Caitlin Whyte ( Host): In 2021, the World Health
Organization reported that one in seven children between 10 and 19 years old,
experiences a mental health disorder. Zach Irwin is here today to talk about
the warning signs and symptoms of mental health disorders among the adolescent
population. He is a Counselor at Oakview Behavioral Health Services.

This is Southwest General Health Talk. I'm Caitlyn White.

Well, it's great to have you back on the show today, Zach. My
first question for this episode is, at what age can the development of a mental
health disorder begin?

Zach Irwin MSSA, LISW: Fantastic question. Something
that people don't realize, we do have our different categories of mental health
disorders. We have, mood disorders, behavioral disorders, trauma related
disorders, so on and so on. And if we're considering all mental health
disorders, to be honest, they can begin within a few months of birth.

 There's something known
as reactive attachment disorder where you may not see certain behaviors present
until a little bit later in life, pre-adolescence and those kind of things. But
what we know about how it works is it has to do with the relationships that you
form from the time you're born with your caregiver.

So those that have unstable or unreliable relationships with caregivers,
having a caregiver being in and out or transitioning caregivers throughout
life. Those first few months, are, are incredibly important to the point that
we've identified there are disorders that start then. Trauma related disorders,
in my personal experience, I've, I've worked with somebody as young as two
years old that was displaying symptoms of trauma, including there was a lot of
stress and anxiety. There was trichotillomania that was happening for this two
year old. And so yeah, these, these disorders, some of them you won't see until
later in life. Maybe, personality disorders we typically reserve for least
usually 18 years old. There's some exceptions to that, but others can begin
extremely early on.

Host: Wow. I did not know that. Thank you for telling
us. So then, what seems to be the most common red flags that people pose when
battling mental health issues? I know you mentioned a few right there.

Zach Irwin MSSA, LISW: Yeah. So as far as red flags go,
especially with the majority of the work I do is with the adolescent
population. Isolation is a big one, and I say that with a grain of salt because
we do want to differentiate between typical adolescent development compared to
what might be clinically significant.

 If your 15 year old
likes to eat dinner in their room by themselves, that's not something that
would be considered clinically significant on its face. Versus if somebody
tends to isolate, does not want to, every family activity that comes up, they
don't want to participate in. There's these low moods.

 Isolation to the extreme
is definitely a red flag that we want to look out for. The other one that I
think can go unnoticed at times is what we call a future-oriented perspective. We
always want people to be looking towards the future, whether that's tomorrow,
next weekend, five years from now, whatever it is. So when somebody starts to
lack that future-oriented perspective, that kind of gives us an indicator that
whatever's happening right now in the moment, is a little bit more insurmountable
and kind of the main focus of these things that they've kind of lost the
perspective of oh, there, there is tomorrow or there is next year, or next
week, whatever it may be.

 Along with that, the one
other one I would throw out there. It's a term that we use called anhedonia,
which just describes the loss of interest or the loss of pleasure in certain
things that used to really make you happy or used to really be enjoyable. And
so if you have somebody that's  art was
their passion and you've noticed, hey, you're not drawing as much, hey, you're
not painting as much so on and so on, that's kind of an indicator that you know
what's going on right now. Something, something's up.

Host: Those are some good things to look out for. Now,
there is a growing concern that mental health concerns may cause harmful
aggression towards others, or even self-inflicted violence. How should those
who acknowledge those behaviors handle the situation of seeking proper care
from healthcare professionals like yourself?

Zach Irwin MSSA, LISW: So a large part of this actually comes
down to stigma. There's been study after study after study published that show
it's actually quite the opposite. For those that struggle with mental health,
they're more than twice as likely to be a victim of a violent crime, compared
to a regular person, more so than be a perpetuator of a violent crime compared
to the regular person. So unfortunately that does generate a lot of stigma. And
that needs to be addressed through, through spreading knowledge of these
things, through us having the resources to go talk to people, to let them know,
hey, we've, we found this out through research over and over and over. So, as
far as the self-inflicted violence goes, yeah, that's, that's a little bit more
of a concern, especially when it comes to depression and anxiety at times too,
where the intensity of the emotion is so overwhelming that your brain is
telling you, let's do this thing. Let's, let's cause self-harm and maybe we'll
stop feeling what we're feeling.

And so that's also, again, we've talked about negative coping
skills in the past. That's a negative coping skill that can be utilized. And
unfortunately, like we've said before, if it helps in alleviating those
feelings, it's just cementing in your brain that, oh, this is a viable option
for us to return to in the future.

So as far as acknowledging these behaviors and seeking proper
care, we definitely want to address the correct levels of care. There are
differences in the options that are out there. There's school-based counseling,
which is usually, pretty much towards the bottom. It's pretty low intensity, maybe
30 minute sessions, give or take. There's individual therapy or what we would
call outpatient therapy, and that's your standard is maybe once a week for an
hour, maybe once every other week for an hour. And then you escalate from
there.

So what we offer at Southwest, we have intensive outpatient
therapy, which is three days a week for three hours each day. We also have a
partial hospitalization program for adults that is five days a week for four
hours each day. And then escalating above that, there is psychiatric inpatient
hospitalizations, which Southwest offers for adults, and that's a high
intensity, low duration level of care.

 All of this to say that
we need to make sure that we're being in the right level of care when we're
addressing certain behaviors that are happening. If self-harm is occurring, if
there's been serious trauma that's taken place, I don't know that I would
recommend school-based counseling, especially in the context of sending a child
to go talk about their trauma and these awful events that have happened for 30
minutes. And then saying, all right, well, have a good rest of your day in
class. There's a little bit more that needs to go into it.

Host: Mm-hmm.

Zach Irwin MSSA, LISW: With that.

