In most countries adolescent health is greatly neglected which doesn’t bode well for any society given that seventy-five percent of mental health disorders first develop in adolescence, with more than fifty percent before the age of 14 years (Australian Institute of Health and Welfare (AIWH), 2022). Adolescents are our future, and this is a critical period for acquiring socio-emotional skills, so we need to invest in their care as a society across childhood, school and during their transition to adulthood.
Adolescence is the phase of transition from childhood to adulthood, ranging between 10-19 years (United Nations) and 10-24 years (The Royal Children’s Hospital in Victoria). This variance in age suggests that the rate of maturation varies widely and is influenced by different factors, both environmental and genetic.
Thirty-one percent (31%) of young women and thirteen percent (13% ) of young men with mental health problems seek professional help. Of those with severe mental health disease, around eighty percent (80%) seek support, so it’s the mild to moderate group which is mostly being missed and is at risk of slipping through the gaps. This has implications for school failure, which is also a common symptom of family dysfunction. Children and adolescents who live in violent or dysfunctional households, experience emotional disturbance, behavioural difficulties and this has implications for their learning and social development too.
The importance of confidence in early life is key for good mental health so I’ll talk about strategies for raising confident adolescents as well as briefly discussing some of the more common mental health issues such as anxiety and eating disorders. The links at the end are useful but remember to see your GP and contact the school counsellor for help if you are worried about your adolescent’s mental health.
Some interesting stats
- Around half (50 %) of all adult mental health disorders start before the age of 14 years
- Almost 1 in 7 (14%) children and adolescents aged 4–17 years were estimated to have experienced mental illness in the previous 12 months
- Anxiety was the most common condition, experienced by two in five young women and one in four young men in 2022-2022 (ABS 2023).
- Suicide continues to cause the largest loss of life of young people in Australia (36% of all 18-24yr); one third (32.4 per cent) of all Aboriginal and Torres Strait Islander child deaths occur due to suicide.
- School failure is a common symptom of family dysfunction – which results in emotional disturbance and behavioural difficulties.
- Childhood trauma: the impact of family dysfunction, intergenerational trauma, bullying, abuse, neglect, stress caused by poverty can all have a profound effect on mental health.
- Adolescent brain reaches full maturity in the mid 20s. This has implications for higher level decision making and risk taking behaviour, which might explain the increased rates of self-harm be it accidental or intentional, as well as for alcohol and drug taking behaviour during this period.
- Declining mental health in our youth has occurred at a rapid rate over the past 8 years. The latest data from the Australian Bureau of Statistics (ABS) shows nearly 40 per cent of young Australians aged 16 to 24 — more than 1 million people experienced a mental health disorder in the previous year, which was 26% higher than in 2007(Australian Bureau of Statistics, ABS 2023)
- LGBTIQ people who described themselves as gay, lesbian, or bisexual had nearly three times the rate of mental health disorders at 58.7 per cent compared to their heterosexual counterparts at 19.9 per cent
- One in three transgender people reported a mental health disorder within a 12-month span compared with one in five cisgender people.
The most common mental illnesses among children and adolescents were
- Attention Deficit Hyperactivity Disorder (7%)
- Anxiety disorders (7%)
- Major depressive disorder (3%)
- Conduct disorder (2%).
Social media and mental health decline in adolescents
Social media is where people interact, and young people build a view of themselves from these interactions also. Advertising reinforces certain physical appearances and body types which create expectations in young people’s minds. Add to these denigrating comments about photos your adolescent has posted of themselves by peers, or a baseline negative self-image, this can be very damaging.
Confidence in teen years is key for mental well being
When it comes to raising a happy and healthy teenager, ensuring they feel confident about themselves is central. Try not to be distracted when they talk to you, stop what you are doing, listen and let them talk. Find out how they are feeling and if they tell you they don’t feel good, find out why they might feel down in the first place, and it might come down to lacking confidence. If unaddressed, this can feed feelings of negativity about themselves and lead to anxiety.
Confidence building strategies: (this is a long list so any or all of these can be useful)
- Listen. Your body language and facial expression matter, so put down your phone, don’t rush them and don’t interrupt or allow yourself to be interrupted. This shows them you care. This is not about you it’s about them.
- Talk to them and ask about any difficulties they are facing. If you’re worried about your them, let them know this and let them know how much you care.
- Love them. Tell them you love them.
- Keep the doors of communication open always, even when they have upset you or done something that’s disappointed you.
- Speak using their chat style such as email, text message rather than face-to face. Texting throughout the day either sharing bits about your day or just to check in.
- Help adolescents identify their strengths and focus on these, rather than their weaknesses. If you notice negative self-talk, it usually means they don’t feel good about themselves or that something has occurred to challenge their self-worth. Help counter this by highlighting all their good traits.
- Mistakes will be made in life. They need to learn that mistakes are part and parcel of learning, so they need to accept and forgive themselves to learn through them. You as a parent play a key role in helping with this, by forgiving them too and even sharing how you have done this in your life.
- Be honest about your weaknesses. Share with them times you felt the same way and how you worked through this phase – given them hope that it all works out in the end with effort and support. Talking and sharing eases the sense of isolation.
- Praise your children. Acknowledge them when they are kind and show empathy as well as when they have done well with something. It’s not just about achievements, but more about their effort and kindness.
- Set an example yourself. Everything you say is absorbed (although you might think they’re not listening) and everything you do as an adult is noticed, or even replicated. Monitor how much alcohol you drink around your teenagers, how you speak about others and your own self talk.
- Support your child with difficult projects and tasks. Helping them achieve their goal is a big confidence booster.
