Maggie McKay (Host): There's a lot of stress on teenagers today between social media, the fallout from the pandemic, and just everyday peer pressure. It's not easy. So to tell us more about the crucial topic of the teen mental health crisis and helping our kids feel better is Darian Eletto, Director of Outpatient Behavioral Health Services.

 Welcome to Wellness Waves, a podcast from Bergen New Bridge Medical. I'm your host, Maggie McKay. Welcome, Darian. It's so good to have you here. Would you please introduce yourself?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Sure. Thank you so much for having me. My name is Darian Eletto. I'm the Director of Outpatient Behavioral Health Services here at Bergen New Bridge Medical Center, and I'm also a Licensed Professional Counselor.

Host: It seems like things have really ramped up for teenagers when it comes to pressure and anxiety. Why are we in such a crisis with teen mental health in this country?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Well, we have to already look at a very vulnerable population to begin with. Being a teenager in general is pretty difficult, but add on top of that, exacerbating your symptoms due to the COVID-19 pandemic, social unrest in the country, the impact of social media on body image and self-esteem. And pack that on with the mental health crisis having extended wait times for care; it really has had an impact on our teens. In preparation for our interview, I did look up for some information and one of the most shocking things that we've discovered is that right now the CDC is reporting suicide is the second leading cause of death for individuals ages 10 to 24 years old. And these have had a tremendous impact also on the mental health of children, families, and schools.

Host: That is a staggering amount. How much of an impact did the pandemic specifically have on teens mental health? Cause you mentioned that.

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Absolutely. COVID-19 really did have a massive impact on our teens. Again, like I said, a very vulnerable population with their own challenges going on naturally. And now you're tacking on the anxiety from what's going to happen next? When can I see my friends again? Oversaturation of social media as well as technology because children and teens were going to school through using you know, computers and learning more about deaths and the stress of COVID-19 and how it was impacting family systems, as well as the natural changes that happen in a teen's life.

It really did add a lot of additional stressors that probably would not have normally been there if we didn't have a global pandemic going on.

Host: I can't even imagine being a teenager going through all that, knowing what it's like to be a teenager in normal circumstances. So what types of mental health issues are you seeing in your adolescent patients?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Primarily what we're seeing a lot of in our adolescent patients is depression, anxiety, behavioral challenges. These are the most common things we're seeing. We're also seeing an exacerbation of eating disorders and OCD like symptoms showing, for many of our patients.

Host: Wow. What is the Hope and Resiliency Center for Youth? Tell us about that.

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Oh, absolutely. So the Hope and Resiliency Center for Youth is an IOP, which stands for Intensive Outpatient level of care here at Bergen New Bridge Medical Center. We identified a need in our community for a higher level of care on an outpatient level as opposed to an inpatient level. So in terms of levels of care, it's an outpatient level of care, meaning kids can still go home at the end of the day, but they can still attend a more intensive program three days a week. So it's a group treatment modality and we meet three days a week and there's three groups for our patients. We have a psychotherapy group, a psychoeducation group, and a recreational therapy group. What the group modality really helps teens with in our Hope and Resiliency Center for Youth is understanding that there's universality to their problems. They are not alone in feeling depressed or anxious.

We also offer additional supports like medication management, individual therapy, family therapy, and our teens stay with us for about eight to 10 weeks. But we've built a curriculum in that eight to 10 weeks that is specific to the challenges that teens face. Primarily what we really focus on are things like healthy coping skills and healthy relationship building, the things that teens need to be successful in the community and prevent inpatient hospitalization.

Host: That's a great idea. I was just hearing, somebody told me they read an article about how teens are like two years behind socially because of the pandemic when it comes to just interacting with other people. So right there you have a challenge. What are some warning signs that parents and guardians should look out for?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: This is such a great question and this is something that I am as a therapist, super passionate about letting people know. We really want to be paying attention to teens that are having feelings of sadness, hopelessness, or loneliness. Any acting out behaviors like running away or risk taking behaviors, preoccupation with death or dying, maybe withdrawal from friends, family, or regular activities they might normally enjoy.

Alcohol and drug use on a continued or increased level is a warning sign. We also want to be mindful of dramatic changes in personality or appearance. Is the teen taking care of themself? Are they showering? Are they maybe not wearing makeup anymore and they used to wear makeup? Are they not doing their hair?

You know, things like that. But also we want to pay attention if there's any kinds of changes in their behaviors in school. Someone who was once a grade A student is now seeing a huge decline in their school performance. And are they seeing changes in their sleeping or eating patterns? These are big things to look out for when we see our teens and if we notice any of these challenges, we, we need to make sure that we get the teen linked up to help as soon as we can.

Host: As a parent of a teen, I have to tell you, during the pandemic, my friend group, parent-wise, we kept in constant contact cause it was like holding your breath until it was over as far as your kid's mental health. No matter how centered or together or all star your kid was, they all were affected I think.

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: It was such a difficult time too because you think that the proximity of us all being together would help people notice like, Hey, there's something going on out of the normal. But it really wasn't the case. You know, a lot of people kind of didn't know what to look for, so it kind of just sat and got worse before it got better.

