Supporting Youth Mental Health | HealthCasts Season 7, Episode 22

Supporting Youth Mental Health | HealthCasts Season 7, Episode 22

(gentle music) – [Announcer] From Sarasota Memorial and the Deb Kavanaugh Multimedia Studio, this is “HealthCast.” A healthy dose of information
from experts you can trust. (gentle music) – Hi, everybody. Welcome to “HealthCast.” I’m Alison Gottermeier. Thank you so much for joining us today. As we kick off a “Behavioral
Health” mini series, today we’re going to be discussing the youth and adolescent
patient population. Our guest today is Dr.
Conor Malloy, a psychiatrist at the Cornell Behavioral
Health Pavilion at SMH. Dr. Malloy, thank you
so much for joining us. – Thanks for having me on. – Could you start by describing
the types of challenges you’re seeing youth
and adolescent patients struggle most often with? – So in my day-to-day work, the thing that I see the most
is depression and anxiety. I also see a lot of children
and teenagers that have issues with impulse control disorders, some, you know, externalizing behavior and conduct disorders. But the vast majority of the
patients that I am seeing in practice right now are kids who are suffering with
depression and anxiety. – Has this changed over the years? – You know, in terms
of relative prevalence of depression and anxiety compared to other mental
illnesses, not necessarily, but I do think we are seeing a rise in depression and anxiety
amongst the youth age group. You know, we are kind of in the midst of what we would call
a mental health crisis, or for lack of a better word, a mental health pandemic
amongst our youths. You know, adolescents, the boys and girls are much more likely to be diagnosed with depression and anxiety than their adult
counterparts at this time. So I certainly would say it’s
been amplifying recently. – Do you think it’s
because there’s actually more youth and adolescent who
are depressed or have anxiety, or is part of it because
people are finally seeking help and maybe actually being
diagnosed more regularly than they would have been? – You know, I think it’s
probably a little bit of column A and column B there.
– Okay. – You know, I think the younger generation is much more ready to talk
about these kinds of things. What I have found in
practice is that, you know, our gen alphas are very, very active in talking about their mental health. And so they are probably getting in front of people who can diagnose them with these individual issues more often. But I do think that, you know, the unique stressors of our day, you know, the state of the
society that we live in are certainly playing a factor into that. So, like I said, I do think it’s a little bit of both things. – How has technology and social media use impacted this population specifically? I know that it impacts every
population at this point, but let’s talk about for
youth and adolescent, how has that impacted them? – It’s really a double-edged sword. You know, one of the
things that I hear a lot from my patients is that
their phone or their tablet or their computer or their
access to social media is very, very important to them. They feel like they get a
lot of comfort and support from these things. But I think one of the things that our youth population
is not recognizing or maybe the detriments of social media and constant access to those things, there is constant pressure to feel like you need to be in contact with your friends at all times. There is kind of that fear
of missing out that we call, you know, the FoMO category of
things, where kids feel like if they’re not constantly
talking to their friends and they’re being left out. And, you know, even spending
a couple of times away with family to go on
vacation without their phone or without their iPad can be something that
causes kids lots of anxiety because they’re used to
constantly being online. And that’s before even talking about what they’re interacting with online, which sometimes can be
fairly harmful material, sometimes it can be supportive, and sometimes it can be in
this, you know, gray zone. – And how does that impact
sort of the bullying issues? I know cyber bullying is a
big topic of conversation. It used to be that if you were bullied, you could maybe go home and shut it off or be in a safe place with your
family or friends close by. How has the internet
impacted that population? – Yeah, like you said, it used to be that, okay, you could get away from the kid who was stealing your milk money at school by just going home, and now it follows you everywhere you go. You know, kids are encountering
these things on TikTok, Snapchat, Instagram,
whatever kids are using. And some of this is
really hard to track too. I mean, we have apps now that
have disappearing messages, and so it’s hard to verify that these things are happening when kids are telling you
like, these are terrible things that my classmates are telling me online. And so not having these kids get a respite from the kind of toxic nature
of some of these conversations has been really, really challenging
for a lot of our kiddos. – And you mentioned
the double edged sword. A big part of depression
can be isolating yourself. Does social media ever kind
of act as a positive thing to like reconnect some of those people who might try to isolate themselves? – Yeah, this was something that
I was really interested in. I actually, you know,
in a former position, I did some focus groups with kids who were dealing with
depression and anxiety about their use of social media. What are you guys using social media for? What would you like adults to know about your social media use? And a lot of them were telling me things about how positive it was for them and how it helped them even find community amongst other kids or teenagers that were dealing with similar issues. – Interesting.
