Talking to Teen Patients About Mental Health

The United States is facing an unprecedented youth mental health crisis. Nearly 1 in 5 children have been diagnosed with a mental, emotional or behavioral health condition, according to the Centers for Disease Control and Prevention. At Children’s Hospital Colorado, we believe change is possible. That’s why we’ve established the Youth Mental Health Council (YMCH), made up of teens dedicated to improving youth mental health in Colorado. As healthcare providers, we want to make sure we ask teens about their mental health during appointments. But what’s the best way to go about it? Here are some tips for doctors from teens on the YMCH.  

Be upfront and focus on a one-to-one relationship 

No one likes having their parents in the room during medical appointments, and it’s the same for appointments regarding mental health. Teens are less likely to be honest about their mental health with their parent or guardian in the room. They also aren’t likely to ask their parent or guardian to leave the room. To make everyone more comfortable and the environment safer, ask the parent or guardian to leave as a standard practice and protocol. 

Once the parent or guardian has stepped outside, make it clear that the teen is in a safe space and reiterate what that means in terms of confidentiality, particularly with parents and mandatory reporting. Transparency builds trust. 

Use various approaches to start the conversation 

All young people are different and in different stages of their awareness about their mental health. Offer different approaches, like in written form and a verbal follow-up conversation, because not all teens open up in the same way. 

Learn about their daily life — the good days, the bad days and their home life. Ask things like: 

• What is a typical good day like for you? 
• What is a typical bad day like for you? 
• How many bad days have you had in the last month? 
• Do you feel safe at home? 
• Are you getting enough to eat? 
• Are you getting hurt at home? 
• Do you have an adult you can talk to? 
• Do you have a friend you can talk to? 

Strengthen the connection by building trust 

Talking about mental health can make a teen feel vulnerable. It’s important to establish a sense of trust and work to ease that fear of feeling vulnerable. Start building trust early — use small talk to ease into the appointment or bring up little things the patient has mentioned in previous appointments, such as looking forward to a meetup with friends, how a game they love is coming along, what the ending of the book they mentioned was, etc. Keep it light. Avoid talking about school, as school life is often a source of stress for young people. Focus on mentioning things that the teen enjoys. Explain that your role is to keep them physically and mentally healthy and that you’re here to help them with both. 

Be honest regarding what you must do with the information shared. Teens aren’t big on doctors, and they need to know they can trust you. Remember, “A spoonful of sugar helps the medicine go down.” So, provide them with a safe, open space. They need trust to help you help them.