Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. I'm Melanie Cole, and we're talking today about how to be an advocate for mental health. Joining me is Dr. Vicky Bouche. She's a Licensed Pediatric Psychologist at Children's Hospital of Orange County, and she provides mental health assessment, interventions, and referrals for children and families in the emergency department or on inpatient medical floors.

Dr. Bouche, thank you so much for joining us today. As so many parents are right now, we're going through similar things. We're worried about our children, how much anxiety that they're under. Can you tell us about what you've seen as far as an increase in anxiety, anxiety related disorders in our children and teens over the course of the last few years?

Vicky Bouche PhD: Of course, and thank you so much for having me here. I think this topic is so important to discuss because like you've said, I think there is in our community, a lot more parents and children and individuals who are asking for help, who are struggling, and who need support in trying to figure out how to feel better.

There absolutely has been an increase in mental health rates over the last few years and decades. Even in our emergency room, we are seeing, I mean, sometimes double the amount of folks coming in with mental health concerns. But I also think that this is a good sign, that this means that schools are catching mental health struggles and symptoms.

And, hospitals and our primary care doctors are asking us more. And so we're more aware as a community in Orange County. And so we want to know, okay, well, I'm struggling, but now what?

Host: Well, I agree with you. We really have seen a bit of a mental health epidemic, especially among our youth. Now, as you say, that it kind of seems to show that doors are opening and schools are recognizing, these things are being more identified. Do you feel there's still a stigma around mental health issues, especially with youth? So, people may be more reluctant to seek help for depression or other issues, or even more reluctant to talk to their parents about it because they feel like it might get overblown?

Vicky Bouche PhD: Absolutely. I think stigma has always been a big challenge for our community and something that we're still working on. Stigma is that negative attitude or belief or stereotype that people have around mental health conditions. And that can be something where that leads to discrimination of others, but it can also lead to self-stigma. Feeling like we shouldn't reach out, that we are in an isolated, hopeless situation, that we are to blame for our mental health symptoms. And so that can lead to not reaching out for help from other people. That can lead to feeling like no one will understand, if you do. And it can lead to families struggling to figure out too is my child is struggling. My loved one is struggling. But who do I go to for help? Will anybody listen? Will anybody believe me?

Optimistically, I think we are improving, though. More people are talking about mental health every day. Whether it's through social media, online, we're creating policies in the county, and the state that are addressing mental health issues, so it's becoming a lot more visible.

We're also becoming more conscious of our language. Which I think is a key part in addressing stigma. We really try to encourage everybody to be respectful and use what we call is person first language to help address stigma. And that means we try to move away from words like calling somebody who's dealing with mental health issues crazy, or something in the areas that I have expertise in with suicide prevention, we move away from terms like committing suicide because committing implies suicide is a sin or a crime.

So we try to use other terms like somebody who's struggling with mental health illness or somebody who's died by suicide. So stigma continues to be a big issue. And I think as we're becoming more open and talking about mental health, even having this conversation here today, that is how we can address stigma and move through and provide better access to services.

Host: I really applaud the change in terms and the way that you described why we've changed some of those terms. That's so interesting. So access. I mean, obviously in underserved communities, mental health for our youth is very hard to come by, and we're looking to parents to look for the red flags, which you and I'll talk about, but access would seem to be the biggest stopping block for many of these things with this epidemic and a lack of health care providers and certainly mental health care providers, it's very difficult.

So what does it mean, Dr. Bouche, to be an advocate for mental health? Because it would seem that's what we need.

Vicky Bouche PhD: Absolutely. I think I'll start off just saying too, is that access can be hard, right? Because of stigma, like we've talked about, but access is also hard right now with the mental health epidemic is we are actually seeing that there's a mental health crisis in terms of providers as well.

There's not enough providers to support our community. And so families are putting themselves on waitlist after waitlist, just trying to find help and support. And like you mentioned, that's exactly where an advocate steps in. So whether we're advocating for ourselves or whether we're advocating for a family member, trying to get help can be a very difficult process.

So the first step if we're trying to advocate for a family member is of course, checking in with that loved one and asking them questions, giving them the opportunity to explain what they want help with, if anything, and trying to understand how you can better help support them. So that's advocating, of course, for our family members, but advocating can look different on all sorts of levels.

That can be just being more visible in our own experiences, right? Talking more about our own mental health struggles. And of course, advocating can range all the way up to our advocating for policy changes, taking on volunteer opportunities or even taking on employed positions where we are fighting to increase access to mental health or we're trying to support people who are struggling with mental health.

