Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): Why are teens resistant to therapy even when they're in pain? And how can we as parents help them to get the help that they need?

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Neela Sethi, she's a pediatrician on staff at Henry Mayo Newhall Hospital, and her bright and informed teenage daughter, Malika Young.

Thank you both so much for joining us today. And Dr. Sethi, I'd like to start with you. You and I have talked so much about mental health and our youth. What are we seeing today as far as a mental health epidemic? Do you really feel that there is one? And if that's the case, what are some of the common reasons that our teens are having trouble and struggling right now?

Neela Sethi, MD: Yes, Melanie. We've talked about this nonstop. And, you know, this is kind of my mission and purpose in life, as I move into kind of the second phase of my career, is teen mental health advocacy, and really just talking about teen mental health. When I say it's an epidemic, it's an epidemic. It's one out of every two, one out of every three teens that I see on the daily that are discussing issues like depression and anxiety and body dysmorphia, eating disorders, just generalized not feeling themselves and really struggling with the pressure of school and the pressures of social media and the pressures just socially in general, and college acceptance, and just trying to navigate these waters. These teens have more pressure than they've ever had, and they're expected to perform even more than we ever did when we were teens, and they're trying to navigate this sort of world of social media and everything online. And it's almost like we've just given them this huge full plate and we don't know how to deal with it. And we don't really know how to help them in the way that they need.

Melanie Cole, MS: You mentioned social media, so we have to touch on that very quickly. I feel that it makes them both worldly, smarter than we were? Because I don't even know what was going on outside of my community, except for what I saw on the nightly news or in the newspaper. These kids are so immersed in worldly events, you know, whether it's terrorist things or elections or just so much is coming at them all at once. Do you think that that is really a big part of this, is that they are just getting inundated with all of this news all the time?

Neela Sethi, MD: Absolutely. They don't have a break and a breather. They have just jumped into the adult world so quickly and they're spending less time outside. They're spending less time in person. They're spending less time just being teens and just lounging and walking the dog and hanging with friends and having slumber parties. It's so rare that I even hear about slumber parties. Everybody is just on their phone. And when they are in person, they tend to be on their phone. So yes, they're taking on the weight of the world at a young age, which is not great for their mental health. And then, they're not doing all the normal things that teens should do at this age, which is really be in big groups with their phones down and just kind of hanging out and getting that energetic transfer from just being around each other. So, it's just a double edged sword, and it's just too much for them. And they don't have the outlet that they need.

And let's be honest, this is a brave new world. They are our test subjects. We've never done this before. And we as adults and as mental health advocates and providers are trying to figure out, we're reactive instead of proactive. And that's a really scary place to be as a medical professional where they are our test subjects and we're just reacting to how they're behaving instead of really what I'm trying to do, which is being proactive and saying, "Whoa, whoa, whoa, whoa, whoa." For our younger teens in the 12, 13, 14, how can we advocate for them early so that we're not just having to treat them or be very aggressive later, but instead try and really help prevent them from struggling with mental health.

Melanie Cole, MS: And I think the COVID-19 pandemic really cemented all of this because they had to do everything separate. And then, they kind of got into the swing of things with that as well, with being separate and online classes, which have proven to be helpful in some cases, but also, again, take away that personal interaction that they need so much.

Neela Sethi, MD: Correct. I think we're still seeing the ramifications of the pandemic. I think we will for years to come. And our teens especially are the ones that really got hit hard.

Melanie Cole, MS: I think so. So, we're talking about mental health and them getting the help that they need. Dr. Sethi, do you feel, and we've talked about stigmas over the years. Back 20 years ago we used to talk about the stigma of depression and the stigma of OCD and all of these kinds of anxiety disorders. Do you feel that there is still that stigma? And certainly with our teens, do they feel that? Would they be someone who would be embarrassed? I mean, I know my daughter and all of her friends talk about their therapists all the time. Do you feel that there is still this stigma with our kids?

Neela Sethi, MD: I do. I wish that I could say that as a society we've really destigmatized mental health in general and that we're making teens feel like, "Hey, you know what? You can have any sort of mental health disorder, and it's the same as asthma or respiratory infection or any illness." But I'm not finding that that's the case. They're still feeling strange about talking about sad feelings. They still feel weak when they talk about anxiety. They feel like they can push through it or push their feelings down, and that it'll just go away. And what we do know now is the more that you suppress those feelings at that age and the less that you just say, "This is how I feel," whether it's sad, happy, mad, emotional, think of all the emojis, right? Think of all the emotions. There's so many of them. The more that we can get them to just say how they feel in the moment, the better they do. But unfortunately, we still have a huge hurdle, because they just have a very hard time being weak or being different. And they really just want to blend in and fly under the radar.