– Now, one of the things that was a little bit
concerning about that is there’s also been research that shows that, like,
really popular accounts that are posting things about depression and posting things about anxiety are often posting things
that are misinformation about depression and anxiety. So, you know, it’s tough because kids are going to
these websites for support but may not be getting
accurate information about what’s going on with them or may not be getting
the right type of support or the thing that’s going
to be most helpful for them. – And it’s of course not just
the internet and social media. Can you talk about the
factors like family stress, academic pressure, even global events, and how that’s impacting
this patient population? – Yeah, so those are things that are fairly consistent over time. You know, family, stress,
disruptions to the household. There’s been, you know,
immense amounts of research about disruptive upbringings, what we call, you know,
adverse childhood experiences, for instance, you know,
even parental separation, even amicable parental separation can be a really big stressor for kids. Seeing things like your parents, you know, have contact with the
police or domestic violence or even significant verbal arguments. Those things can really
affect kids growing up. We see a lot of kids that have dealt with some
significant family dysfunction in my current work and
inpatient psychiatry. You asked about the current state of kind of, you know, global politics or things that are going on socially. And regardless of what
side people are taking, there’s a lot of animosity that exists and kids are definitely
not immune to that. They’re more online than adults are, and they are seeing all of
it and hearing all of it. And they are in this stage where they’re trying
to form their identity and form who they want to be in the world. And they’re trying to do that in a world that to them is very uncertain. – Interesting. What role can parents or caregivers play in identifying and supporting
kids who may be struggling? – So identification is tough because, you know, parents
aren’t professionals. However, the things that
parents are experts in is their own kids. They know their kids
better than anybody else. And so they can identify
changes in behavior. And if they notice a
change, a significant change in a, you know, discreet
period of time from their kid, that may be a time to
just have a conversation with their kid about how they’re doing. Not necessarily trying to pin them down and ask ’em what’s going on, what’s wrong, but just say, hey, I’ve noticed that you’re maybe acting
a little bit differently. Tell me how you’re feeling. And that can be a good
way to open the door to those conversations. One of the things that I see parents struggle the most with is they’ll tell me, I had no idea this was
going on with my kid. And kids will tell me, well, I wanted to talk
to my parents about it for a long time, but I didn’t
want to disappoint them or I didn’t want to
make them upset with me. So parents coming at this
with a kind of open mind, letting their kids know, I’m
not going to be disappointed with you if you tell me
that you’re feeling bad or you’ve had thoughts that are maybe, you know, pretty dark. I just want to help you and I love you and I’m here to support you. – That’s a really good point. But this is also a population that goes through a lot
of changes very rapidly, whether it’s growth,
whether it’s development, whether it’s brain changes,
hormonal, whatever. How can parents try to identify what’s a simple hormonal shift that a kid might struggle with temporarily versus this is something that maybe we should seek
professional help for? – Yeah, I think that’s
the hardest part, right? What is, you know, a
teenager being a teenager and not wanting to hang out
with mom or dad as much, or what is something that
is significant depression or what is something that
is significant anxiety? And I think it comes down to function. If you notice that your kid
is no longer functioning in those aspects of life
that are kind of expected. So for instance, is your
kid spending so much time in the room, not just
away from the family, but not talking to any of their friends? Are they not going to school or do you see a dramatic decline
in their school performance over a short period of time? I think those are the big red
flag kind of warning signs that this maybe goes
beyond what is typical for kind of that teenage
angst that we call it. – Yeah. And in the even younger population, how does a parent know this is a tantrum and
maybe age appropriate because my child doesn’t yet know how to communicate their emotions versus these emotions are
getting out of control or something is not right here. – Yeah, I think a similar answer there. It all goes down to a level
of function, you know, is your kid having to
be pulled out of class, you know, frequently
because of these tantrums? Are you able to bring your
kid to the grocery store and go shop for 15 minutes without having one of these tantrums? And kind of the length of
time when we talk specifically about temper tantrums is important. Can your kid be soothed
after they understand that they might not be
getting what they want? Or does this just last
and last and last and last until you actually do
have to change settings and you have to leave the place? Those can be indicators that maybe there is a more
significant developmental issue going on than just a
simple temper tantrum. – What new or emerging
treatments or approaches are proving effective
