Mental health: Supporting youngsters

Around 20% of adolescents experience a mental health problem in any given year.

Often things start to become apparent at school, when they begin to experience problems with friends, family or schoolwork. In addition, they can become anxious, depressed, angry or scared and confused. This may just be a normal part of adolescence but could also be a sign that they are struggling with their mental wellbeing.

It is normal for life to have ups and downs, but when negative thoughts and feelings start to intrude, preventing them from doing the things they would normally enjoy, or resulting in marked changes in their behaviour, they are likely to need help with their mental health.

Trust your instincts and if you think there could be something wrong, use the CARES approach to initiate a conversation.

Just as with a physical health condition, often there is no definite cause. There are a huge variety of factors can lead someone to struggle with their mental health.

Often people look to blame themselves for someone experiencing a mental health condition and desperately look for a cause. In your eyes they may have a charmed life with no cares or worries, do not judge, or reflect your opinions upon them.

Remember, this is about them and getting them the right help when they need it.

Getting the help they need

If there is a mental health problem emerging, or you believe they could need help, help should be available. Often it is a relief for the young person realising they don’t have to help alone.

Professionals can support them with coping strategies to help manage the way that they are feeling and behaving.

Just as with physical health problems, diagnosing and treating a problem early can make things a lot easier.

Counselling and other advice services can help the child or young person talk about the way they are feeling and support them without making them feel judged. The range of advice services for children and young people includes face-to-face counselling, one-to-one phone calls, webchat, email, forums and face-to-face sessions. There are also extremely helpful self-help forums, apps and online support.

MIND has a page of helpful pointers that may be useful for someone reticent about speaking about a possible mental health issue: seeking help for a mental health problem

Early intervention can make a major difference to their recovery.

Prevention programmes and early intervention, such as parenting classes, family support, drug education, resilience programmes in schools, stress management, mental health awareness, have had a positive impact in reducing the numbers of people experiencing mental health crises.

Click here for an article on how to help someone who you think is self-harming

How to start the conversation:

1: Choose a good moment and be ready to help them.

• Calmly approach them and assess the situation.
• Choose a quiet room, where you won’t be interrupted, where they will feel relaxed and more able to open up.
• Respect their right not to want to discuss things. It could be because they are not ready to talk, it could be because they do not see you as the most appropriate person to open up to, or maybe they don’t realise there is a problem, or possibly there has been a miscommunication and you have misread signs.
• Carefully choose the best time and place to speak with them
• Be sensitive and culturally aware – avoid doing anything that could offend, be misconstrued or could be considered culturally insensitive.
• Don’t be worried about asking them how they are feeling and how long they have been feeling this way.

2: Actively listen without judgement

This is the first step to someone recognising there may be a problem and that they might need help, it is of vital importance. It is critical that they appreciate you are listening in a totally non-judgemental and confidential way and they can speak openly without any worry about prejudice, stigma or implications.

• Try not to make assumptions, be patient and non-judgemental.
• Never express any anger or disappointment or try to rationalise how they are feeling.
• Think about your body language, where you are sitting and how you can make them feel most at ease.
• It is important to ensure the person feels you are listening to them completely and concentrating on what they are saying.
• Ensure you are not distracted or interrupted during this important communication.
• Set-aside any pre-conceived judgements and ensure you listening to them with a completely open mind.
• Use verbal and non-verbal listening and communication skills to ensure that the person knows you are actively listening to them and engaging in what they are saying.
• Think carefully about your body language.
• Do not be tempted to interrupt them or to suggest how they may be feeling.
• Empathise through gestures and body language.
• Accept what they are saying, even if it doesn’t make sense from your perspective.
• Try not to jump in and offer solutions.
• Never give examples of someone else with similar problems as that is seriously breaching confidentiality and will dent their trust and confidence in you too.
• Clarify and repeat back what they have told you, so you are both sure you have understood and summarised the situation properly.

Click here for an Enhanced Mental Health First Aid course in collaboration with the Maudsley

3: Recommend sources of immediate help

Once they have felt they have been listened to and better understood, they may be more receptive to you offering further support and information.

• Make it clear you recognise how they are feeling and explain how you can help them to get help and start feeling better.
• See if there is any obvious practical help that can be sorted to help ease their stress. For example, if they are overwhelmed with school work or exam stress, there may be a way school can help.
• Be ready to support them making an appointment to see their GP – they may or may not feel more comfortable with someone coming with them.
• Be ready to signpost them to additional support, providing the time is right and they are not too overwhelmed with their current distress.
• It is extremely courageous of them to open up to you and not an easy thing to do. They are likely to feel worried and vulnerable and uncertain as to whether there are any negative implications to the conversation. Reassure them, thank them for confiding and explain, they are not alone – 1 in 4 people experience these feelings and you are here to help.

4: Encourage to seek professional help

Someone with a mental health issue will generally recover faster with appropriate professional help.

