I’ve been working in the field of children’s mental health for more than 45 years, most of them with the North Shore Child & Family Guidance Center, the leading children’s mental health agency on Long Island, where we turn no one away for inability to pay.
During the early months of each year, we conduct an informal study in an attempt to understand who is calling us for help and what needs they’re calling us about. In recent years, the trend has been that most of the children and teens we see are experiencing anxiety and depression. According to studies, more than 1 in 20 American children and teens have anxiety or depression.
It’s normal in stressful situations to experience anxiety, but some young people have anxiety that interferes with everyday functioning at home or in school. As for depression, while everyone can have a bad day or two that eventually passes, with serious depression there is a more intense and prolonged feeling of hopelessness and inability to function in the important areas of one’s life, at school, at home or with peers.
Some of the signs of clinical depression are feelings of sadness, emptiness, hopelessness, anger or frustration. You no longer care about activities that you typically enjoy; you may not be able to fall asleep, or you sleep longer than usual; you’re often tired; you experience feelings of worthlessness and guilt; and you can’t concentrate or easily make decisions.
Bruce Springsteen, who has opened up about his depression and suicidal thoughts, described it this way in an interview with Esquire: “I once got into some sort of box where I couldn’t figure my way out and where the feelings were so overwhelmingly uncomfortable.”
Depression in teens is widespread: Research indicates that one of every four adolescents will have an episode of major depression during high school, with the average age of onset 14. Sadly, only 30 percent of depressed teens receive treatment, despite the fact that suicide is the third-leading cause of death for young people ages 15 to 24. In fact, according to suicide.org, teen suicides have risen dramatically in recent years.
Why are 70 percent of depressed teens not receiving professional mental health care? One reason is that stigma and shame have the effect of marginalizing and isolating those living with depression. The other reason is that families that seek care for depressed loved ones have trouble accessing professional help, with fewer and fewer providers accepting health insurance.
Despite a federal law that requires health insurers to maintain full rosters of providers — the Mental Health Parity and Addiction Equity Act of 2008 — they often fall short. In addition, the government has failed to adequately enforce the law.
In a 2018 research study by the North Shore Child & Family Guidance Center called Project Access, of the 650 people surveyed, almost half said it was more difficult to find help for mental health or substance use problems than for other illnesses, especially when they were in crisis. Almost 40 percent said their insurance company didn’t have an adequate number of providers, and two-thirds said their insurance company wasn’t helpful when it came to finding care.
There is good news: Anxiety and depression can be treated. Individual and group therapy and, when needed, medication can help. But first you have to be able to find help.
Beyond professional help, how we relate to our loved ones, friends and neighbors living with depression can make a real difference. When we stigmatize someone living with depression, we act as if they have a character flaw or lack of willpower and are undeserving of support. It’s only when we begin to view illnesses above the neck the same as illnesses below it, like cancer or diabetes, that we can reach out and connect rather than further marginalizing and isolating. Sometimes a simple, “How’re you doing? I see you’ve been feeling down. Just know that I’m here for you” can make all the difference.
You can’t instantaneously cure depression, but genuine support and unconditional love can make all the difference in the world for someone living with a mental illness.
Lady Gaga, another artist who has opened up about mental illness, called suicidal thoughts a “spell.” She explained, “We have to have empathy. Be kind, and help each other break the spell and live and thrive.”
Andrew Malekoff is the executive director of the North Shore Child & Family Guidance Center, which provides comprehensive mental-health services to children from birth through age 24 and their families. To find out more, visit www.northshorechildguidance.org.