Melanie Cole, MS: I love that you brought up emojis because that is true. I never really thought about it like that, but there's so many of them. So Mali, honey, we didn't forget about you. If what your mother says is true and there is still this stigma, tell us what you hear from your friends. What are some misconceptions about therapy that teens have? What do you hear?

Malika Young: Well, the biggest thing I hear is that by going to therapy, you're going because something's wrong with you, which isn't necessarily true. And that your problem is so big that like you need professional help to help you get rid of it. When in reality, therapy can be used for big flaws such as suicidal thoughts, drug usage, alcohol consumption; but it can also be used as just a friend to talk to when you need to get emotions and feelings off your chest.

Another misconception I see is that therapy will make you feel worse about yourself than better, because they're just going to nitpick at all your flaws and tell you that everything's wrong with you. Again, that's not true. They're just trying to help you feel better about yourself. They're going to make you feel more empowered to do things and to get out there.

Neela Sethi, MD: Yeah, very true.

Melanie Cole, MS: Those are some interesting concepts. Dr. Sethi, you wanted to say something?

Neela Sethi, MD: Oh, it just breaks my heart to think that there are teens out there that are struggling in silence. And it makes me emotional because there is this misconception that, you know, you're going to go to therapy and they're going to say, "Oh gosh, you're so sad. And that makes you so awful. And how can you be sad today when you have everything going for you?" And honestly, that may be the rhetoric that they're hearing in their households as well. And that just makes me so incredibly sad, because therapy is the exact opposite.

And what I tell my teens is think of camp counselors. Think of when you were, you know, a kid and you went to a camp and you loved your camp counselor because they related to you and they talked to you and they saw you and they heard you. That's really what these teen mental health advocates are doing. They're seeing you. They're talking to you. Their whole point is to befriend you so that you open up to them. And the last thing that they're doing is stigmatizing you. They're just making you feel like you have a friend and someone to open up to. These teens are labeling themselves already so negatively, and then they're using their fear to guide them. And that just worries me.

Melanie Cole, MS: Mali, I'd like you to speak to the parents watching this right now. What would you like us to know about helping you to find those therapists? What would you like us, as far as words-- because I'm going to ask you the same question for teens, but right now for the parents, how do you want us to interact with our children? If we see those red flags, we know that our child needs more support than we can give them. Are there some words? Are there some ways that you can tell us as parents? Because you and your mother obviously have this wonderful, lovely relationship. And I know so many parents would like to have that. Do you have some advice on how to have what you have?

Malika Young: Yeah, I think the biggest thing is just to remember that you're never going to get it first try, and that it may take a couple therapists to find the right one. But the reality is that everybody has flaws, so everybody can use a therapist in some capacity, again, whether that's for severe issues or for small issues.

Melanie Cole, MS: Do you have a preference for gender?

Malika Young: Gender, I think, again, that's just a personal preference, and it might take time to figure out.

Melanie Cole, MS: I'm just wondering if you feel when we're talking to our teenagers that they might be worried that they'll end up with a female therapist if they're a guy or a male therapist if they're a girl. Does that seem to be an issue at all that you see?

Malika Young: I don't see that. However, I'm sure there's ways to request that you get the person that you'd like.

Neela Sethi, MD: Absolutely. And when we're dealing with that in the office, we'll ask the teen and say, "What are your preferences? Do you absolutely want to see a male or a female? And I'm sometimes surprised by the answers, but Mali brings up a good point that you don't have to stick with the first one. If you have a couple sessions and you're not jiving with a person, you can switch until you find the right fit. That being said, you do want to give it a shot. You don't just want to go in in the first 20 minutes and say, "Nope, I don't like them. Nope, I don't like them." But it's just like building a relationship with a friend or another doctor, you're allowed to choose and you're allowed to advocate for yourself. But for parents out there, they should ask their teens what their preferences are. They should say, "Hey, what are you looking for? Young? Do you want older? Do you want seasoned? Do you want someone in training? Do you want a student? Do you want, like we said, gender? Do you want someone more that's a better listener? Or do you want someone that's more outgoing?" These are things that you can ask your teen and start building that communication, and then try and find that right fit for you.

