When is a mental health issue not a mental health issue?

October 19, 2022

Most parents are fully switched on to the state of their child’s mental health, but because of how adolescents, in particular, communicate figuring out what is really going on is far from straightforward. Here is an example of what I mean.

I get a message from a family seeking an urgent appointment. They have a 16 year old daughter who has said she is suicidal. I arrange an appointment for the coming days. On the morning of the appointment the mother messages me to say could they please cancel the appointment as their daughter is now fine ? How can you be suicidal one day and fine there next ? Of course she wasn’t suicidal just feeling low.This sort of referral is not unusual. 

Lets try and unpack this a little and see if we can get a sense of what might be going  on. In the first instance I attach no blame whatsoever to the parents. What are you to do if your teen ( and its usually teens) expresses suicidal feelings ?

‘Dont worry you’ll probably feel better in the morning’, isn’t necessarily the best response.

Here is another instance. A mother rings to ask what she should do ? She tried to take her daughter’s phone away and the daughter threatened to jump out of the window. Would you call her bluff, knowing how impulsive teens are or do you back off ?

These are a couple of tricky modern parenting dilemmas, and there are many more. The teen of today bears very little similarity to the teen of 5-10 years ago. Parenting them is no easy task even for an experienced parent 

There are several issues to hold in mind in thinking about their behaviour and mental health.

The first is their use of language. For reasons I don’t quite understand they communicate in ‘extremes’. A difficult day at school is the ‘worst day of my life’. A fallout with a friend translates to ‘everyone hates me and I have no friends’. A disappointment can elicit the ‘ I want to kill myself’ response. These ‘extremes’ make it very difficult to track what is actually going on. Do I, as parent, take them at face value or do I ignore them? There is no easy answer.

There is a second parenting roadblock. It sometimes appears as though any adverse emotion, feeling or experience translates to an apparent ‘mental health problem’. It can often appear as a badge of honour among teens as in, 

‘Im depressed’

‘Yes I know and I hear you but Im more depressed than you. Im so depressed that I feel like killing myself’.

This has particular relevance to cutting among teenage girls. It would seem that no girl teen life is complete without a bout of cutting.

There is a third component to this and that is their use of screens. Much has been written about this so I don’t want to labour the point. However one of the side effects of screen use is that they can block out adverse or negative experiences to the extent that they never have to process them. When screens are either unavailable or ineffective in blocking out difficult feelings they are often temporarily overwhelmed.

How are parents meant to make sense of their teens behaviour and more importantly how do they manage them ?

The first point to make is that it’s important to look for patterns of behaviour rather than one off events. If you son says he is ‘depressed’ you need to look at patterns. Is he still socialising with friends or  is he withdrawing ? Has his school work fallen off? Is he losing interest in his hobbies or passions?  Is he sleeping excessively ( keeping in mind that teens tend to sleep a lot anyway). If all of these are a concern then there is a good chance that something is wrong and you need to intervene. Taken together they don’t necessarily mean your son has a mental health issue but some exploration of what is going on is definitely needed. If most of the above are ticking over relatively well then the likelihood is there is nothing to worry about. 

The second point that needs making is that there needs to be some discussion with your teen about how they communicates their ‘feelings’. Using ‘extremes’ makes parenting them very difficult. You cannot track their emotional state through time if they use dramatic and sometimes hysterical language.  They need to tone it down. 

It is important to have an idea of who is who in their friendship group. This is particularly important 


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