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Spotting the red flags for teen mental health

Parents should be aware of mental health warning signs to assist with supporting teen mental health needs

In this stressful new post-pandemic world, teens face significant mental-health challenges and can be at risk of depression and suicide. Supporting teens to find healthy coping mechanisms can help reduce the risk of parasuicide (a call for help without the actual intention of killing oneself) or more serious suicide attempts.

Knowing the warnings signs can help parents to help their teenagers. This begins with transparent and open conversations to help destigmatise any mental health concerns or, in finding the suitable professionals for teens and families to talk to about their stresses, emotions and mental health struggles.  It’s crucial that all teen suicide threats and attempts be taken seriously.

Life Healthcare has seen a marked increase in the proportion of adolescents accessing counselling as part of their employee wellness programmes and a rise in depression cases.

Before COVID-19, adolescents accounted for less than 6% of high-risk mental health cases; this number rose to 11% during the height of the pandemic and remains high, at 7.3%. Across the past five years, suicidal risk has remained the top driver of high-risk case management for this age group.

2023 has seen a proportional decrease in mental well-being cases but an increase in couple and family-related problems.

According to Life Healthcare, child behavioural issues account for 1 in 4 problems for this age grouping, followed by stress and phase-of-life or adjustment difficulties.

The South African Depression and Anxiety Group reports an estimated 23 known cases of suicide in South Africa every day and 230 serious attempts at suicide daily.

Claudette Marais, clinical psychologist based at the Life Brackenview mental health facility, has also seen a significant increase in teenage mental health issues during the pandemic and its aftermath. She says if left unaddressed, these problems can lead to suicidal ideation, suicide attempts and even the loss of life.

“The post-COVID-19 period has us all under stress and we need to destigmatise the need for mental health,” says Marais. “There's also been a definite increase in anxiety and depression among teenagers.”

Marais says the social and practical challenges of COVID-19 have made things worse. There are complicated bereavements, panic attacks and increases in substance abuse as teens use unhealthy coping mechanisms.

“What has been quite shocking is that teens who may have been susceptible to parasuicide before COVID-19 are now making serious attempts at suicide,” says Marais. Parasuicide is a cry for help, where the goal is not to kill oneself. Marais says that since COVID-19, she is seeing more serious suicide attempts.

“It seems like a post-traumatic stress reaction, as well as a reaction to the stresses of the “new normal,” says Marais. “We are getting back to school, and to our social groups. Many teenagers are overwhelmed and have not yet learned the coping skills – skills they would have learned had there not been a pandemic.”

Pandemic lockdowns also created conflict in the home environment. Marais reports seeing more cases of emotional abuse, physical abuse, and families coming for help.

She recommends that families be proactive about managing their mental health.

“We need to be outside. We need hobbies, and extra-mural activities. We need family and friends for support,” she says. “The pandemic took all these away in an instant. We have also learned that loneliness hurts our mental health – especially for teenagers. During the pandemic, they would isolate and feel even more alone.”

Specific factors contribute to poor mental health for teens. Difficulty communicating with peers is an issue, as is a stigma regarding mental health, which can lead to bullying, and feeling ashamed.

Marais highlights a few mental-health red flags that parents should be aware of. Indications of teenage depression include:

  • Major changes in emotions and in behaviour
  • Becoming extremely sensitive to rejection, failure or critique
  • Lack of interest in activities they previously enjoyed
  • Isolating in their room or avoiding contact
  • Low self-esteem, self-blame, guilt or self-loathing
  • Sleep disorders
  • Changes in appetite
  • Restlessness or slow motor movements
  • Headaches, joint, or muscle pain
  • Poor personal hygiene
  • School marks dropping significantly
  • When a child starts talking about death
  • Worrying social media status updates
  • Alcohol or drug use
  • Self-harm

In addition to being aware of mental health warning signs, parents should seek to be present for their children at all times. Talk, connect, and listen actively. Schedule activities that you both enjoy.

“Try to get your teens out of their rooms,” says Marais. “They may be withdrawing, dealing with overwhelming feelings. Share activities, so your child can experience positive emotions.

Parents should look to normalise using mental health services and be direct when they can see their teens are feeling down.

“It’s important to show how much you care about your child,” says Marais. “Tell them you can see they are battling, and that you’d like to get help as a family. A child can also be admitted to a psychiatric hospital, and that’s also okay. We are all in this together.”

For teenagers who prefer social media, Marais recommends mental health apps such as Calm, and Finch and the Instagram account @ItsLennnie.

 “I have seen social media helping some teenagers with self-care and goal setting. However, we do need to limit screen time,” says Marais. “We still need to go to gym and; meet and talk to friends. So, we need to set boundaries.”

She recommends that teens be involved in helping to set house rules, so they learn to take ownership and learn responsibility.

“Our main goal is to normalise mental health. Let us educate ourselves, and become aware of our own mental health needs, and those of our loved ones. Let us be brave enough to face the new normal and all of the emotions that come with it,” concludes Marais.