The other thing I want to add real quick is that it's really important to say that you don't have to do it in person. And I think that's one of the hugest biggest take-home points for today that has been a positive since COVID is you can Zoom. And you can find a therapist online, and I know my therapist I do on Zoom, and it's one of the best things because I just come home from work and get cozy, and I make my cup of tea, and I sit and chat with her. And I don't have to go anywhere, I don't have to be performative, I don't have to drive anywhere. And for teens, I tell them it's really no different than FaceTiming a friend, and they're on their phone all the time anyway, so why not use it for something that's actually beneficial?

Melanie Cole, MS: I agree with you. And that's where I was going with my next question here is how to find one, Dr. Sethi, because as you and I have discussed, there is a lack of mental health professionals in this country with this mental health epidemic that we're seeing. And so, it is very difficult. And telehealth, boy, that has made it so someone from another state can be your counselor in a different state and made it much more cozy and inviting. How do you find therapists for your kids?

Neela Sethi, MD: It's not easy. I really feel for parents because this is a huge struggle for them. I will start by telling parents that you may not be able to get a therapist that's in-network, that's fully covered. And just as you have funds for other things, this is one of those places where you're going to need to save your money and you're going to have to place it in a specific area for your child, because that is one of the biggest barriers that I see with parents is they think that this is going to be like a $10 copay. And while that can be true, there are a lot of therapists out there because there is such a shortage that charge a certain fee. And I tell all my parents, you have to be able to wrap your head around that. Whatever you need to do to make other cuts and make other sacrifices in your household, your teen's mental health and your teen's health in general is important. Just like you would save for cancer treatment or asthma meds, you would save for therapy. So, that's a really huge point.

The second thing is that you can always call your insurance and get a list of people who are a network for you and that are accepting new clients. And you just have to start making the calls. It's not easy. You're going to have to just call every person, see who's accepting new clients, see if they're the right fit.

And then, third and final is your pediatrician. We are here. I mean, I consider myself a mental health advocate. I have a list of therapists that I use in the area. I have therapy groups that I use in the area that I give numbers to. But it's not easy, and it takes a lot of time and effort, but I hope and pray that your kid is worth it.

Melanie Cole, MS: I love that you said that. Because going to our pediatricians, and they are the gold standard, they're the ones that have helped us to raise our kids healthy, safe, happy, and keeping a list like that is such a great go-to for parents. So, that's a really great place to start. And as Dr. Sethi said, you got to make the calls. Mali, I want to give you the last word here, honey. Some tips for breaking through that haze for our teens that might feel that stigma, that might feel embarrassed. What can we say to them that can help them to realize, "Hey, you know what? It's not all bad." Mom gets therapy. We love to talk to someone. It really helps to unburden yourself so that you're not carrying the weight of all of the things we've discussed here today. How can we break through that haze and talk to you teens and get you to see that this is a really important part of our general health and overall well-being?

Malika Young: Yeah. We just need to normalize it, we need to talk about it, we need to tell other people, encourage other people to go to therapy. Society, like my mom touched on, society has put such a negative meaning behind therapy when in reality, it's completely normal. It's normal to want to go to therapy, it's normal to have to go to therapy. So, let's talk about it between teens, and people who like therapy should encourage others to go to therapy as well.

Melanie Cole, MS: That's such great advice. Dr. Sethi, do you have some final thoughts?

Neela Sethi, MD: I'm just so proud. I'm looking over to my right and I'm thinking, if every teen out there could have this sort of mentality and to talk about it and advocate, what a difference it would make. So, start small, use your big voice and just get out there and let's destigmatize together. And the more that we talk about it and the more that we communicate about it, the more tribal that we are, the more that we are a community and the more that we can help save those struggling teens out there. My heart just bleeds for them, and I wish I could just take them all in and give them all the love that they need. But I know that if we were to work together, and if we just keep communication up, we can make a change.

Melanie Cole, MS: You really could make me cry very easily, Dr. Sethi. And my heart is full seeing the two of you because it is lovely and it is important and that's what these kinds of episodes are all about is that we're trying to help each other. Because we have to, in our bubbles, in our communities, really get together and help with this mental health issue that we're seeing.

Thank you both so much for coming on and really helping to normalize this and to destigmatize the need. We all need a little help sometimes. We all need a helping hand. And thank you both for joining us and for more Teen Health Tips. You can always visit the free Henry Mayo Newhall Hospital online library at library.henrymayo.com. And you can choose Teen Health in the drop-down topics menu at the top of the page and find so much great information there. Thanks so much for listening to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Until next time and please come back and join us again.