Host: No, absolutely a great point there. Now, for those
who are working on the betterment of their mental health, what are some
important questions or points of reflection that should be taken to allow
oneself to acknowledge that therapy or some form of treatment would be a
healthy option?

Zach Irwin MSSA, LISW: This is actually a really good reference
to what we call the stages of change. There's five stages that kind of assess
how a person's readiness to change, or there's also another technique of
therapy called motivational interviewing that does the same. So when we do
this, there's the pre-contemplative stage, which is a person is unaware or
unwilling to recognize that something that's happening is causing an issue. And
then we move to the contemplative stage, which is where you recognize, okay,
this might be a problem, but I don't really know what to do about it. From
there, you have planning, action, maintenance, and relapse can also be a part
of that cycle too.

So when we're asking ourselves, Wwhat am I looking for when it
comes to treatment and how do I know that this is going to be a healthy option?
First things first, I would really encourage people to establish goals. Having
some type of that future oriented perspective, having some type of thought of
what is it that I really want to work to. Going into therapy without goals, there's
absolutely nothing wrong with that. You'll actually find that in those
situations you're going to be developing goals pretty quickly and pretty early
on. Cause we want to have a target. We want to know what people's baselines
are. How did you used to be able to function that you no you no longer can't
function in that way? And that gives us something to work towards, something
measurable that we can progress towards.

So, I would say questions to ask ourselves to reflect on going
into treatment, what do I want to be different? Do I have a plan but maybe I
don't know how to get there. And if the answer to that is yes, then you know,
that's a pretty good indicator that we're ready for therapy.  Cause therapy does come down to timing.

 So if you have an idea
in mind that you want to achieve and you're really just struggling on, oh, I
don't have the skills for this, or I don't know what to do, therapy would be
great in those instances too.

Host: So can you tell us more about what healthcare
institutions are doing to better educate the community and primarily those
schools where children are so densely located?

Zach Irwin MSSA, LISW: Yeah. So one of the great things
that I, I truly appreciate about Southwest is the abilities they've given me to
go out and do some community education, do some advocacy for mental health and
mental health treatment. So schools being willing to, to take in these quote
unquote outsiders. We're, we're not school staff. We're not a part of their
workforce. And, sometimes, schools do a, a pretty good job of having maybe
different agencies involved, different therapists coming there. But we want to
make sure that we're creating a mutual understanding of the importance of
mental health treatment and schools, at least the ones that I've been fortunate
enough to work with, have been so receptive to those things. They've come out
and let me do staff trainings. They've come out and let me give presentations
and talks. Schools are really looking, and again, just in my experience,
they're really looking for help in these areas because they're identifying that
they can benefit from partnerships with healthcare institutions that have
experience in working in mental health. We need people that are willing to go
out there and talk to these schools, to present to schools, to train staff.

 As much as teachers are
around kids, if they don't get extensive training on how to deal with certain
mental health issues, especially in crisis. So having people who are qualified
to go out and do those things, I mean, those partnerships are really invaluable
for the kids.

Host: Well, on that note, how can parents and guardians
also advocate for their child when that child is neglecting or driving away
from receiving any assistance or help?

Zach Irwin MSSA, LISW: This is the million dollar
question. Again, with working with adolescents, a lot of the patients that I
see, could be described as treatment resistant to an extent. And so as a
parent, part of this is about understanding how therapy works and what the
intention is. Therapists, as a whole, we are here to help people who are
interested in receiving help with their mental health.

Forced treatment does not typically have good outcomes. So as a
parent, if you really know that your kid would benefit from therapy and it's
the kicking and screaming, I don't want to do this, I don't want to go, you
can't make me go, so on and so on; rather than forcing the treatment in those
circumstances, it's more so about providing the support as a parent. Be
understanding, be willing to listen. And that doesn't mean to deviate from you
know how you feel and how you see fit to raise your child. But knowing that if
we're trying to set up the best possible chance of success, that trying to
force somebody into treatment is not how we get there.

Host: Of course. Well, Zach, one last question for you
here today. What type of programs and initiatives does Southwest General offer
to help adolescents suffering from mental health disorders?

Zach Irwin MSSA, LISW: So we have for our adolescents,
an IOP program, which stands for Intensive Outpatient. This program is eight
weeks long, give or take. We meet the individual's needs. So if people need
more than eight weeks, we do what we can to accommodate that. If people feel
like their issues are resolved sooner than that, we're able to discharge sooner
than that too.

 But that program runs
three days a week, from 4:30 to 7:30 on Monday, Wednesdays, and Thursdays.
Throughout that program, we use primarily what's called DBT which stands for
Dialectic Behavioral Therapy. In that, we review skills that are related to
mindfulness, so things like grounding, relaxation, meditation, those kind of
things. Interpersonal effectiveness, which is just a fancy way of saying your
relationships with other people. So things like communication, boundaries,
those you know types of skills. Emotion regulation, which are the skills that
help people remain in charge of their emotions instead of letting their
emotions run the show.

And distress tolerance, which are skills that are used to get
through those high stress situations and make it to the other side of them. So
we have that eight week program and we have a lot of awesome resources that
have been provided to us. I wanted to give a special thanks to Wayne and Debbie
Brisel, who have been massive supporters and donors to the program, and
identifying mental health needs in the community and using our program as an
outlet to help support those needs and meet those needs. So that's, that's what
we have for adolescents currently.

Host: Well, Zach, thank you so much for joining us again
and for all you do at Southwest General.

If you believe you or a loved one is suffering from a mental
health disorder, reach out to our team at Oak View Behavioral Health Services
to schedule a free assessment. Visit swgeneral.com to learn more. I'm Caitlin
Whyte, and this was Southwest General Health Talk.