Youth mental health: Finding support

Steven Adelsheim (00:00):

We do need to acknowledge we have serious challenges in terms of really creating the mental health support that our young people need.

Dan Schwartz (00:11):

Today, we are addressing a critical and timely issue. This is the mental health of our children. Unsurprisingly, the pandemic played a large role in our students' mental health, and it intensified the challenges many young people face. It's made it more important than ever to understand the signs and know how to support them.

Denise Pope (00:30):

I completely agree, Dan. We are seeing rising rates of anxiety, depression, other mental health issues, and it's really crucial for parents and educators and communities to come together to support the young people. This is not just a side issue. This is a really central issue facing our kids today.

Dan Schwartz (00:47):

Fortunately, we have Dr. Steven Adelsheim, and he's going to help to guide us through this conversation about mental health.

Denise Pope (00:56):

Welcome to School's In, your go-to podcast for cutting-edge insights in learning. Each episode, we dive into the latest trends, innovations, and challenges facing learners. I'm Denise Pope, senior lecturer at Stanford GSC and Co-founder of Challenge Success. And I am with my co-host, Dan Schwartz, who is Dean of the Stanford Graduate School of Education and Faculty Director of the Stanford Accelerator for Learning.

Dan Schwartz (01:26):

He's a child, adolescent and adult psychiatrist who works to support community behavioral health partnerships locally, regionally, and at the state and national level. He is the Director of the Stanford Center for Youth Mental Health and Well-being in the Department of Psychiatry. And he's partnered in developing statewide mental health systems, including those focused on school mental health. And so for many years, Steven's been developing and implementing early detection and intervention programs for young people both in school and in primary care. So Steven, I'd sort of like to start indirectly. How did you get into this business?

Steven Adelsheim (02:03):

The truth is Dan, I actually started thinking in high school that I really did want to actually become a child and adolescent psychiatrist. And I was a pre-med psychology major in college. And my first job was on an adolescent inpatient psychiatric unit. And then I worked in a very rural community in Alaska and actually went and worked in schools doing... In villages, in rural Alaska, working with kids in different school settings. And I did that for a year before I started medical school.

Denise Pope (02:40):

So then Steve, I know you did a lot up until this point, but one thing that I'd love to talk about on this show is this new thing, this allcove. Do you want to ease us into that?

Steven Adelsheim (02:53):

Sure. I was a director of school mental health programs actually in the state of New Mexico for about 16 years. And I was in New Mexico for 28 years before coming to work at Stanford. And during that time, I spent at least a day a week working in school-based health centers. And in that role I worked with all the school health and mental health professionals. I worked side-by-side with primary care providers working in school-based health centers. And at the state level, we were really expanding access to health for adolescents really through school-based health center settings. I found that after doing that for a very long time, it was really great work in terms of early detection and there were young people that didn't want to talk to someone at the school. There were issues about what would happen over the summer. There were concerns about issues related to the confidentiality.

(03:55):

There were principals turning over on a regular basis, some of which said, this is all really nice, but our job is education. It's not about the healthcare of our students. And so there was a point where I started looking for other ways to provide the support in the community side-by-side with school mental health services so we could more broadly build those connections. So we learned about this model called Headspace back in Australia. This was before the meditation app. And Headspace was this clinical program for young people, 12 to 25 to come in on their own or with a friend for early mental health care and primary care, support, education, employment.

(04:42):

We learned it was a model that was very successful in Australia, and I'll share with you now there 170 Headspace centers in Australia, which is half the population of California. And this is a model that every legislator in Australia wants to have in their home community. And it's a model that really has taken off all over the world. And so we started exploring how do we bring this community-based access to the young people of the United States and particularly starting here in California.

Dan Schwartz (05:17):

So you rent space off the school campus or?

Steven Adelsheim (05:21):

Actually no. We really look for physical spaces in the community that are near transportation, that are near community centers, that may be accessible from the school but aren't really by or necessarily next door to a school, but accessible for students. And we continue the initial model. We see young people 12 to 25, and our role as a center has really been to support the implementation of this model. And so we've worked with the state of California's Mental Health Services Commission to create some initial funding. And now through the Department of Healthcare Services, there's more funding. There are three of these centers open right now, one in Palo Alto, one in San Mateo, one down in Redondo Beach, allcove Beach Cities. And we've got eight more actually on the way that are sort of in the process of getting started that are physical spaces in the community for young people.

