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Sound Familiar?

"Nobody could possibly understand how I feel." "If I start to cry, I'm sure I'll never stop." "I'm so bad that no one could ever like me." "If I don't hit something, I'm going to explode." "If people knew what I was thinking, they would say that I'm crazy." "I try as hard as I can, but I just don't understand things like I used to." "My family is driving me crazy!" "I just don't enjoy anything anymore." "I wish I could just stop feeling."

Adolescent Mental Illness

Canadian adolescents, like teens throughout the world, are at high risk for mental illness. Research has shown that in Ontario alone, about one out of five 4 to 16 year-olds suffers from some type of psychiatric disorder.

In the U.S., adolescents represent the only age group where the mortality rate continues to increase. Combined, the top three causes of death — accidents, suicide and homicide — account for 75% of adolescent deaths.

Professional mental health care resources reach no more than 1 of every 6 children and adolescents in Canada. It is important to better understand what is going on with our youth, why they are at risk, and how we can try to better address the needs of adolescents with psychiatric disorders.

What Is Mental Illness?

Mental illness and mental disorder are not easy to define. Misunderstandings lead to misuse and abuse of the terms, reinforce myths, and even prevent people from getting help when it is really needed.

In general, mental illness refers to clinically significant patterns of behavioral or emotional functioning that are associated with some level of distress, suffering (pain, death), or impairment in one or more areas of functioning (such as school, work, or social and family interactions). The basis of this impairment is a behavioural, psychological, or biological dysfunction, or a combination of these.

Myths and Facts

A number of myths surround child, adolescent and adult mental illness. Society can go a long way to de-stigmatize mental illnesses by having a better understanding of mental health issues.

myth: People with a mental illness are psycho or dangerous, and have to be locked away.
fact: Many individuals with a mental illness can have difficulty coping with day-to-day living. When in great distress, such individuals are at greater risk of harming themselves than others.

myth: People with a mental illness never get better.
fact: With the right help, many people with a mental illness do recover and go on to lead healthy, productive, and satisfying lives.

myth: You can tell if someone has a mental illness by looking in their eyes.
fact: Although there are many signs and symptoms for when someone may be developing a mental illness, diagnosis is a difficult task best undertaken by health professionals. Quick judgements and stereotypes are poor substitutes for comprehensive assessments by professionals.

myth: Only crazy people see shrinks.
fact: People of all ages and all walks of life seek help from a variety of mental health professionals, including psychiatrists. Seeking and accepting help are signs of coping and of preventing situations from getting worse.

myth: If you talk about suicide, you won't attempt it.
fact: Suicidal comments have to be taken seriously as they often lead to plans, attempts, or completions.

Youth And Mental Illness

Different kinds of mental illnesses are commonly seen in adolescence and have significant effects on a teen's day to day living. Some of these include:

Adolescents and Depression:
Many teens feel down and blue at times, but for some these feelings do not seem to go away but are there day and night. Life can become a chore. These teens may not realize that they are experiencing symptoms of a potentially treatable disease.

adolescents and suicide:
Suicidal thinking and behaviour often go hand in hand with depression in adolescence. Suicide is the second most common killer of Canadian teens. While some suicidal behaviour may be impulsive, all indicators of suicidal thoughts and actions should be taken seriously.

adolescents and anxiety:
Many physical symptoms (such as headaches, stomach aches, or a racing heart) can be associated with anxiety in adolescents. Feelings of fear and dread can become so intense that they can keep an adolescent from going to school, from being in a group, and from many activities that would not otherwise be a problem. Anxiety can be tied to a past trauma (for example, a car accident or incident of abuse) or an identifiable source (such as snakes or heights), or present in everything one does.

adolescents and risk-taking behaviour:
Accidents represent the number one cause of death in Canadian teens. Many accidents can be traced to risk-taking behaviour. Risk taking is a broad category of behaviours that includes: alcohol and substance abuse, unprotected sex, thrill seeking, and delinquent behaviours. Adolescents who engage in one risk-taking behaviour are likely to engage in others. Such behaviours, which can result in real tragedies, are often symptomatic of various mental illnesses.