• Exploring possible options together and be ready to allay fears of possible stigma, or mistaken beliefs about various options.
• Helping them realise that they are not suffering alone, can be empowering for them. They may not have known about possible options; including counselling, psychological therapy, medication, financial support, help for family members, specific support groups. They may not have even realised why they were feeling as they were.
• Ask if there is anyone else (such as a friend, family member, teacher, other trusted adult) who they would like to tell who might be able to offer additional support to them.
• Their GP – can offer ongoing holistic support and treatment and refer to appropriate professionals as necessary. They will also be able to rule out medical reasons for the way the person is feeling.
• Crisis Line – they may have already been given the Crisis Line number. If so there will be a trained healthcare professional who should be able to help them.
• Samaritans – 116 123 – open 24 hours a day, 365 days a year. With trained operators ready to help.
• Call NHS 111 or 999 if seriously worried that they are a risk to themselves or others.

Reasons to contact the emergency services:

• The person is experiencing serious suicidal thoughts or feelings
• They are thinking or talking about harming themselves or someone else
• Experiencing acute medical symptoms
• They have already hurt themselves
• You feel threatened by their behaviour and our worried that in approaching you could aggravate the situation and put yourself, or them at greater risk.

Please note:  It is vital to respect the person’s consent. They cannot be forced to seek help or to go to A&E. It is quite common for people to periodically have suicidal thoughts, but not to act on them.

5: Suggest possible self-help options for better mental health

• Explain available self-help strategies
• Let them know about specific support groups
• Encourage them to discuss how they are feeling with other close friends and family
• Signpost to appropriate community and voluntary sector organisations, there are online communities and peer support networks. All there to help. MIND is a superb website to explore together.
• Look at proven self-help coping mechanisms
• Respect the person’s wishes if they prefer to seek culturally-based care.

MIND has some excellent resources to help someone experiencing a mental health issue https://www.mind.org.uk/information-support/helping-someone-else/ and a huge range of specific topics for the person experiencing the mental health issue to access themselves https://www.mind.org.uk/information-support/.

Young Minds also has a wealth of resources.

Click here for a Mental Health First Aid course for Young People

Getting help:

Your GP is often the first port of call.  Be open to all suggested options.

If the first thing they try doesn’t work, encourage them to look at alternatives. Sometimes the first counsellor may not have quite the right approach or be the best person to help. Support the young person in gaining alternative help – they deserve it.

Furthermore, sometimes online support or group therapy may be the best approach. They should have a say as to what works best for them.

The Royal College of Psychiatrists have produced information specifically for children and young people to help them get the support they need – U can cope! .

Once you have had the initial conversation, things you can do to support them:

1. Try not to change how you behave towards them. Retain boundaries and consistency – this keeps a level of control and stability in their life.
2. However, be sensitive to changes in their mood. If they are not feeling their best, ensure you are ready to further talk if they wish to.
3. Arrange a time and place that is stress-free for both of you, ensure you will have enough time to have a proper conversation without being interrupted.
4. Be calm and positive.
5. They may have been very worried that someone won’t understand, your continuing support will mean a great deal.
6. It is important to reinforce that you care about them, are there for them and will do whatever you can to support them in getting the help they need.
7. Make it clear that everything they tell you will remain confidential. Never break this confidence (unless you have a significant concern for their safety).
8. However, encourage them to think about other people that might be safe and helpful to confide in (e.g. other family members, a teacher, trusted adult, carer, friend, GP, helpline).
9. Suggest moderated self-help groups, these can be really helpful to talk things through with others with similar experiences.
10. Be ready to help with practical support, such as taking them to appointments, even if you wait outside.

Counselling and talking therapies

There are various talking therapies available and they are generally extremely helpful and effective.

CounsellorsMany schools, colleges and universities offer trained counselling services. Otherwise, their GP can refer you to NHS counselling (although there may be a long wait)

Counselling is often recommended for young people who need additional support with a mental health disorder such as depression or eating disorders. The Counsellor will help them explore and address possible underlying problems and stress such as anxiety, bereavement, trauma, bullying, anger, relationships, low self-esteem and self-harm.

Counsellors can help young people better understand their feelings, identify what might be causing them to feel or behave a certain way and help them develop strategies to cope.

MedicationMedication can be prescribed to enhance mood, reduce anxiety, reduce psychotic episodes. However, with all medication there is a risk benefit ratio and it is important to be aware of possible side-effects and ensure the medication is taken appropriately, avoiding possible drug interactions and contra-indications.

Some medication can affect sexual performance, or make your skin more prone to sunburn, they can affect your ability to drive, your mood and energy and ability to safely operate machinery at work.

All these factors need to be carefully considered and discussed before embarking on medication.

Psychological therapiesTalking with a mental health professional 1:1, or in a group session. For some people, these can be incredibly powerful. They are also accessible as apps, skype and zoom consultations, self-help books and courses. They are designed to help people gain self-help coping strategies, insight and find new ways of managing their condition.

There are numerous complementary therapies and lifestyle changes that can be prescribed by community health professionals or just accessed as self-help. Exercise and changes in diet, both have major roles to play in our mental health.

Other optionsSupport groups can be extremely helpful, MIND have a large online community Side By Side and access to many other support groups from their excellent website.

Rehabilitation programmes help people to re-build confidence and regain skills to be able to live independently.

Family, friends and work-colleagues will play an important role in someone’s recovery.