Denise Pope (06:25):

So Steve, if I am a parent who's worried about my kid or a teacher who's worried about a kid, how does this work? They go to allcove and what do they get? How do you get in?

Steven Adelsheim (06:35):

Great question, Denise. So these allcove centers are run by different agencies and basically young people can walk in for some initial support. And these centers have early mental health care. They do sort of short-term therapy. They have physical healthcare providers as well. They have peer support specialists. They have people who work with you around supported education and employment, early addiction treatment as well. And you can schedule an appointment or you can go in. Most of the centers have evening and other weekend activities so that young people can come in for a group or an activity and just get a feel for the place, see if they're comfortable there. And then they might decide they want to talk to a therapist there. They might want to talk to a peer support specialist about some issues that they may be dealing with or want linkages to other supports and services. So we see these as central hubs for young people to access the supports they need either on site or with linkages into the community.

Denise Pope (07:46):

And I just want to point out that that's super rare, that typically what used to happen, and Steve correct me if I'm wrong, is someone would be worried about a kid. Maybe they'd have to go to an emergency room and get a psych hold placed on the kid and the kid would... Then they'd have to find a place like a hospital to hold the kid. Or you just are on a wait list for months to try and find a therapist for your own kid and to have the ability to walk in and get care almost immediately, right Steve? it's like a miracle for some of these kids and for some of these families.

Dan Schwartz (08:21):

So, well, I've heard from teachers and principals that mental health issues on adolescents are becoming more pressing concern. And I know you do lots of important surveys. Do you collect information on this?

Denise Pope (08:40):

Yeah, so challenge success, we don't collect specific information like a modified depression index or something like that. But one of the main questions that we ask early on in our survey to adolescents is what are some of your major sources of stress? And we have about 30% of our students are saying that mental health is a major source of stress. So most of them are choosing workload or homework or grades, but mental health comes up quite frequently, and particularly if they are LGBTQ or from historically marginalized communities, we see that even higher.

Dan Schwartz (09:24):

Does the item say mental health?

Denise Pope (09:26):

It says mental health. Yeah. So it's a pull down menu, right?

Dan Schwartz (09:29):

How do you think people interpret that?

Denise Pope (09:31):

That's a great question, Dan, because sometimes they'll say it's just overwhelming stress. Sometimes they will name things as depression or anxiety, which may not be officially diagnosed depression or anxiety, but they will say things like, I can't fall asleep because I'm always so stressed, or I'm freaking out about this, or I get so nervous that it prevents me from doing things. Or I'm afraid to do some of the things that I'm normally doing. I can't get out of bed in the morning, right? So we hear all sorts of things in our focus groups. But we also just know from statistics around the country, even the U.S. surgeon General has written about this, that particularly since COVID, the mental health of adolescents has really been getting worse. And there's a very high percentage of parents who said 35% of teens according to parents experience mental health issues. And it's definitely become a more prominent thing that people are worried about, always worried before the pandemic, but now even more so.

Dan Schwartz (10:38):

Some of it is I don't do the things I normally do.

Denise Pope (10:43):

Or I can't, my brain is not allowing me to, right? I'm perseverating or I'm catastrophizing, or I just can't fall asleep because I'm spinning, right? We have some of that, but we also have literally, I'm too anxious. I can't get out of bed, I won't go to school.

Dan Schwartz (10:59):

That's a complicated set of feelings.

Denise Pope (11:07):

We know that the challenges facing youth's mental health today are really, really significant, but the good news is, so are the opportunities to make a difference. So Steven, can we go a little bit deeper into how these community-based approaches like the allcove model are really empowering young people to take control of their health and also to support each other?

Steven Adelsheim (11:27):

One of the things that's exciting about these allcove models is that they really are grounded in the idea that young people really have a critical role in creating safe and comfortable places for other young people to come in. So the allcove centers all have very active youth advisory groups that are made up of the diversity of the communities where they're developed. And those young people make a lot of the decisions about hiring, about the look and feel of the place, about the groups and different activities that happen at allcove centers.

(12:01):

And they are the voice of outreach also that will tell their friends, this is a comfortable place to come into and you should feel free and comfortable coming here. Whether to be hanging out with other youth or be able to get access to some type of service as well. So that peer voice is really important when young people come in. A peer specialist is often the person that greets you at the door and helps you decide what kind of services you might want or gives you a tour of an allcove center so you can get a sense of what's going on there and what's available as well.