Being an advocate is such an incredibly wide range of tasks. And I think the most important thing that I stand on is that everything matters. Everything from just trying to understand yourself and what you're going through and talking to a family friend and sharing your journey, to changing policies, to advocating, to participating in politics, to having a job that is mental health related. All of that matters so much.

And

Host: It certainly does. Now, as we are looking at what these kids are going through today, which is, I'm so much older than you are, but we went through such different things and I feel like the kids today are so much more worldly. As we look at some of the causes, which is much bigger than you and I could discuss in one podcast, but when we look at some of them, do you feel that with the advent of social media, that our kids are smarter, more worldly, but also this can contribute to that cause of stress. So when we talk about being an advocate as a parent or a loved one, is social media into that mix of things that we want to look at and say, well, maybe you need to shut it down a while?

Vicky Bouche PhD: I think parents ask me this honestly, every day of the work that I do. Social media is a part of our reality. It's a part of our world. I think that our young people are so savvy online and social media comes with such benefits like being more worldly, learning more about ourselves, having more access to other communities who are struggling.

Like maybe we're dealing with anxiety. We can go online and type anxiety groups and we can meet other children who are dealing with anxiety. And on the flip side, absolutely, that means that we're also maybe being exposed too young to things that are terrifying, that we're not ready to handle yet. That means that we're trying to navigate this online world that maybe our parents or our mentors don't know how to navigate themselves. Some of us didn't grow up online or with technology, and so it can be hard to support each other when your child has access to so many different things.

In terms of the research, I think the research has shown both that social media is incredibly supportive in some ways, it can help to build connections and relationships, and it can have negative impacts on mental health. So, as an advocate for your loved one, both for yourself, remembering that sometimes taking care of yourself means going offline and taking a break from technology, but it also means trying to be there for your child when they are learning about the world and they're on social media and they're online.

So we like to say you wouldn't give a car to a child without teaching them how to drive and helping them through that journey and being right there next to them. We also recommend don't give a phone to your child without being there every step of the way and mentoring them through the use of that phone and being on social media and online. 

And that is a really tough process. I think most parents struggle with teaching their children to drive and trying to teach a child to be online in a safe way is also a difficult journey. 

Host: I agree with you. It can be quite confusing for parents. So how do you advocate for your child, for a loved one? If you see signs of mental distress, and I'd like you to go over a few of those, what steps do you take to get your friend, your child, your loved one, the help that they need?

Vicky Bouche PhD: This is a good question, and this is a lot of the time, I think, where we get stuck. So there's a lot of different symptoms to look out for. I think in general, though, we have to be also checking in with our loved one, with our child. We have to be asking them, how are you doing? How is life going? How are you feeling? Is there anything you're struggling with? And just paying attention to your child.

What we can look out for, what I recommend is big changes in either mood or behavior. So that could look like a child who maybe withdraws, who starts to isolate, who doesn't want to talk anymore, who stays in their room all the time. That could be a child who maybe, they start seeming really worried, they're having trouble leaving the house. That could be a child who used to do well at school who's now struggling. Any big changes like that, it's always worth checking in on. And something that comes up a lot with parents of adolescent teenagers is, is this normal teenage behavior?

There's a lot of change, there's a desire for independence. Or not. And again, the most important thing, the first step is to sit down and check in with your child, your loved one, and ask them, how are you doing? What can I do to support? Are you struggling with anything? Is there anything you want me to know?

And know that your loved one, your child, they may not know how to answer that question yet. They may need professional support, and so that becomes the next step. If they're open to that professional support, if they would like help changing something, then we have to try and get support for them. If your child or your loved one is already a part of a community, I always recommend reaching out first so that can look like going to the school, checking in with teachers, with their counselors, accompanying your loved one, your child to a hospital visit or a doctor's visit. There's other types of communities. We have like the boys and girls clubs. We have a lot of religious communities that can offer a lot of support. So, helping your child feel connected and getting support from the communities they already have.

And then from there, when we are noticing there's been such a big change and it's leading to your child or your loved one really struggling emotionally and they are not doing well anymore, we also can ask for mental health support. And there's a couple ways of doing that. One way is you can always ask your doctor during a visit.

You can also always call your insurance, numbers on your insurance. You can Google online, there's a lot of organizations that can support. And if you are desperate, if you don't know what else to do, if you're in a crisis, you can always go to your closest emergency room, and that's where I work. We will be there to support and to help with connecting to mental health services.

Host: Thank you for saying that. And is there a way that people can get more training to become a better advocate for mental health?

Vicky Bouche PhD: Yes, absolutely. So, we've talked, I think, about how advocacy can be such a wide range of things, everywhere from supporting your loved one, your family, to trying to change policy, to trying to get jobs in mental health. There are actually volunteer paid positions in Orange County in California in the US that provide training around being an advocate, at many different levels.

