Mental Health Protocols: Why Speak Up?

TW: discussion of suicidal thoughts, mental health crises, and inpatient/outpatient programs

Although mental health has become less stigmatized amongst teenagers in many ways, it remains an incredibly challenging topic to open up about. Reaching out to a trusted adult during a mental health crisis can feel simply impossible, especially when you don’t know what their response will be. I can’t even begin to unpack the stigma surrounding mental health with a single article, and for some people, it can feel like there is no choice but to keep quiet. I can’t pretend to provide an “easy way out” for those who are struggling to speak out and to be heard.

One thing I have heard from a lot of friends who are dealing with severe mental health challenges has been, “I can’t tell my therapist because they’ll tell my parents.” They worry about the possible consequences of opening up, especially when the challenges that they are dealing with would require an adult to help. There isn’t a ton of well-known, accurate information about the more extreme responses, such as admission to an inpatient or outpatient program at a hospital, and because of this, the mere existence of those institutions is enough to steer some people away from confiding in trusted adults.

What I can do is attempt to thoroughly explain the protocols for teachers, guidance counselors, and therapists when it comes to dealing with teenage mental health, because according to Sara Shine, the Director of Needham Youth and Family Services, “the longer someone waits, the worse the symptoms can get. Depression and anxiety can quickly escalate to panic attacks, isolation, self harm and suicidal ideation, and substance use can become to an addiction. Not seeking treatment can be harmful.” 

Especially for students whose parents seem unsupportive of their mental health, it can be anxiety-provoking to reach out to another trusted adult for support. It's important to remember that all mental health professionals, including school counselors and clinicians, are required to keep any information about their students or patients completely confidential, the exceptions being if the student is at risk of hurting themself or someone else, or if they believe that the student is in an abusive situation. These professionals know how emotionally challenging it can be to talk to family members about mental health struggles, and won’t involve those family members unless they decide that one of those serious risks are present. This is all the more reason for students to come forward with all smaller-scale mental health challenges, such as growing anxieties, apathy, or depressive thoughts, before they escalate and require parental notification. 

Should a mental health professional decide that it is necessary to inform the parents of someone’s mental state, they will begin by talking to their client. They will explain exactly what they plan on saying to the parents and why. Counselors and therapists are “mandated reporters,” but they care about their clients and students first and foremost, and will make sure that they are fully aware of how and why their information is being shared. Although certainly not reflective of everyone’s experiences, Shine noted that “most individuals are a bit relieved once the information is shared because it allows for the needed, more intensive support to be put into place.”

Sometimes, the idea of getting treatment is scary, especially for someone who is used to dealing with their mental health issues alone. Treatment will look different for every individual, and the type of treatment that someone receives is based on the level of risk that their mental state poses. School counselors can recommend that a student be evaluated so that they can discuss their risk levels with their parents or an outside professional. And yes, inpatient programs are an option that is explored for those at immediate risk of harming themselves or others, but Shine made it clear that “although all signs/thoughts of suicide should be taken very seriously, it does not always mean that someone will need to be hospitalized.” There are also outpatient programs, which don’t involve staying in the hospital overnight but still ensure that those struggling with mental illnesses have the support they need on a day-to-day basis. The two types of programs provide the same care and treatment options, but as explained by the Psychological Care and Healing Center, inpatient programs can be extremely beneficial because they allow people to practice coping strategies without external stressors. Outpatient programs are more useful for those who feel more ready to practice those skills in a real-world environment after a day of treatment. 

And although it sounds scary and extreme, Shine notes that ”many times the hospitalization is a very supportive and lifesaving option where people feel heard and connected.”

These steps towards recovery may sound intense, and for those who are scared of being placed in these types of treatments, it is vital to remember that counseling and therapy look very different for different people. There are tons of methods proven to help teens learn to manage anxiety, depression, OCD, and other mental illnesses. And for those battling severe mental illnesses, Shine believes that it is “all the more reason to seek out help to prevent tragedy from occurring.” In her experiences, “most times a mental health professional can help the individual navigate mental health challenges without outside intervention. It’s important to understand that when a person demonstrates a willingness to get better, this is usually an indicator that they likely do not require any sort of forced hospitalization. Being open and  honest with a trusted adult is always going to be the best first step, even though it can feel absolutely terrifying at first. 

Battling a mental illness can feel difficult, hopeless, and incredibly lonely, and when coupled with the stigma surrounding mental health and lack of support from many adults, it can seem completely impossible to speak up. Despite this, there is always somebody to turn to. Here at Needham High, every student is assigned both a guidance counselor and a personal counselor. All members of the guidance department are in direct contact with Needham Youth and Family Services, which provides professional mental health services for free when needed.  Reaching out is the first step towards recovery, and no matter what that journey looks like, it will always have been worth it. “Recovery is possible and mental health services work,” says Shrine. “Having this hope is a crucial first step.”