Denise Pope (12:39):

So a peer specialist is like a 15-year-old, like a kid?

Steven Adelsheim (12:44):

No, no. The peer specialists that are there, generally people with lived experience who are employed and work there. But at the same time, one of the things that's interesting Denise, as you say, is that we're finding that actually many of our youth advisors, as they're progressing through their maybe year or two of leadership training and development of the youth advisors, a number of them are actually taking jobs as peer support specialists in these different allcove settings. And we're seeing it become almost beginning of a behavioral health workforce in terms of seeing those roles happen.

Denise Pope (13:21):

Well, that's good because I know we are desperado for more people to go into this, right? We don't have the adults employed to cover the need of all the kids who need clinicians and therapists, right?

Steven Adelsheim (13:34):

Absolutely. And one of the things that also has been happening is we see young people, and I would say the generation of youth, we have now quite a bit more comfortable talking about mental health issues. The stigma issues are much less for them than for many of us in our generations. And so we're seeing a lot of peers interested in supporting each other as well. So we're seeing frankly at many of the high schools in California and in programs across the country, the development of peer-to-peer opportunities. And this is for that 15, 16, 17-year-old student you were talking about, to get skills to learn how to support themselves and support their friends and have those conversations. So we've also been working with a group of young people as well to develop a peer-to-peer curriculum so that youth can start then supporting other youth directly, allcove centers as potential places where then that training and support can also happen down the road.

Dan Schwartz (14:38):

Can I ask a slightly tangential question?

Steven Adelsheim (14:41):

Sure.

Dan Schwartz (14:42):

So a couple years ago, I'm at a dinner and a very senior famous psychologist professor asked me about my feelings and I say, "I don't really like to talk about my feelings." Is this a generational shift? This sort of willingness to talk about one's mental contents?

Steven Adelsheim (15:02):

I think there's more of an acknowledgement that all of us as human beings have these issues. I think culturally, we see a real difference. I think for young people from very diverse cultures, there was quite a bit of stigma and taboo in many cultural groups around talking outside of the immediate family about mental health challenges. And I think for many of our young people, there's more of a willingness to acknowledge it. We see it in our famous American athletes now breaking down that stigma. And for many others, it's becoming more comfortable just to acknowledge that this is part of our lives.

(15:43):

Just like any other medical condition, we have mental health conditions as well. And so I do think at least there's some more honesty about it. We will encourage parents to be more honest with their own kids about their own challenges, their own failures, their own struggles. So their parents don't often come across as sort of perfect beings that never had a problem in their lives. And then their kids thinking, well, what am I doing with all these issues? My parents are so perfect. So we're trying to build that intergenerational conversation, but it's the young people who were more comfortable with it, frankly right now.

Denise Pope (16:23):

Okay, a cynic... And I'm not a cynic, but a cynic might say, is this too much? Because now you've got kids who are sort of self diagnosing as depressed when they're not. Everything is now elevated. I'm having a mental health crisis. We see some reports saying maybe we're doing too much. I am not this person. I'm just asking you as a potential cynic might say. How would you react, Steve?

Steven Adelsheim (16:49):

I still feel like we have a long way to go to be doing enough, to be quite honest with you. I think it's great that young people are getting more sensitized to these issues. I am grateful that we're creating opportunities to develop resiliency skills potentially in some school settings. We had a youth mental health crisis before the COVID epidemic, and it's only been accentuated over time. And so even if you look nationally at the rates of young people with serious depression, anxiety, higher rates of not only suicide attempts, but at times suicide rates going up in our young people, we do need to acknowledge we have serious challenges in terms of really creating the mental health support that our young people need.

Denise Pope (17:37):

So if you are a parent or an educator, what are some things to look for? Because I think we miss a lot, right? What are some things to look for?

Steven Adelsheim (17:46):

I think some of the key things really to be looking for are a change in a young person. And that can often be whether or not they're struggling to get out of bed to go to school, but also less interest in social activities, more time spent at home alone in their room not interacting or socializing with friends. Often tearfulness, for many young people there are also increasing somatic complaints. So what I mean by that is sometimes kids will have more stomach aches or more headaches or more physical complaints or saying, I don't feel well. I can't go do whatever my regular activity might be as well. So all of those things can be signs of the potential of an early mental health challenge, which at least it's important to check in well with our kids and see how they're doing.