And sometimes it's through non profit organizations, sometimes it's through universities. So, I'll name maybe one, NAMI, the Peer to Peer Program, so it's a National Association of Mental Illness Program. It's an program that has 700 state organizations and affiliates across the country. They're huge. They do a lot of advocacy work, and they actually have a specific program called that NAMI Peer to Peer Program, where you receive training and then learn how to support others for individuals with mental health conditions.

So, the peer to peer program, the goal of it is if you're struggling with your mental health and you feel like you've overcome it, you've become empowered, you want to help others, you get training on how to support other people who went through what you went through. But there's also different types of programs.

There's certificates for mental health advocates that can be received either online or through universities. And there's some more specific programs too, like we have a mental health first aid, which is a program in the United States. And it's actually, I've gotten training in that type of advocacy too.

Mental health first aid, the goal is to teach people to identify and understand the first signs of mental health challenges, because it's very tough, and then to figure out how to respond. Usually these are programs that are set in place after maybe regional or national emergencies like fires or large crises.

And then you can actually go in and try to support community members using that first aid mental health training. So, a lot of different opportunities if you want to get more support and training around how to communicate around mental health, how to advocate, what to be looking for, and also just to get support yourself and more resources.

Host: This is such great information and what an important discussion we're having today, Dr. Bouche. So as we wrap up, I'd like you to offer your best advice to parents with kids struggling with their mental health, some home care, self-care things we can do with our children, whether it's stress management, exercise, yoga, nutrition, just kind of an all around whole body wellness and how we can best support our children when they are struggling with their mental health.

Vicky Bouche PhD: That comes up every day with the parents I work with. And this is going to be a little bit silly as my first recommendation, but it's to educate yourself first. Just try to really understand, what is your child going through? They may not have the words for it, and so we have to go do our own education.

And that can look like, picking up some self-help books, learning more about anxiety, about depression, about psychosis, trying to really understand from an outside perspective what people tend to go through and figuring out what the language is that is appropriate to be using and also some things that might help.

There's different ways of treating and supporting children depending on what they're going through. So that first step, educate yourself, and try to really understand what your child is going through from a bigger perspective. And also try to learn and grow and reflect on your own experiences.

So, what does it mean to be struggling with anxiety sometimes, or to feel really sad? Like, how have you, yourself, gone through those things? And that can actually help you be a better advocate for your child, because it helps you understand and empathize with what they're going through. Of course, we all have different experiences,so it's not going to be the same thing, but it's important to come from a space of learning where you have shown to your child that you are trying to understand what they're going through. And then from there, it's all those really practical things, that you recommend that are so wonderful. So we really, really aim for mental health to treatment and support to be holistic. So that means working at every angle.

That means that we need to really be connecting our child to a mental health therapist, but we also need to be helping them with sleeping well, which usually comes with technology management, like we've talked about already. We also need to be helping our child eat healthy and to eat balanced.

We know that there is research that shows and we don't know, is it the mental health or the eating, but we know there's a link between eating and mental health. So people who struggle with their mental health either don't eat very much or eat a lot. So even their nutrition is not quite where we want it to be.

And then once we have all of those different things we're working on, in addition to any medical health needs that we want to make sure are addressed; the things that we can do day to day is continuing to ask our children, how can I help you? What are you going through? Would you like me to support you in this moment by just hearing you. Would you like some solutions?

I think a lot of our young people will probably tell us, I just need you to listen. I don't want you to give me any suggestions. But if they do want suggestions, then we can absolutely be putting in place things, we call them coping skills. What are some things that your loved one, your child knows that they like to do that helps them, and how can we help them use that every day when they're struggling, or when they feel a little bit down, they want a little bit of distraction.

Every child has their own set of skills that they use. We all do this naturally. When I'm stressed, I pace, or I drink cold water. But maybe your child, they might want to talk to a friend, or maybe they want to take a nap, or maybe they want to try and take some deep breaths. We all do different things to manage the stress of everyday life, and we all do different things to help us with some of our mental health struggles.

Host: Beautifully said, and thank you so much, Dr. Bouche. What a great guest you are. How compassionate. I can hear it in your voice, and really, you're such a good educator. Thank you so much for joining us today. And for more mental health and wellness tips and information, please visit choc.org/mentalhealth. Thank you so much for listening to this episode of Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County.

Together, we can keep kids happy and healthy. We'd like to invite our audience to download, subscribe, rate, and review Long Live Childhood on Apple Podcast, iHeart, Spotify, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.