Stigma and Awareness: Rewriting the Narrative About Mental Health

When a teenager has mental health issues, they don’t always get the help they need. That help can come in many forms. For some teens, it may mean once a week outpatient treatment. For others, it may mean something more immersive, like an intensive outpatient program, called an IOP, or a partial hospitalization program, called a PHP. Teens with a severe mental health disorder may need 24/7 support, like the kind of care offered in a residential treatment program, which typically occurs in an adolescent residential treatment center, called an RTC.

In some cases, teens with mental health issues are in crisis. Teens in crisis may need inpatient psychiatric hospitalization. That level of care is offered in psychiatric hospitals or the psychiatric wing of a typical hospital. It’s reserved for teens at imminent risk of harming themselves or someone else, or for teens who are unable to participate in the most basic activities of daily living.

However, there’s something parents need to know about teen mental health: the earlier a teen gets treatment for a mental health disorder, the better their chances are of learning to manage the symptoms of that disorder and return to a state of positive mental health and well-being.

That’s what parents want for their teens – because positive mental health and well-being is, for all practical purposes, a synonym for happiness. Parents want their teens to be happy and lead fulfilling lives.

That’s why parents take kids to the doctor when they seem them struggling with a health issue. They notice something is amiss. Their kid is not firing on all cylinders. So they take them to someone who knows how to diagnose problems and give them the help they need: a doctor.

That all makes sense.

So why don’t parents take their kids to a doctor when they struggle with mental health issues?

Understanding Stigma Around Teen Mental Health

Stigma is the first thing mental health professionals and mental health advocates talk about when they answer the question we just asked.

For clarity, let’s define that word.

Merriam-Webster says stigma means “a mark of shame or discredit.”

The Cambridge Dictionary expands on this and defines stigma as “a strong feeling of disapproval that most people in a society have about something, especially when this is unfair.”

That’s why mental health professionals talk about stigma when they explain the reason parents wait to get help when their teen has mental health issues. They fear their teen will carry a “mark of shame” and that “most people will disapprove” of their teen – and by extension, them – for having a mental health problem, although the mark of shame and disapproval is unfounded and unfair.

Stigma around mental health is more complex than these basic dictionary definitions of stigma, though. According to the American Psychiatric Association (APA), mental health researchers identify three types of stigma:

1. Public Stigma

This refers to the negative attitudes about mental health issues than can lead to discrimination, stereotypes, and prejudice. Examples of public stigma are the ideas that anyone with a mental health issue poses a danger to the public, is somehow at fault for having a mental health issue, or unreliable and incompetent as a result of their mental health issue. For parents, public stigma can be two-fold. They may fear the public will apply these negative attitudes to their teen and to them.

2. Self-Stigma

This type of stigma includes negative attitudes about mental health that someone directs toward themselves. Shame and self-blame often accompany internal stigma. Teens who self-stigmatize often feel they’re the cause of their own mental health problems, that they’re somehow dangerous to the people around them, or that their problems create unnecessary problems for their families, friends, or other loved ones. Like public stigma, parents often blame themselves for the mental health problems their teens experience. Parents may also blame themselves for the mental health issues their teens experience.

3. Institutional Stigma

This refers to systemic policies and practices that purposefully or inadvertently reduce support and care for people with mental health issues, or limit access to existing support and care for people with mental health issues. Systemic stigma can appear in public institutions, such as non-health-related government agencies, health-related government agencies, or schools. It can also appear in private organizations, such as large corporations, small businesses, or non-profit organizations. This type of stigma often has the most significant impact on the people with the fewest resources and can result in delays in care that persist for months, years, or in some cases, decades.

Those are the three primary types of stigma. They’re what cause the lion’s share of delayed treatment for mental health problems among teens. One thing to understand about these types of stigma is that they have no basis in scientific evidence or the facts about mental health, mental illness, or the treatment of mental health disorders.

In other words, stigma is perpetuated by a lack of awareness about mental health. We’ll now address some basic facts about teen mental health for parents who’ve never had to think about how mental health – positive or negative – may affect their lives or the life of their teen.

Mental Health Awareness: What Parents Need to Know

First, parents should understand this: evidence-based treatment for mental health issues is effective. That means it works. That also means that one way to look at mental health issues is the same way we look at other health problems. When we notice a problem, like a cough or a sprained ankle, we go to the doctor. We get a diagnosis and a recommendation for a course of treatment. Then we follow that course of treatment.

We’re not minimizing mental health issues by equating them with a common cold. Real mental health disorders are more similar to chronic mental health conditions. Which, in most cases, require professional treatment, lifestyle changes, ongoing care, and, in some cases, medication. We equate mental health problems with simpler issues because we need parents to understand the process of identifying and treating them is almost identical. We describe it above: parents notice something is amiss, they go to the doctor, they get a diagnosis, and they follow directions.

