COVID-19 has many parents of teens confused.

Especially parents of teens with mental health issues.

If you’re a parent in that category, you might have thought living under the same roof as your adolescent would decrease the severity of their emotional, behavioral, or substance use issues. After all, you wake up together, eat together, and spend practically all day in the same house. You check in more often on them than when they were in school. There are no extracurricular activities or clubs. Your adolescent can’t even escape to friends’ houses. No peers to influence or trigger them.

Shouldn’t this all make it easier, not harder, to keep their symptoms at bay?

Our answer:

Not necessarily.

In fact, the COVID-19 restrictions, in certain ways, exacerbate mental health issues in teens.

For example, many parents report that their teens are, to their surprise, still engaging in suicidal and/or self-injurious behaviors. Adolescents are still cutting, despite all the time spent together with mom, dad, or both. Teen suicides are not likely to decrease. On the contrary, some experts predict adolescent suicide because of COVID-19-related stress and anxiety.

According to CNN, calls to a mental health crisis hotline have increased more than 800%, compared to the same time last year. The Los Angeles-based Didi Hirsch mental health hotline has received over 1500 calls just this past month alone. Top concerns were anxiety, stress, loneliness and isolation. The LA Times reported that twenty percent of these callers engaged in suicidal ideation.

You’re right to ask:

What’s a concerned parent to do?

In this article, we’ll address non-suicidal self-injury (NSSI), otherwise known as self-harming behavior. We’ll offer suggestions for what you can do when your adolescent engages in NSSI at home during COVID-19.

Mental Health Treatment for Self-Harming Adolescents

First things first: if your adolescent isn’t already in therapy, then get on that immediately. Any teenager engaging in self-harming behavior needs help.

Depending on the recommendations of mental health professionals, they may need to be enrolled in an Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP), or Residential Treatment Center (RTC).

At the very least, a teen who engages in NSSI should receive regular outpatient therapy. During COVID-19, most IOP and PHPs for teens offer virtual support via teletherapy. But if your teen engages in these behaviors regularly and chronically, to the point where they’ve become a danger to themselves, IOPs or PHPs may not be enough. Teens who engage in chronic, repeated NSSI may require residential treatment, where they receive 24/7 monitoring and support.

All of these mental health treatment options – outpatient, intensive outpatient, partial hospitalization, and residential – can teach your adolescent coping strategies and distress tolerance skills to manage the emotions that lead to their self-harming behavior.

A Physically Safe Home Environment

In the meantime, you need to maintain both a physically and emotionally safe home environment.

This includes trying to remove as many sharp objects from the home as you can. Understanding, of course, that despite the fact that teens can self-harm with whatever they find around the house – even something as innocuous as a piece of paper – it still helps to remove all clearly dangerous objects. Razors are an obvious example. Kitchen knives should be kept under lock and key. Do a sharps count every night to ensure you know where all the dangerous implements are. Go through your home and make a bag of anything and everything that could be used to self-harm.

Yes, this will be time-consuming. Yes, it will be draining. And yes, you will throw a lot of stuff away or place it under lock and key. But if your teen is home with you, doing all of this can – at the very least – help deter them from harming themselves.

Additionally, the emotional message is strong: it shows your teen that you care. You want them to be safe, you want them to be healthy, and you care about their wellbeing.

If your teen has a history of hiding their self-harming behavior, we also recommend doing a thorough check whenever they come home. Go through their bags and backpacks to make sure they didn’t bring home any sharp objects.

An Emotionally Safe Home Environment

As important as maintaining a physically safe home environment is maintaining an emotionally safe home environment. Yes, cutting is scary. Yes, it may want to make you scream. You may want to yell at your teen – but that might be the worst thing you can do. Whatever you do when you find out your teen is engaging in NSSI, don’t shame them.

Compassion and love are far more powerful than shame, though it may be very difficult to find them inside yourself when you’re angry.

You need to stay calm and make yourself emotionally available (and willing) to listen to both the verbal and nonverbal cues your teen is making. After an incident of self-harming behavior, let your teen know you’re there for them and want to help them with whatever they’re going through. When they open up to you, be present. Listen with compassion. Understand that teens who harm themselves often harbor deep feelings of shame. Try your best to show unconditional love and acceptance – no matter how much their behavior hurts you and your spouse. In spite of the stress and anxiety you may feel due to this pandemic, your role in the home is to be the adult. No one is perfect, but you can do your best to create a happy, peaceful, and low-stress environment at home.

Remember that NSSI behaviors like cutting are often chronic maladaptive coping mechanisms that functions to release pain, alleviate stress, manage emotions, or distract from other personal, family, or social problems.

Don’t Leave Your Teen Alone

If your teen is still cutting, scratching themselves, or engaging in any other type of self-harming behavior, you need to keep a closer eye on them. We know you’re home with them almost 24/7 during COVID-19. We know you’re always just a room (or a foot) away. That doesn’t matter. Even if you check in on them very often, they might use any opportunity they can to engage in this dangerous, addictive impulse. They might cut when they go to the bathroom. Or when you think they’re going to sleep. Or in the morning, before you wake up.

Which means one thing: your teen should be alone as little as possible. You need to shadow them as much as you can. They’ll be annoyed and angry at the lack of privacy. It may infuriate them. And it may seem impossible to keep your eye on them all the time – but there are certain measures you can take that will help.

For example, some parents remove locks on bedroom doors if their teen is engaging in maladaptive behaviors in their room. Many take away car keys and forbid them from leaving the house alone. In certain cases, parents come up with a system to have someone check on their adolescent every 15 minutes throughout the night. But if these steps won’t work for you and your teen continues to engage in NSSI, then you may need to consider a residential treatment center for adolescents.

Residential Treatment Center for Self-Harming Adolescents

If your teen engages in self-harming behavior despite all the measures you take and the situation is getting worse, it might be time for a complete change: residential treatment is an effective way to keep teens safe, and provide the 24/7 support they need. Safety is the number-one priority for your teen. Don’t just assume your teen is cutting to get attention: while self-harming doesn’t always lead to suicidal ideation or suicidal attempts, sometimes it will escalate to those behaviors – and that’s more likely when they underlying issues that lead to cutting are not addressed.

Which is why mental health treatment is so essential: it can help your teen get to the root of what drives them to engage in NSSI.

You Are Not Alone

And now some words of reassurance for you, the parent.

If your teen is cutting, you’re probably feeling confused, helpless, and hopeless. It’s disturbing and shocking to realize your adolescent is hurting themselves on purpose – right under your nose.

First, try not to feel guilty. We know this is easier said than done. Try your best to show self-love and self-compassion during this difficult time.

During a pandemic, everything is harder – including parenting.

Especially parenting at-risk teens.

But the good news is that there is a solution:

High-quality mental health treatment can reduce and even eliminate adolescent cutting or other self-injurious behavior.

If your teen hasn’t already had a complimentary evaluation from a mental health treatment center for adolescents, schedule one as soon as possible. A clinical assessment can help identify and address their root issue, whether it’s defiance, stress, depression, anxiety, trauma, family conflict, perfectionism, bullying, or curiosity. Many teens who engage in cutting or other self-injurious behavior have poor coping skills, while others have experienced neglect, abuse, or significant loss: in all of these cases, mental health treatment can help.

The result of the assessment determines what happens next. The mental health professional who completes the evaluation may recommend treatment in a residential treatment center (RTC), a virtual partial hospitalization program (PHP), virtual intensive outpatient program (IOP), or virtual outpatient therapy (OP). Once you receive their recommendation, it’s time for you to discuss the options with your family and make the choice that best suits your needs.