Amanda Wilde (Host): Welcome to WakeMed Voices. I'm Amanda Wilde. How do we actually talk to our teens about mental health? WakeMed psychiatrist, Dr. Danielle Keyton, is here to address that question and offer guidance on how to start honest conversations about mental health with our teens. Welcome to the podcast, Dr. Keyton. Thank you so much for being here.

Danielle Keyton, DO: Thank you so much for having me.

Host: It's hard for teens to open up when they're struggling, even with people they trust. What makes it so difficult?

Danielle Keyton, DO: Well, I think it comes down to the fact that we're talking about teenagers. And so, for many teens, it comes down to just being judged or just the fear of not being understood. So, a lot of teens that I work with, there's a lot of talk and discussion about mental health, but they're worried about people not understanding them and people not being supportive or being judged in the environment. So, I think it's really trying to get a child or a teenager to understand that you're really just there to help.

Host: Well, how can we make it easier for teens to speak up and feel heard?

Danielle Keyton, DO: Well, I think, coming very just straightforward at them, trying to say, "Hey, I'm here. I want you to understand that you can say something to me without being judged, without being misunderstood. Like, I'm here to help." And just creating that environment. And then, listening, being easy to talk to instead of always offering advice first or making it seem like that guardian or parent interaction

Host: Yeah, it's really hard to refrain from jumping right in there, isn't it? We all want our teens to thrive, but what do adults sometimes get wrong when trying to check in with their teen?

Danielle Keyton, DO: Like I was saying, that immediate solution, trying to solve the problem before making sure that the teen is being heard, sometimes they will feel like it's more of an interrogation, and then that'll immediately lead them to shutting down the conversation. So slowing down, making sure that you're validating their feelings helps to build trust and make it more likely that they'll open up again.

Host: So, there's some approaches, like you said, creating that environment of no judgment, "I'm here to listen." We mentioned the jumping in of parents sometimes. What other things might shut them down, things that we might mistakenly say?

Danielle Keyton, DO: So, I think if we make a comment or respond with something that feels like critical or judgy. So for instance, if you say something like, "Oh, you shouldn't have done that" or "Why didn't you come to me first?" or "Why did it take you so long?" or "Oh no, that's not true" or "Don't think that. You're not." So, I think a lot of times we want to immediately show the person that maybe what they're thinking is a little bit outside of maybe what we believe or we see them as. But instead, it sounds like we're not validating them. So, it's very important to not, like, try to immediately get them to think differently from what they're actually saying.

Host: It sounds like it's just so important for teens to really feel listened to really feel heard. And it's just so hard for adults to refrain to just check in and listen, and really listen. For parents who are really trying to create that open environment, nevertheless, are there some early warning signs families should watch for that might suggest a teen is struggling emotionally?

Danielle Keyton, DO: Yes. So, I think it's important to make sure that we notice patterns in our teens instead of like jumping to conclusions about maybe a bad day, because everybody has a bad day. But when you start seeing patterns and behaviors, so like several days or several weeks of a teen shutting down or being isolated, not really interacting with their family or friends like they normally would, that is something to really kind of check in with them about and say, "Hey, you know, I noticed that you're not eating dinner with us anymore" or "You're not really talking to your friends or spending time with the people that I know you enjoy. Can you explain to me why that is?" That is something that I would say, you know, really kind of helps them notice that you have noticed the changes and then creates that environment where you're like, "Okay, they notice that something's different. Maybe this is okay for me to talk about." So, I would say, yeah, noticing those patterns and those shifts in emotions, the withdrawal, the isolation, or maybe just the mood change with a small—you know, it may not be sadness, but it could be a little more irritable or on edge.

Host: So, we're talking about how we should respond when stress is obvious or even becomes something more serious. How do we also steer our teens toward other places of support?

Danielle Keyton, DO: Well, early support can make a big difference, and it will depend on the situation. So, making sure that a teen, if they have never talked about something that is really serious, that it is discussed with them that, "Hey, this is very serious and we need to go to the proper authorities," or we need to go to—if you're not their parent or guardian, making sure that their guardians are aware of something going on.

If it's something that is not at risk or they're immediately causing harm to them, then those are things that can be discussed slower, when they feel comfortable saying, "Hey, I can be that person for you" or "I can connect you with a support person or a counselor." I think it really is important to really understand the situation though before you start seeking resources because there is a level of resources available depending on the severity.

Host: And what kind of difference have you seen that early support make?

Danielle Keyton, DO: Getting support early can definitely prevent significant changes in their daily function. So, we are worried about teens declining in their day-to-day functioning, which a lot of times can include their academics. Academics are very difficult for teens because they're worried about the next steps, they're worried about what they do after school. And once you fall behind, then that can lead to a whole additional bag of worms. So being more stressed out, feeling like they can't get caught up, feeling like this messes up their whole entire future, or feeling like a disappointment in their friend group or their family. And so, making sure that they get that support early prevents them from having to have another additional thing to worry about academically or just kind of feeling different or like a disappointment.

Host: So, we do prevent the snowball effect there when we can get early support in place. what should a teen expect from their perspective when they reach out for mental health support?

Danielle Keyton, DO: Well, one of the biggest fears I think is like the fear of the unknown. So, it is important to reassure teens that seeking help is safe, sometimes confidential, but a supportive process. So, a lot of times with younger groups, I like to kind of tell them that they're not in trouble. So, if they did something that essentially could get them in trouble if a parent or guardian knew about it, and now they're anxious or they're sad or withdrawn, I make sure they understand like, "You're not in trouble. This is more to make sure that you get the help that you need" regarding substance use or regarding, you know, doing something that caused them to now feel like they are going to be in trouble. But making sure that we know and explain that this is how this process works. I'm going to set you up with a counselor. You can talk to them. You can learn how to cope with different things going on. When you feel ready, then you don't have to go anymore, or you may need to continue with this process until you get more of the control over what's going on.

Host: Now, Dr. Keyton, for families who feel overwhelmed or are unsure where to start, what resources or next steps do you recommend, including those available through WakeMed?

Danielle Keyton, DO: I think starting the conversation is definitely the first step, and it doesn't require the perfect words. So, just showing up and listening and creating that space for honesty so we can just reduce the stigma, making sure that you're building the trust and helping the teen feel comfortable to seek the care that they deserve. And then, knowing the resources available in our community is very critical to making sure that our teens as well as their friends or other people are able to get the help that they need. At WakeMed, we definitely are a large hospital system, but we are a very community-oriented system. So, we have resources available just by going to WakeMed's mental health and wellbeing, connecting with our department.

We can always help someone find resources. A lot of times at WakeMed though our time is spent seeing those who are in emergency need or acute crisis. So, knowing when to escalate the situation to get the help in a acute crisis is very important.

Host: Dr. Keyton, thank you so much for this important information on how to get started and how to create openings for conversations to support our teens.

Danielle Keyton, DO: You are so welcome. I was happy to do it. Thank you so much for having me.

Host: Dr. Danielle Keyton is a psychiatrist at WakeMed Mental Health and Wellbeing. For more information, go to wakemed.org/conversations. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is WakeMed Voices. Thanks for listening.