The need for proactive and comprehensive mental healthcare for Canadian youth has never been greater. Anxiety and depression in adolescents has doubled since the beginning of the pandemic, with rates being most significant in older adolescents and girls.
If you suspect that your child is among the 1 in 4 who are suffering from anxiety or depression, determining how to go about getting a diagnosis as well as the best course of treatment can seem overwhelming. You may also struggle to overcome the stigma around mental health disorders that is still so ingrained in our society.
While mental health disorders are increasingly destigmatized, in practice this is still something that takes time during the therapeutic relationship. As a physician, I seek to remove the concerns of my clients and their loved ones and create an environment where they can see success. Through my own experiences, as well as those supported by numerous studies, a multidisciplinary approach to mental healthcare is optimal to seeing improvements. This is especially true for teens and young adults. The support of multiple healthcare practitioners plus parents and teachers can bring about amazing change.
What to look for in your teen
Signs and symptoms of anxiety and depression in teens are extensive. Generally speaking, a sustained change in emotions or behaviour, particularly those that interfere with their life or that cause you concern are important to note. Sometimes anxiety or depression can manifest as vague unexplained physical symptoms such as: fatigue, abdominal pain, or headaches. Anxiety or depression symptoms likely won’t resolve on their own, so it’s incredibly important to seek help before they worsen.
As parents, it can be challenging to distinguish between normal teenage development and signs of mental health disorders, so it’s important to have a personalized assessment done by a healthcare professional.
Overcoming the mental health stigma
Clients are often hesitant to initiate a conversation about mental health. The “label” of a diagnosis or being prescribed medication is something many have trouble accepting.
The apprehension to seek help for mental health concerns is completely normal.
There is often a sense of loneliness for those with anxiety or depression, so it’s important to find a provider who helps to normalize and emotionally validate your symptoms. They should be an advocate as well as a care provider.
Once diagnosed, clients and their parents typically overcome the fear of a “label” because it provides a sense of normality and is a huge step towards recovery.
A team approach to mental health is best
As with the physical body, healing the mind also benefits from a holistic approach. A physical illness is commonly supported through diet, exercise, regular assessments and, if needed, medication. When we think of someone with a mental health concern, the same should be true. According to research, a multidisciplinary approach is the most effective method.
What does a multidisciplinary approach look like?
For a teen or young adult, a multidisciplinary approach to mental healthcare typically involves a team of healthcare professionals, including a physician, nurse practitioner, dietitian, exercise physiologist, psychologist or psychiatrist (if needed) plus the support of parents and teachers.
To help share some insight on what this may look like in practice, the following is a real life example of successful care from a collaborative team:
The Client
A young adult client came to me with severe depression and anxiety. After considering other causes and providing a diagnosis, I connected them with the most appropriate team members and community health practitioners for a collaborative approach.
Registered Dietitian
Our Registered Dietitian focused on optimizing the client’s nutrition, which helped lower their cholesterol and optimize their metabolism. Eating a nutritious diet, maintaining a healthy weight and making personalized food choices had a strong impact on the young client’s energy levels and overall mental well-being.
Exercise Physiologist
The client also worked with an exercise physiologist who optimized their fitness routine. This helped them reach a healthier weight and promoted the release of natural endorphins, or “feel-good” hormones.
Physician and Psychologist
I focused on providing longitudinal care with ongoing mental health assessments. This involved frequent safety checks and focused on managing medications and coordinating care with our psychologist colleagues who assisted with cognitive behavioural therapy (CBT) and counselling techniques.
Care Coordinators & Registered Nurse
Of course, none of this would have been possible without our amazing care coordinators and nursing team checking in and helping to ensure continuity of care.
Psychiatrist & Pharmacology
The client was referred to an excellent psychiatrist who provided therapy and helped optimize their medications in conjunction with the team at Harrison Healthcare.
Client Outcomes
The team-based approach to care combined with the support of family has helped this teen immensely on their journey so far. Where previously they had passive suicidal ideation, felt hopeless and anxious, they now have a brighter mood and lower scores on objective measures of anxiety and depression severity (ie. GAD-7 and PHQ-9). They have become more active, reached a healthier weight and are even sleeping better.
I strongly believe that this level of improvement could not have been achieved without having an entire care team involved to provide the best quality of mental health care for this young client. The family felt well cared for and supported by all members of the team due to regular, consistent follow-up. This holistic approach sets them up for long term success, as they now have several strategies (diet, exercise, counselling and medication) to keep them well and help them better cope in the future if mental health challenges arise.
Ongoing Dedication to Care
A dedication to optimizing care has led to the creation of a new role at Harrison Healthcare called a Mental Health Navigator. The Navigator is someone with a mental health background who helps connect clients to the most appropriate mental health professionals within the community. This role was established to fill a very real need that stems from the difficulty and confusion many clients or their parents have when seeking a mental health professional that is the right fit. Having a psychologist, counsellor or psychiatrist that truly connects and understands your needs can make a world of difference.
What are the best treatments for mental health disorders in youth?
There is no best treatment for everyone. Each case and person is unique, which is why it is so important for there to be a personalized, multifaceted approach that is precise and effective (this is also referred to as Precision Medicine).
Generally speaking, as practitioners for young adults, we stress work/school/life balance and normalize talking about mental health. Practitioners help promote sleep hygiene, encourage self-care, healthy social relationships and safety planning. A thorough mental health assessment typically includes conversations about school, relationships, practicing safe sex, and drug and alcohol use.
Whenever a client comes in with mental health presentations, we first consider reversible medical causes that stem from organic causes such as: thyroid issues, iron and vitamin deficiencies (ie. calcium excess or vitamin B12 deficiency). It is important to keep our differentials broad to ensure we are reaching the correct diagnosis.
If there are any safety concerns regarding a young person, expediting their urgent treatment in hospital may be appropriate. Educating clients that safety concerns are a “red flag” and require emergency treatment is crucial. A safety assessment is a priority with any mental health presentation and consists of ensuring the patient is not at risk of physically harming themselves or others or having any thoughts of suicidal ideation. We also assess for substance use, history of suicide attempts, impulsive behaviour, risk of harm from others and how they cope with stressors.
Everyone experiences mental health in their own unique way. Determining how to best support our clients takes time and experienced clinicians. Within a multi-disciplined approach, the best results are seen through a combination of CBT (cognitive behavioral therapy) with our psychology partners, consideration of medication (SSRI vs SNRI) when appropriate and above all empowering our clients to be actively involved in their mental health treatment.
Ultimately, the most important step towards better mental health for your child is to first seek help. Please contact your healthcare team or physician for a personalized assessment so your child can get the help they may need to better cope and begin their journey to lifelong wellbeing.