with young patients now? – So, you know, maybe not a new approach, but something that we’re seeing emerging is something that kids
are being more open to is a lot of kids are more open to going to therapy regularly. Kind of irregular cognitive
behavioral therapy and working through cognitive distortions. Some of the more emerging technologies for things like treatment
resistant depression, things like TMS haven’t quite made it to the youth and adolescent population, but I think those are going
to be emerging treatments. And, you know, certain newer therapies that are specific to things like trauma, like EMDR, or Eye Movement
Desensitization and Reprocessing, has been something that a
lot of patients have told me has been very helpful for them. – Can you talk about some
of the programs available to these patients specifically at the Cornell Behavioral Health Pavilion? – Yeah, so in the youth population, we kind of serve two big groups. One of those is on our inpatient unit that is for kids and adolescents that are going through
significant mental health crises. So that’s what we call like an acute crisis stabilization unit. It is a primarily group
based intervention. It’s a beautiful facility. We have multiple group rooms, you know, multiple groups throughout each day from multiple different therapists. Learning things like anger
management, impulse control, dealing with negative thoughts,
and self-harm thoughts and even dealing with
difficult conversations between family members. We also on that unit have a
gym available to the kids. So when they’re there,
most of the kids are there under a baker act, but they
have oftentimes ability to engage in recreation through the gym. We have a sensory room,
we have patios there. So it’s a really tremendous
facility, you know, if you have the, you
know, unfortunate event where you do have to be hospitalized, Cornell is a wonderful place. And then from the out-patient standpoint, we have an intensive
out-patient therapy service. It’s a group that runs
about 10 to 12 kids. Again, primarily a
group based intervention that might help, you know,
mitigate some risk in kids that are higher risk for
things like self harm or for, you know, to
avoid hospitalization. And sometimes we actually do have kids that were hospitalized
and then will step down to care in the intensive
outpatient program. I’m the medical director of that program. Currently, we have three
full-time therapists on staff, a coordinator for the program on staff. We’ve gotten great feedback from our families and our kids
that it’s been helping them with significant episodes
of depression and anxiety as well as other things. That program is nine hours
a week, so they will come… It’s primarily for kids
that are in high school. So they come after school
gets out around 4:00. So from 4:00 to 7:00 PM on
Mondays, Tuesdays and Thursdays. – How important is it to have, both the inpatient and outpatient programs sort of under that same
umbrella, under the same roof and available to that patient population? – Very, very important, because I think it helps
identify our staff downstairs to identify kids that are
kind of teetering on the edge, but don’t need to go to the hospital to, you know, for an in-patient stay. But we can offer them the service of, hey, we have more
intensive services available as an outpatient that we think would be very, very helpful for you rather than someone
needing to be hospitalized. And then vice versa too, giving us peace of mind
from an inpatient setting. We’re dealing with a kid or a teenager who has gone through a significant crisis. There still might be some risk there, but it gives them an opportunity to be in front of more
professionals, more often for a six to eight week period. – What is that line, where it goes from
maybe outpatient therapy or outpatient programs are good to, this is something more… What is the line where it’s
this is an inpatient situation? – Yeah, that’s a tough question, and it’s often something that I’m asked. It’s, you know, part of my role is to kind of stratify risk
and it’s all about risk. You know, if there is an imminent risk that this kid or this teenager might do something to harm themselves or potentially somebody
else, then it’s likely that we’ll suggest that they go inpatient for a brief period of time. But if there are, you know, thoughts that a child or teenager is having that aren’t necessarily things that that child or teenager
is planning on enacting, they might be appropriate for an intensive outpatient service to help get them through
some of those things. – If they might not need
something as intensive, but they do need help, what other resources do
you point your patients to? – Yeah, so often that’s when we lean on
our community partners. There are several
organizations in the area that will provide therapy and actually provide
psychopharmacological services too. So providers that can prescribe
medications if need be. It’s not every kid comes in and needs to go on a medication
for depression or anxiety. Oftentimes, I’ll talk
with parents about that, “hey, the suggestion is,
let’s try therapy first. And if you feel like therapy isn’t going in the right direction, maybe we consider medications later on. But there are a number of
different community resources that we often refer to. One of those is, you know, Elite DNA, that’s a company in the Sarasota area for, if you’re just looking for therapy, I always recommend parents
look on psychology today. It’s a website free to use. You can look up available
the therapists in your area and also see if they take your insurance. And then always recommend