Host: So you mentioned the outpatient center. What treatment options are available for our teens, both inpatient and outpatient?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: So at Bergen New Bridge Medical Center, we do have a inpatient unit for minors. It's called the CCIS unit. So there is that controlled environment that's closely monitored. Medication management is administered and managed every single day. So that's the most restrictive level of care. As mental health providers, we want to provide patients the least restrictive level of care, but we understand that things like an inpatient hospitalization might be necessary to keep patients safe, especially patients who are really struggling with their mental health. Maybe having active or passive suicidal ideation. That level of care is really needed just to make sure the patient is one, safe and two, gets the care they need immediately. On the outpatient level of care, there's things like intensive outpatient programs like the Hope and Resiliency Center for Youth.

There's also things like in-home therapy, which is really great because the family gets involved in the environment. So we kind of see a continuation of care and problem solving within the home. We also have medication management on an outpatient level. We have an outpatient department here at Bergen New Bridge, and in that program we do medication management.

This is the least restrictive level of care. It's like once a patient's been stabilized, they're doing well, and they've maybe had some continued success in the community; we want our teens to get continued medication management, but we also have individual therapy for teens so they can kind of come talk to a non-biased third party and maybe get some feedback and some help that maybe they don't want to talk to their teachers, their school counselors or their family about. So there's lots of options in terms of care for kids.

Host: That's great. A lot of choices, and it sounds like you've covered every possible scenario. So on a practical level, how can families, friends, schools, and communities help support our teens? What can we do?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: I think the biggest thing we can do is offer help and listen. I know it is so hard because as parents and caregivers and teachers, all these great impacts in a teen's life, we want to fix the problem, but sometimes we just need to listen. We need to encourage our teens to talk about their feelings, and we need to listen and not lecture.

The goal is to create a safe space and a safe relationship that encourages the team to speak to you. But if we come at it from you're in trouble, or this is a bad conversation, I don't want to talk about it, it's going to shut that teen down. So we want to facilitate conversation. So listen, listen, listen. And we want to trust your instincts.

You know, if there is something that seems off about a teen, utilize emergency services. Utilize professional mental healthcare. Don't wait for something to happen. Be proactive. These things are so important because what we noticed in the pandemic specifically, was that when teens finally came to the emergency room before COVID, you know, if there was something slightly off, we would see people come because they're like, you know what? Let me get this checked out. But in the pandemic, because there was such a stigma and fear around going to a hospital and getting COVID; finally when teens did come to treatment or their families brought them to treatment, it was when the symptoms were so severe that the only thing that could be done is a hospitalization.

So making that teen feel safe and letting them know like, you come to me and we speak and you are safe. That's the biggest piece of feedback I can give, but also as important as it is to recognize the things that might be going negatively in a teen's life; celebrate and acknowledge successes. If a teen's doing well, give them a compliment. Let them know that they're doing well. Tell them the positive changes you've seen. We need to acknowledge the good as much as we acknowledge the bad, because that positive reinforcement again, creates that trusting and disclosing relationship that a teen will feel comfortable coming to us.

Host: I have to say, I think you cannot compliment teens enough, like even when they open the door for you or you know you're getting a sandwich and they're just outgoing, you cannot compliment them enough. I think teens need all the love they can get from everybody. I have to ask you about social media. What do you think about limiting it?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Social media is a tough one because social media is such a big part of the day-to-day communication in teens. But what we also know is that social media has a negative impact on mental health because teens are constantly seeing a highlight reel of their peers or people they look up to, or influencers.

They're constantly seeing the best of someone's life. They're not seeing the day-to-day struggles that someone deals with, and they're seeing this as the reality. And social media plays a large role in self-esteem as well as body image issues because there's all these apps that people can face tune their face or change their body to look a different way.

And it gives unrealistic expectations of body image for teens and teens compare themselves to that. Or they wonder, why do I not look like that? Why can't I be as successful as my peer who just got into their first choice college or has a boyfriend that loves them, or whatever it may be. It's, it's a great tool to stay in communication, but it's not such a great tool to keep teens' healthy expectations on what it is to be at their best.

Host: Right. So is it fair to limit the time on it when they're very young, like, 12,11 or is it already just, it's just too far gone? I mean, it's been around and all their friends have it, and that's just the way it is.

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: Hard to say, but I, I mean, I personally believe that there's such a thing as oversaturation of social media. Having worked with clients as a therapist, I think there is sometimes that we need to say, like, you need to put a limit on that. You need to take a breather from it, because again, it just feeds in, especially to someone who's suffering from low self-esteem or body image issues, it feeds into that negative thought process. So it's not a bad idea to put a limit on it, but eventually they're going to consume it one way or another.

Host: I know. Darian, is there anything else you'd like to share with us that we didn't cover?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: I just want to again reiterate, you know, offering teens a safe space to talk is such an important goal of the mental health community agencies in the hospital setting. Because we want teens to know, like, there's no stigma around seeking help. In fact, it's a really healthy thing to get the help you need for your mental health.

Mental health is just as important as physical health. We can't have one without the other, so just like we go to the doctor every year to make sure that we check in and that we're doing okay, we need to sometimes check in with our mental health and take care of ourselves.

Host: Thank you so much for this invaluable insight into our teen's mental health, which is so important, especially right now. If someone would like to find out more, where would they go?

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: If anyone's interested in our services here at the Medical Center, you can go to newbridgehealth.org.

Host: Thanks again, Darian. This was really eye-opening.

Darian Eletto, M.Ed., LPC, LCADC, NCC, ACS: My pleasure.

Host: Again, that's Darian Eletto. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This has been Wellness Waves from Bergen New Bridge Medical. Thank you for listening.