Other professionals who can help:

The community health team:

GPs can offer a holistic approach to helping someone with a mental health issue. In addition, they can exclude any physical cause, explain how the disease might manifest itself and progress and prescribe medication and complementary therapies, through social prescribing networks.

Community psychiatric support and psychologists can also be helpful in supporting the person’s recovery, along with other community support.

Counsellors, psychologists and psychotherapists: have also been proven to help people find new coping mechanisms with their illness. They offer various talking therapies that are specific to different conditions. Sometimes they focus on helping people cope with their conditions and sometimes the focus is more about problem solving, to assist them to solve stressful situations in their lives to cope better. This therapy can be conducted as 1:1 or in groups or families.

Psychiatrists: are medically trained doctors, specialising in treating mental illness. Their focus is usually more medication focused and they would be more likely to see people with more complex or long-term conditions. Your GP can refer someone to a psychiatrist if they are experiencing more complex illness or are not responding to first line treatment. Although it is possible to access this help privately.

Mental health nurses: specially trained nurses focusing on caring for the mentally ill.

Occupational therapists: Can help re-train people and make appropriate workplace adjustments to help them return to work.

Care Co-ordinators – or key workers are community-based workers who co-ordinate care under the Care Programme Approach CPA and assist a multi-disciplinary team to communicate and work together to help the person cope in the community and workplace.

Different types of counselling

There are many different counselling options, but the following are the most commonly recommended for young people:

Some private psychotherapists work from home.

Family Therapy: This is inclusive therapy for the whole family. It can help improve family cohesion. The family counsellor can assist everyone in communicating more effectively and finding ways forward with areas of potential conflict. It is particularly helpful in addressing and assisting issues such as children’s behavioural problems, family breakdown, addiction, abuse and domestic violence.

Cognitive Behavioural Therapy (CBT):  CBT encourages people to think more positively about life, to review patterns of behaviour and try and change things to a positive spin. Typically, someone is offered 6 or 12 goal orientated weekly sessions. With practical homework in between.

Mindfulness: Mindfulness is often used alongside CBT. It is effective at helping people to face difficult thoughts and feelings, rather than avoiding them, consequently this lessens their fear of them. Therapists often include meditation, yoga and breathing exercises. This combination can be extremely helpful.

Psychotherapy: This is conducted by a Psychotherapist, usually in a clinic or hospital.  It is particularly helpful with long-term problems such as depression or eating disorders.

If they are referred to CAMHS (Child and Adolescent Mental Health), the team will try and include the family if appropriate and helpful. Parents and carers can also ask CAMHS staff questions at any point in the assessment or treatment.

Parents Guide To Support A-Z – Young Mind’s excellent resource

Finding further help:

The NHS Mental Health Team are overstretched. If the child or young person does not fit the criteria for CAMHS, your GP may be able to suggest alternative local counselling provision for young people.

Schools, colleges and universities can also refer young people to CAMHS. In addition, they may offer their own counsellor or mental health services on-site.

There are many charities  and other organisations out there offering advice, support and solidarity from helplines, group forums and message boards, email- webchat- text- and email services.

Counsellors and therapists also operate privately:

British Association for Counselling and Psychotherapy (BACP)

• Professional body that sets standards for therapeutic practice, and provides information for therapists, clients of therapy, and the general public. Their helpful website includes information about counselling and psychotherapy and how to find the right therapist.
• Phone: 01455 883 300 (Mon-Fri 09:00 – 17:00)

Association of Child Psychotherapists

• This is a register of accredited Child and Adolescent Psychotherapists in the UK.

Counselling Directory

• Lists private counsellors and psychotherapists registered with a professional body. They can also provide information on the different types of talking therapies including family therapy.

British Psychological Society

• Has information on how psychologists can help with mental health problems, and how to find a psychologist.

Youth Wellbeing Directory

• Lists local services for young people’s mental health and wellbeing.

Counselling for families – Relate

Support, guidance and counselling services for families and young people. When families are going through a tough time, Relate offers support to help everyone settle. Phone: 0300 100 1234 or contact your local Relate Centre.

• For families
• For family life and parenting
• Parenting teenagers
• Relate counselling options: Live chatroom, message a counsellor, webcam counselling, telephone counselling

Online and phone support for children and young people:

Childline

• Children can confidentially call, email, or chat online about any problem big or small
• Freephone helpline: 0800 1111 (24 hour service)
• Sign up for a childline account on the website to message a counsellor anytime without  email

The Mix

• Provides a confidential helpline, email, webchat and telephone counselling service for young people under 25. Advice and information on support services for young people including counselling.
• Freephone: 0808 808 4994 (daily 13:00-23:00)

Kooth

• Provides free, safe, anonymous online support for young people – counselling, messaging, personal stories. Only available in certain parts of England and Wales.

Relate (for children and young people)

• Children and young people’s counselling for any young person who’s having problems.
• Free Live Chat session with a trained Relate Counsellor
• Phone: 0300 100 1234

Royal College of Psychiatrists – You Can Cope https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/young-people/u-can-cope!-how-to-cope-when-life-is-difficult-for-young-people