School is a production of the Digital Futures Institute at Teachers College, Columbia University. You can follow the Digital Futures Institute on Instagram or Twitter @tcdigitalfuture. 

More soon.