adolescents and eating disorders:
Two psychiatric eating disorders, anorexia nervosa and bulimia, are on the increase among Canadian teenage girls. They also occur in boys, but much less often. Both disorders are characterized by a preoccupation with food and a feeling of lack of control over aspects of one's life. Teenagers with anorexia nervosa are often perfectionistic but suffer from low self-esteem and an irrational belief of being overweight, regardless of how thin they become. Teenagers with bulimia binge on huge quantities of food and then purge their bodies of dreaded calories by self-induced vomiting, laxative use, and often excessive exercising.

Eating disorders can be fatal. Adolescents with these disorders are typically very good at avoiding discovery. Denying the presence of their problem delays much needed help.

adolescents and conduct disorders:
Conduct disorders are a complicated group of behavioural and emotional problems in adolescence. These teens have great difficulty following rules and behaving in a socially acceptable way. Their major problem is expressing anger. They are often aggressive to peers and adults, and may lie, steal, destroy property and be sexually inappropriate.

Risk-taking behaviours are common in this group, including the full range of suicidal behaviours. They frequently have contributing problems including school failure and negative family and social experiences. Conduct disorders can co-occur with adolescent depression and attention deficit disorder.

Mental Illness Is A Family Affair

Many of the major psychiatric illnesses that are commonly seen in adults surface during adolescence. Although not directly linked, there is a strong predisposition for mental illness within families. Some families can also operate in such ways as to trigger mental illness within their members, especially their most vulnerable members.

Family awareness, early identification and prevention are often the first steps to effective treatment. Relatives can play a key role in identifying and treating a teen with a mental illness, and the family members themselves often need help and support.

Don't Ignore The Signs

Parents, teachers and friends are usually the first to recognize that an adolescent may be having significant problems with emotions or behaviour. The following signs in your teen, student, brother, sister, classmate or friend might indicate that a psychiatric evaluation will be useful.

• marked drop in school performance or increase in absenteeism
• excessive use of alcohol and/or drugs
• marked changes in sleeping and/or eating habits
• many physical complaints (such as headaches or stomach aches)
• aggressive or non-aggressive consistent violations of rights of others: opposition to authority, truancy, thefts, vandalism, etc.
• withdrawal from friends, family and regular activities
• depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death
• frequent outbursts of anger and rage
• low energy level, poor concentration or complaints of boredom
• loss of enjoyment in what used to be favourite activities
• unusual neglect of personal appearance
• intense fear of becoming obese with no relationship to actual body weight
• uncharacteristic delinquent, thrill seeking or promiscuous behaviour
• marked personality change
• comments about “feeling rotten inside”, wanting “to end things”, and “no longer being a problem for others soon”

What Does "Help For Mental Illness" Include

The cornerstone of successful help for a mental illness is a comprehensive assessment by a child or adolescent psychiatrist, and/or other qualified professionals who coordinate information from parents, educators, and other relevant sources.

Treatment can include psychotherapy (individual, family or group), skills programs (learning, social skills and behaviour) and psychiatric medication, and can be provided in a variety of inpatient, outpatient or day treatment settings, including special schools, residential placements, hospitals, private offices or community clinics.

Effective treatments depend upon the strong partnership between patient, family and professionals.

Where To Go For Help

Research shows that teens are most likely to tell a friend about concerns that they have regarding symptoms of a mental illness. Unfortunately, a friend might be a great listener but might not be the best person to get help. You can be a better friend by looking for signs and symptoms of mental illnesses and helping someone you know reach out to some of the following people.

• family doctor or paediatrician
• teen health clinic
• school counsellor or teacher
• parent and other family member
• psychologist
• psychiatrist
• social worker
• help line
• emergency department

This brochure was prepared for the Canadian Psychiatric Association by Dr. Simon Davidson and Dr. Ian Manion, Department of Psychiatry, Children's Hospital of Eastern Ontario. The authors wish to acknowledge the "Facts for Families" series, from The American Academy of Child and Adolescent Psychiatry in the document's preparation.