- Encourage them to speak to the school counsellor. If you or they are concerned, encourage them to seek support. Book a long appointment with your GP for your adolescent. If you escort them to the doctor, be prepared to leave at some point so the adolescent can talk for themselves in confidence, without you listening in.
- Plan one-on-one time with your adolescent on a regular basis. These are precious times where you can just do simple daily or new things together. It might be a bike ride or a walk. If they want less time alone with you, respect that too.
Setting limits can create tension
They are dependents and the role of parents/guardians remains important, although this is also the time during which they test their independence. It’s natural for adolescents try to assert themselves, disagree with authority, take risks and even break rules yet few parents receive any training or support to navigate this period.
Limits set by parental monitoring are necessary to create a sense of security, structure and predictability, yet may also provoke tension. On the other hand, giving in to adolescent resistance can result in poor parental monitoring, which is clearly linked to negative outcomes in adolescence. For parents reading this, many will be familiar with the need to be firm but loving and find this parenting phase difficult, especially when all your buttons are being pushed and tensions rise. For some parental guidance and support, check out the links from the Australian website Raising Children (https://raisingchildren.net.au), and refer to them when you feel stuck for ways to navigate this phase.
Eating disorders
An eating disorder is an unhealthy obsession with eating, exercise or body shape and can affect anyone at any age but occurs commonly in adolescence and young adulthood and it affects more young women. It can escalate quite fast which can be very scary for parents and adolescents can be ambivalent about seeking support. There are number of different types of eating disorder but anorexia nervosa which results in profound weight loss and is associated with a dysfunctional body image is referred to here.
As a parent you might notice your adolescent experience a lack of energy, change their behaviour around food, change in appearance, wear baggy clothes all the time, eat in private, change in weight and become highly sensitive to comments made about this, and they might exercise excessively. They might display rigid black and white thinking – foods are labelled either good or bad, which creates tension in the home. Parents need to take control of this situation, but they need help to understand what is going on in their adolescent.
Give the adolescent space to talk about their emotional state rather than commenting on their shape and appearance. Try to remain non-judgemental and calm. Avoid being critical. Talking about this with someone makes them feel a lot better so booking to see your GP is a good step. Recovery and treatment require a multi-disciplinary team which includes the GP, the therapist, a psychiatrist, dietician and parent. It’s not a one-size-fits-all approach. It’s a step-by-step process and recovery is not linear, but goes up and down, so getting the right support for a long period of time is key. In Australia, the government has acknowledged how complex this is and how costly it is also for a family so has a special mental health care item number for eating disorders which funds up to 40 sessions per year. The Butterfly Foundation offers a suite of programs and services for people with eating disorders and teaches everything from mindfulness techniques, like visualising putting a negative thought on leaf that floats away down river. They teach the person to stop the inner voice telling them they are fat and help them realise it is the eating disorder, not them saying this. Eating disorders like anorexia nervosa can be a life-or-death situation.
Anxiety in Adolescents:
Feeling anxious or very worried sometimes is normal but it is when it overtakes you or becomes a daily feeling which doesn’t go away, this requires attention. The adolescent might feel jittery and worry excessively about what might happen or what has occurred. It can affect their school focus, socialising behaviour and enjoyment of life. Help through early intervention plays a big part in preventing the consequences of anxiety which can be debilitating. Seek support from your GP and have a look at the Brave Program which is a cognitive behaviour therapy tool based on established clinical practice guidelines for the treatment of child and adolescent anxiety, as described by the Royal Australian and New Zealand College of Psychiatrists. This online program provides support on how to deal with anxiety and is for teenagers and parents: https://brave4you.psy.uq.edu.au/teen-program
Symptoms and signs of anxiety or anxiety disorders in teenagers can include:
- feeling constantly agitated, tense, or restless
- being sensitive to criticism or extremely self-conscious
- always worrying about things that aren’t likely to happen
- avoiding difficult or new situations that make them anxious
- being withdrawn
- having trouble concentrating and starting or finishing schoolwork
- having trouble sleeping
- changed eating habits
Their future is our future:
Adolescents are our future, so we need to invest in their care as a society across childhood, school and during their transition to adulthood. They are dependents and the role of parents/guardians remains important, although this is also the time during which they test their independence. It’s natural for adolescents try to assert themselves, disagree with authority, take risks and even break rules yet few parents receive any training or support to navigate this period. Check out the resources and remember that it takes more than one person and one system to support a child into adulthood.
Resources and support for parents/guardians
- raisingchildren.net.au/teens/family-life
- raisingchildren.net.au/teens/development/adhd
- raisingchildren.net.au/guides/a-z-health
- Brave program
Community resources for children – adolescents
- Kids Helpline — 24 hour free advice line – telephone and online counselling for ages 5 to 25, call 1800 55 1800.
- headspace — online, in-person and phone support for people aged 12 to 25.
- headspace also has mental health information and resources for multicultural young people.
- Lifeline (24 hour advice line) T: 13 11 14 (local call)
- Orygen Youth Health T: 1800 888 320 (free call)
- Suicide Call Back Service T: 1300 659 467 (local call; free 24 hour advice line) or their webpage has details about their online or email counselling service too
- Suicide Line T: 1300 651 251 (local call; free 24 hour advice line) or their webpage has details
- Reach Out — youth online mental health service.100% online, anonymous and confidential
- Black Dog Institute
- The Royal Children’s Hospital Melbourne – Information for Patients and Families
- Victorian Nurse on Call (free 24 hour advice line) T: 1300 606 024 (local call)
- Youth Beyond Blue (free 24 hour advice line) T: 1300 224 636 (Iocal call)
- Butterfly Foundation
References
*Associate Professor Magdalena Simonis AM MBBS FRACGP DRANZCOG MHHS
