Destination Mental Health: Helping depressed young people arrive at a better place

Depression in young people is something we hear more about these days, but sadly, it is still something that goes undetected and can seriously affect a young person…even to the point of suicide. There are many programs out there that attempt to make things better for young people and mental health. The great news is that young people are more aware of mental health issues than in years gone by. In fact, I would go so far as to say that young people are very interested in their mental health and in learning more. The other great news is that young people are better at help seeking then they once were. The not-so-good news is we still do not have an iron clad way of preventing depression in young people and the terrible news is that there are still many depressed young people who go undetected. However (more great news…) we can prevent depression from worsening if we work with high risk groups and with those who have the early signs of depression.

We know that young people at risk for depression may have a family history, some past traumatic experiences, a personality type or come from some marginalised or minority group because of their race, gender identity or even risk of homelessness. We also need to keep an eye out for the early signs of depression in young people. Warning signs to watch are:

  • Bodily signs – tiredness, change in appetite, change in sleep patterns or a change in energy levels
  • Emotional signs – feeling worthless, sad, low self worth, anger, guilt, fear and worry, change in personality, flatness to mood
  • Behavioural signs – agitation, aggression, withdrawal, isolation, avoidance of preferred activities, self harm, poor self care/cleanliness/hygiene, poor school attendance, reduction in school grades
  • Thinking signs – preoccupation with death, difficulty staying focused, reduction in memory, indecisiveness

I know that many of these things sound like day to day symptoms of being “just a young person” and that is why it can be hard to detect, but be aware of change and be especially mindful if things remain concerning for longer than they might normally be. Also keep a close eye on young people if there are stressors in their friendship groups, if relationships end, if they have issues with drugs or alcohol, if they have a disability or chronic medical illness or if there has been a death in the family or in their social circles.

Once we’ve noticed the signs…what to do then?

Well, this is where all sorts of people in all sorts of professions selling all sorts of snake oil might come into play. If we want them to get a depressed young person to a happier place, we want to get them there by the most direct route and with the least mucking about. This is an important, sometimes even a life and death, issue – too important for any mucking about.

If you knew the fastest route from here to, say, Hawaii was a plane and you wanted to get there as quickly as possible, why would you walk?

The research clearly tells us that the best way to get a depressed young person to a happier place is by using a qualified psychologist or other mental health professional. In Australia, AHPRA register health professional and you can check any registered professionals qualifications or even make complaints at the AHPRA website. If we are looking for the best person to assist a young person on their journey to mental wellness, we also need to make sure that the services are youth-friendly and culturally responsive and that the young person is supported to develop an ongoing relationship with the psychologist or other mental heath clinician.

Okay – so we have the type of professional we need. What techniques should we be looking for? Aerobatic manoeuvres are likely unnecessary on a trip across the Pacific.

If we want to get a young person well in the fastest, most straight forward way, the research tells us that Cognitive Behaviour Therapy (CBT) or Interpersonal Therapy (IPT) work best with young depressed people.

CBT encompasses a variety of sub-types, but at its essence focuses on thinking and behavioural habits that precipitate and perpetuate depression and looks at a variety of techniques to change thought patterns and behaviours. With young people, it is especially important that the psychological work that is done is done with respect to the context of what is happening for the young person and that there is appropriate involvement and collaboration with family, support people and even school.

Sometimes if the young person has a moderate or severe level of depression, some medications may be warranted. Medication for young people with depression can be controversial because young people are much more at risk of suicide when they are agitated and the early side effects of many antidepressant medications are agitation. Current guidelines suggest that medical practitioners should consider an SSRI, but that they need to monitor the young person closely after prescribing pharmacological treatment and that best outcomes occur when the medication occurs in conjunction with CBT or IPT. Also, when things start to get better, best practice guidelines tell us that we should continue to provide treatment and monitoring for a further six months.

Also, while we are flying to our destination, it’s important that we have a safety plan.

Flight attendants repeatedly tell us about the need to know what to do in the “unlikely event of an emergency”. A young person’s psychologist or mental health clinician and medical practitioner should also discuss an emergency plan with the young person and the young person’s support team.

Knowing what we know about young people and the path to recovery from depression, we should not stop looking for other routes that could be even more effective, more comfortable, less expensive, or less effort. More research into mental health is always warranted because we still have a way to go to make the journey smoother – especially for those with really complex issues.  Meanwhile, I would encourage everyone who has an interest in the mental health of young people to read the Clinical Practice Guidelines published by Beyond Blue who have done an amazing job of reviewing the available evidence to help clinicians with good practice points.

If the destination is mental health, then, at this point in time, the best way to get a young, depressed person there is CBT or IPT with a qualified psychologist or registered mental health practitioner who can build rapport with young people and appropriately involve their families or others to ensure the safest, most effective journey with the happiest of landings.

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