NAMI as a good resource. That’s a great community
resource there countrywide. You can plug in your zip code and find support groups in your area too. – How do you engage adolescents
who might be resistant to therapy or reluctant to
talk about their emotions? ‘Cause I know you mentioned that this generation tends
to be less resistant, but that’s not true for
everyone, of course. – Yeah, I think it starts
with trying to understand where the resistance comes from. Because, you know, if a kid comes in and says, well, I don’t
want to do therapy, and then I just say, well,
you need to do therapy, that obviously isn’t going to work. I have to do a little bit more on my part to understand why exactly it is that they don’t want therapy. And sometimes the answer
is as simple as, well, I’ve already got my friends that I talk to and so I don’t really need a therapist ’cause my friends make me feel better. And oftentimes, that’s when
I have the conversation with them about, well, what
if you are mad at your friend, then you don’t have a therapist anymore. And most of the kids, you know, hear that and go, oh, that’s probably a good idea that I see a professional
about these things. And then other times it’s trust, it’s building trust too. So sometimes, it is helpful
when I see kids either in the in-patient setting
or the out-patient setting to just be a friendly face, be someone that they
feel like they can trust and show to them that they
can trust other professionals in the field too, because it’s hard for kids
to talk to adults, strangers, that they don’t know about,
things that are really hard for them to talk to anybody about. – I know that there is a national
and international movement to de-stigmatize the need
for mental health assistance. How important is that specific
to this patient population? – Very, very important. I think this patient population uniquely has done a better job of
de-stigmatizing it on their own. I mean, like I said, you’ve
got a generation of kids who is more willing to talk about it with their friends all the time. You know, I hear kids
talk about their medicines with each other or talk about their
therapists with each other. And so I think there has been
a lot of really good work that we have done to de-stigmatize mental illness
amongst this population. I think one of the things that we still need to continue to do is de-stigmatize it amongst parents too. I think a lot of parents
can feel like embarrassed if their kid, you know, is admitted or needs intensive therapy. But there’s really no reason to be embarrassed by those things. Like we’ve talked about, kids are really facing a
lot of challenges these days and, you know, parents becoming
less destigmatized to it and being open about the challenges that they’re facing as a
family can be very helpful too. – And do you think it
shapes a child’s willingness to address mental health if their parents are willing to address their own mental health as well? – Yeah, absolutely. I think it kind of goes back to that, you know, one of those original points that we were talking about the reasons that kids might not tell
their parents about things. And if they see that
their parent has been open with their own struggles
or their parent is, you know, willing to be
kind of a sounding board to their thoughts that they didn’t think were appropriate to talk about before, that will definitely help them open up and may help identify some problems before they, you know,
get worse or, you know, can cause harm. – If you could give one message
to parents or caregivers listening today, what would it be? – Just be supportive. Listen
to your kids and be supportive. Those two things will go
a very, very long way. And then, you know,
sorry, you ask for one, but I’m going to give a
third, you know, listening, being supportive, and
then identifying positives in praising those things. So if your kid does a really great thing and you’re really happy with
them, praise them for it, because, you know, it’s oftentimes easier for parents to discipline when kids are doing things
that don’t want you know, parents don’t want to see. But being a reinforcer
of positive behaviors, kids respond so well to that. Just be open, be honest, don’t feel like you have to hide things. This is, you know, we live in a world now where people are more willing and more accepting to hear those things. And so being open and being honest will get you the help that
you need much quicker, and it can really relieve
a lot of that angst and a lot of that anxiety. – Thank you so much for
joining us, Dr. Malloy. And if you liked this
episode of “HealthCast,” please like and comment
and visit smh.com/podcast to listen to more experts like Dr. Malloy, talking about the health
issues which matter to you. The behavioral health
miniseries will continue with our next episode. As always, we encourage
everyone in our community to visit smh.com to get the
latest from Sarasota Memorial. Have a great day. (gentle music)

Because young people go through a variety of hormonal and developmental changes, it can be difficult to spot mental health challenges. For the first episode of a HealthCasts behavioral health mini-series, Conor Malloy, MD, shares insights from his work at the Cornell Behavioral Health Pavilion at SMH with teens and families. He discusses the growing challenges young people face in an age of social media and constant pressure, and offers practical advice for parents and caregivers. Check out other interviews with SMH experts at smh.com/podcast, and subscribe on your favorite streaming app.