Denise Pope (18:47):

And we usually tell people, if you're at all worried, you go talk to a pediatrician, talk to the school counselor, but don't just ignore it. Parents are like, oh, teenagers will be teenagers. They're moody, they're sulky, they have outbursts, right? But it's better to catch this early. Is that right, Steve?

Steven Adelsheim (19:04):

Well, like any other medical condition, early intervention has really shown for all mental health issues to be really beneficial as it is for anything else. And so the earlier we can link young people to the supports they need as well as their families, the better outcomes people have. Not only short-term, but long term as well.

Dan Schwartz (19:26):

What's an example of an early intervention to help?

Steven Adelsheim (19:30):

In a school setting, it would frankly be a young person telling their friend that maybe they're feeling like they don't want to go out with their friends anymore, they're feeling sad, or they're feeling like they don't have the motivation anymore to do their work. And they tell their friend and their friend actually convinces them to go with them to talk to the counselor at school in very simple terms. Or if they refuse to go to that friend, maybe even telling their parent, I'm worried about my friend here and I just want you to know that this is going on. And then having that family member taking it seriously. And then really, like Denise said, maybe calling up the pediatrician and asking for that early guidance.

Dan Schwartz (20:18):

So the kid goes to the counselor and then what happens?

Steven Adelsheim (20:22):

The truth is, I think it really varies in terms of our school settings and our counselors. Right now in California, as we're seeing the broader potential for school mental health professionals to be more involved directly in therapy, I think there are more opportunities for young people to get that supported school, often, as I mentioned, working in school-based health centers. We have community providers also in school where even that school counselor can say, let's go talk to that person from the neighborhood mental health organization who's at our wellness center. And let's have an initial conversation with them and see what kind of support you need.

(21:06):

And then it might be some kind of talking through with that young person what's been going on, helping them maybe in a few sessions sorted out. Or maybe that young person says, "I don't want to talk to someone at school."

(21:18):

And then the counselor can help make that call or connection to the allcove center down the street to be able to help that young person get over there for a first visit as well. Or maybe talk to the family with that young person and get them to the allcove center for early support.

Denise Pope (21:35):

This has been so helpful. I have one question that I know people will probably have on their mind, which is early prevention. What can I do as a mom to really support mental health? I mean, should we take the phones away? Should we prevent them from ever going to parties? People are just grabbing at things because they're so nervous about this suicide rate going up and the levels of depression and anxiety. What do you think?

Steven Adelsheim (22:06):

Yeah, I think we're seeing a lot of things about the dangers of social media, but I have to say that from the work that I and our center teams have been doing, I think we feel like there's some real benefits for young people around social media. And what's important is they get support to think about how to use it safely. Our young group of advisors through a good for media program, our young people that are mentoring other youth and how to use social media in ways that support their mental health, they put out a guide for parents on how to talk to your kids about using social media.

(22:43):

They provide support for young people and how to think about what to turn on and what to turn off for it to be safe. I think for parents, what's really important I think, is to find those ways to check in and to listen to young person and to be able to do that in informal ways, to do it in a non-judgmental way. And I think our young people are getting pretty good at sort of having a sense of what they need. And I think being able to trust that without us really sort of telling them necessarily all the time what they need in terms of some of those issues.

Dan Schwartz (23:17):

We hear you Stephen. We definitely want to equip everyone with the right tools to succeed. So thank you so much for sharing your insights today. The work you're doing to support youth mental health is crucial. It's innovative, it's making a difference, and it's going to help us face these ongoing challenges.

Denise Pope (23:35):

I completely agree. I completely agree, Dan. And now it's time to talk takeaways and I will kick us off this time. I think the biggest one for me is really the importance of early intervention. Catching mental health issues early seems to make all the difference. And I think having community-based resources like the allcove centers also really helps make support more accessible for our kids. It gets them in there and we know that they're getting the help that they need.

Dan Schwartz (24:00):

And for the parents and educators, the thing that stood out to me is remember to stay engaged and watch for changes in behavior that might signal something more serious. And of course, just continue to encourage conversation as much as we can.

Denise Pope (24:14):

That's right. We've got to show up for the kids. So keep your eyes and ears peeled for those opportunities. So Steven, thank you so, so much. We learned so much today. Thank you for this really important discussion and thank all of you for joining us on this episode of School's In. Remember to subscribe to our show on Spotify, Apple Podcasts, or wherever you tune in. I'm Denise Pope.

Dan Schwartz (24:40):

And I continue to be Dan Schwartz.