There’s no reason the steps a parent takes to address a mental health problem in their teen should be any different.

But there’s a catch.

What is Mental Health in a Teen?

To know when there’s a problem with teen mental health, we need to know what positive mental health looks like. We need to know what it looks like when a teen thrives on physical, psychological, and emotional levels. We mention this because it’s easy to fall into the trap of thinking adolescence is always tumultuous, problematic, and filled with serious emotional issues.

Sure, adolescence is all of that – sometimes. Most of the time, though, adolescence is simply a teen going about the business of being a teen. It’s not all drama and it’s not all heavy.

So, what does positive mental health in a teen look like?

We offer this list for your consideration.

Mental Health in Teens: Seven Signs They’re Thriving

1. They’re happier more days than not
   • Or at least not miserable more days than not. No one expects anyone to be all smiles all the time.
2. They have positive, affirming relationships with friends and family
   • It’s quality, not quantity, that counts.
3. They get enough sleep, regularly
   • But okay – sometimes you can’t stop them from being up on their phone way too late, which may mean some bleary eyes and cranky mornings.
4. They eat healthy food consistently
   • And it’s not like pulling teeth to get them to do it
5. They’re resilient
   • When they experience the inevitable social or academic disappointment, they bounce back within a few days.
6. They participate in extracurricular activities
   • Sports, arts, academics, or anything: they have interests that matter to them – bonus points if they have a passion
7. They feel like they belong to something, somewhere
   • It may be a sports team, it may be a social group, or it may be family: what matters is that they feel connected to something outside themselves

That’s what life for a typical teen may look like. Not perfect, but not a daily rollercoaster, either. Now let’s have a look at another list, which describes some of the characteristics a teen with a mental health issue or issues might display.

Mental Health in Teens: Seven Signs They’re Struggling

1. Persistent Sadness

• They’re sad, upset, or gloomy more days than not
• Feelings of sadness that persist every day for two weeks or more indicate the possible presence of a depressive disorder

2. Persistent Worry

• They’re anxious or on edge more days than not
• Feelings or worry, anxiety, fear, or apprehension every day for two weeks or more indicate the possible presence of an anxiety disorder

3. Persistent Anger

• They’re frequently very irritable or often get disproportionately angry
  • A cranky teen is no problem. A teen who is irritable every day for two weeks or more, or a teen who reacts with extreme anger when it doesn’t seem logical, may have a serious issue. Persistent anger and irritability may indicate depression. Extreme anger or rage in reaction to what seems like small things may indicate the presence of a personality disorder.

4. Sudden Academic Problems

• Their grades fall a long way, fast
  • We’re not talking about getting a C in a tough class. When an excellent or average student – in one semester or less – drops to failing or almost failing their classes, we encourage parents to consider something significant is going on. It could be substance use. It could be depression or anxiety. In any case, it merits investigation.

5. Loss of Interest in Favorite Activities

• They stop doing things they love
  • Interests change over time – we all know that. However, when interests don’t just change, but completely disappear, that’s a red flag for a mental health issue like depression or anxiety.

6. Withdrawal From Loved Ones

• They pull away from friends and family
  • A teen may hole up in their room and not want to talk to anyone, at times. However, when they cut themselves off from all contact with people they used to love, that’s another red flag for a mental health disorder such as depression or anxiety.

7. Absence of Self-Care

• They completely stop managing personal hygiene.
  • Teens may go through phases when they wear the same clothes over and over, fail to clean their rooms, or let their hair turn to dreadlocks. Parents may think these habits are, in a word, gross. But when a teen fails to tend to the basic necessities such as brushing teeth, showering or bathing, eating, or getting out of their pajamas, their may be a mental health issue at work, rather than the typical teen aversion to doing what they’re told.

That’s a solid list of warning signs for any mental health issues in teens, but it’s not comprehensive. For an in depth look at details about the various mental health disorders common in teens, please navigate to our Parent Guides page.

The best thing for parents who notice any of the warning signs above to do is this: take action now. We’ll expand on that in a moment. With regards to the information above, the first list is what a thriving teen might look like – but every teen is different. The second list, however, includes clinical criteria that mental health professionals use when diagnosing mental health problems in teens.

Pay careful attention to that list.

Wrapping This All Up: What You Can Do

If you’re the parent of a teen and you see the warning signs we list, don’t let the stigma we describe in the second section of this article keep you from seeking professional help for your teen. Ignoring a mental health issue – just like ignoring any health issue – almost never helps. In fact, it almost always leads to bigger problems down the road. We’ll repeat that in a different way: waiting to get help can make the problem worse. We say that based on clinical evidence, and we say that based on our experience and first-hand observation.

Here’s a rule of thumb: the sooner a teen with a mental health issue gets evidence-based treatment for that issue, the better the outcome.

If you’re ready to seek treatment for your teen, please read our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources for teens and families.