Mia Flegal tells middle school students about her bouts of anxiety, depression, and mental illness in children and teens, when a student raises her hand to ask a heartbreaking question:
“What do I do if no one believes me?”
When kids struggle with their mental health and mental health, it can look different than adults — and signals of distress can manifest in ways that are subtle or easy to write off.
Flegal, who just finished 10th grade at Nashua North High School, said she first experienced symptoms of generalized anxiety disorder when she was eight. She began to have trouble sleeping and began to notice that the anxiety was making it difficult to breathe.
“It starts with this hole in my stomach,” Flegal said. “That hole in your stomach starts to creep up into your chest, and you feel like someone is pressing you.”
She remembers waking up in a cold sweat when she was 10 on a trip outside the house. Her mother, Shilo Flegal, remembers picking her up early from a slumber party when Mia, who is usually outgoing and talkative, felt trapped by her anxiety.
Her Nashua North classmate, Arika Roy, said she remembers her anxiety that started as a stomachache when she was in fifth grade.
Erin Murphy, who has now finished 11th grade at Wyndham, remembers when she came home from middle school and found herself shivering, unable to stop crying and irritating.
“It’s hard to tell if this is a stage of growth, or if it is turning into something,” Flegal said.
Even if it’s upsetting to think of children of primary and middle school age who suffer from anxiety, depression or other mental illnesses, Flegal said, Talking about bad feelings can help.
“It can’t be a very silent topic,” Flegal said.
The pandemic and panic around social media have highlighted the enormity of the mental health challenges children and adolescents face today.
According to a survey by the US Centers for Disease Control and Prevention, about one in three high school students reported poor mental health during the pandemic. Half of them said they felt persistent sadness or despair. (cdc.gov/healthyyouth/data/abes.htm)
Generation Z, born between 1997 and 2012, has a reputation for being more open about mental health, but Flegal still isn’t sure her peers feel comfortable talking about their mental health in an earnest, serious way.
“A lot of what Gen Z does is joke about it. But telling the joke about it is not the same as asking for help,” Flegal said. “If jokes are the first step, that’s okay, but ultimately we need to encourage people to seek help.”
More online resources are being made available to deal with acute crises, such as New Hampshire’s new “rapid response access point” for people who need help in a crisis, and the 988 National Crisis Line, which will be activated July 16. The state hopes to open more beds this fall at Hampstead Hospital for children and teens who need more intensive care.
Community mental health centers in the state can connect people to treatment and make calls to help with other aspects of someone’s life.
Rick Cornell, vice president of community relations at the Greater Manchester Center for Mental Health, said the center has been able to recruit staff at nearly every school to work with students and train staff, and offers similar assistance in summer programmes.
“For many years, mental health went downhill and I waited for people to come in. That’s not what we do anymore,” Cornell said. “We can’t keep picking up the pieces. We have to prevent these pieces from collapsing.”
There are still barriers to actually getting help.
When Flegal’s colleague in Nashua North, Arika Roy, had a nasty bout of anxiety two years ago, Roy said her family had tried to contact therapists across New Hampshire and Massachusetts for the better part of two years, but they weren’t able to get an appointment. with a psychiatrist.
Cornell said there is an acute and worsening shortage of psychologists, therapists and all kinds of other health care workers — but he said families with a lot of money have an easier time getting treatment and other mental health care.
Many therapists are reluctant to accept health insurance, because it can be difficult to convince insurance companies to pay for their services. Cornell said some therapists are accepting new patients — as long as those patients can pay in cash.
But Cornell said 10 community mental health centers in New Hampshire (nhcbha.orgIt can help people who find they do not have access to mental health care.
“Call us,” Cornell said. “We’ll see what we can do to get you in.”
Roy said she has found other ways to deal with her anxiety due to not being able to see a healer — drawing on her family’s Hindu spirituality and even checking out YouTube to watch videos about breathing and meditation.
Flegal said she’s found ways to deal with it, too.
She began writing her diary after bouts of anxiety, working through her thoughts. In the middle of a seizure, when she is stuck in a cycle of hyperventilation and crying, she counts her breath, or grabs two ice cubes and squeezes them to get her body out of the cycle.
Flegal said these coping mechanisms have evolved over the years, but she said having people to talk to — her family, friends, trusted teachers — helps her stay on top of things.
In the event of a pandemic, Flegal said, much of that support network has fallen through — an experience many children and adults share.
Isolated from friends, with limited opportunities to interact with teachers as Nashwa has been in distance learning for most of the 2020-21 school year, Flegal said she will get out of bed a few minutes before Zoom class and sit silently in front of her computer with the camera turned off. When she gets out of class, she takes a shower, plays music, and cries.
“I was stuck in a hole,” she said. “You haven’t seen an end to it, and it’s very difficult.” She was worried about asking for help, fearing that she would somehow be a burden to her family or add to the tensions at home.
Flegal said that when she actually admitted those feelings of hopelessness, her family listened, cared for her, and helped her.
“Seeking help does not make you weaker, nor does it have a negative effect on those around you,” she said.
Feeling less lonely
Family members, teachers, and coaches — anyone who knows a child or teen well — can monitor and ask about changes in behavior, such as changes in sleep or hygiene, said Diana Shriver, clinical coordinator of the children’s division at Diana Shriver. The Greater Manchester Center for Mental Health.
Adults can ask questions about the behavior first, gently, and from there open up a conversation for a young person to talk about their emotions and sanity.
“One of the things we talk about helping people do is building their observational skills,” Shriver said. “It may not be a crisis, but it may be a construction crisis.”
Murphy, a Wyndham student, remembers an eighth-grade teacher pulling her aside one day, when she came to school in her pajamas and bobble hair, to ask how she was doing. That conversation gave Murphy space to admit for the first time that she wasn’t feeling well.
“He asked me if you were okay,” Murphy said, “and the answer was no.”
She is grateful that the teacher made the effort to check.
Feeling safe talking about feelings — especially difficult feelings — is important even for younger children. Flegal said she is working with community groups to develop programs where she can talk to young people, talk about her mental health history and try to help other children feel comfortable talking about their own feelings.
Flegal said she’s open about her difficulty with mental health because she wants others – especially young children – to see it’s safe to talk about their mental health. To that girl who asked what she should do if no one believed her about her mental health struggles, Flegal said to go on.
Shriver said the same.
“I would say to that young man, don’t stop talking. Don’t stop asking for help, until you feel like you are getting the help you need.”