We Can Ignore Mental Health -- or We Can Invest in Real Help

EDITOR'S NOTE: Today we hear from Tiffany, a VOICES Youth Policy Fellow about her own experience and recommendations for youth mental health support in Hoosier communities. The following essay contains references to suicidal ideation, depression, and self-harm. If you are in crisis, you can reach the National Suicide Prevention Lifeline online or at 800-273-8255.

The first time I held a knife, I thought about killing myself. I was 4. I wondered what would happen if my brother or my mom walked in and saw my corpse. I remembered the clock ticking and the sun streaming through the windows as I stared at my pudgy hands gripping the knife. It wouldn’t be that difficult; I was alone after all.

In the end, I let go of the knife.

Looking back, I have alternating memories of experiences where I felt as though I wasn’t in my body , where I felt painfully grounded in a reality I couldn’t escape. I felt like I was a mistake, that I wasn’t enough. Talking with people from my school and others, I know that I was not alone in this feeling.

I tend to think that I had a relatively normal childhood. I lived in one place my whole life, went to school, and had friends. I visited my grandparents every year and my family made the dutiful pilgrimage to Disney World. I was able to learn instruments, dance, and attend drawing classes. My family wasn’t necessarily happy, but we were fine, and that was good enough.

The one thing I didn’t have growing up was the opportunity to make my own choice. I was unable to visit my friends unless they got to the same church as my parents. I wasn’t allowed to not learn an instrument of my own choosing. I was told that everyone else learned these things and they did them well, so I should as well. As I grew older, I needed to be great with STEM, tennis, and other very specific things that my peers were good at.

I hated everything, especially being told whatI should be good at. I had no interest in piano. I was told to drop my hobbies so that I could focus on math. Why do I not like what they want me to like? Since I didn’t excel at these activities, people told me I wasn’t good enough. They would compare me to others and remind me of how useful these activities would be after high school. It made me feel as though I was a failure in life.

By the time I was in middle school, I felt an approaching sense of doom. I believed that I would kill myself before I graduated or shortly thereafter. At school, I would sometimes break down into tears. I stopped eating and lost 30 pounds in 3 months. I would stare at the people around me and wonder why they were so happy. My life had no real meaning.

I felt that everything I have done was immaterial and useless. It was not helpful when I was being compared with people who have already gone to Carnegie Hall or elite colleges. In contrast to them, I felt that I wasted resources with my existence. I had few friends and I was constantly miserable. It felt like falling into the abyss and there was no way out. By the end of middle school, I slept most of the time since I hated being awake and cognizant of my misery.

That should have been the time I asked for help, but I chose not to get help for another year. This was because my parents come from a culture where it was taboo to talk about mental health. It was considered a shameful weakness. Most of the adults I spent my time with had similar views of mental illness. They were not sure what to make of me since I didn’t fit their mold of what a child should be.

On top of that, I didn’t think asking for help would change anything. One of my caregivers has a severe mental illness. This individual threatened my brother and I with torture on a semi-regular basis. They also screamed at other children and made them cry. Everyone knew there was something wrong yet almost everyone ignored it. Their indifference to this person made me think nothing would change and I was doomed to have a miserable time.

My parents finally got me help during the summer before 10th grade. I was exhausted; I felt that I constantly straddled the line between trying to live and giving up entirely. I doubted talking with someone wouldn’t make a difference. Adults didn’t particularly care about children. I was already considered “other” for saying that I was definitely mentally ill. It wasn’t until I self-harmed in front of my parents that they finally got me help.

The therapy gave me a new perspective, it made me realize that what I thought normal was actually deeply unhealthy. Because of my relatively isolated childhood, I didn’t understand that threats to my life were inherently wrong. I was made to believe that as long as this person never followed up their threats with action, it was fine. Others told me that this deeply flawed person cared for me and I should be more patient with this person.

The turning point in my life was when my therapist told me I was enough. She was the first adult to tell me that. I was aware of this concept but have never applied it to my life, nor have I ever been told to. It was strange for me to think that I am actually worthy simply because I existed. I spent my life thinking that I was nothing more than an instrument to create or do things that would benefit others. I believed that I was not enough compared to the people around me because of it, that I was not saintly enough, smart enough, nor talented enough. Not having any real concept of self-worth, it made me internalize criticism and comparisons thrown at me by adults.

Through therapy, I internalized positive concepts that built up my self-confidence. I am able to appreciate myself simply because of my existence. It’s alright to not be perfect, especially if you are a kid. It’s unrealistic to expect perfection the first, second, or third time. Failure is a part of life; I wasn’t a “quitter” like what my mother said.. I was trying to figure out what I liked and didn’t like, which most people do. I realized my failures d are not sins but a natural process to undergo in life.

My life wasn’t ending; it had just begun. What I thought were insurmountable mountains were in fact small bumps in the road. Not being able to play an instrument in front of others doesn’t mean I will fail at life. Just because I was average at math doesn’t mean I’ll be incapable of having a job. I started thinking about how to live a good life. Since I thought about killing myself before high school graduation, I consider my existence with this new found confidence as a second life. I planned on making the most out of it. So I spoke with the elderly and read classics from people who knew much more than me. I spent junior and the beginning of senior year expanding my worldview and slowly rediscovering my interests.

When the Coronavirus hit, my life did not slow; I did not fall into a pit of depression. Rather, my life accelerated and my thinking ascended to a new height I was not able to encounter before. I met people of varying backgrounds from my town in online initiatives -- people who routinely failed or met personal obstacles, yet got back up and tired again. The people I met are optimistic, altruistic, and confident. They helped other people because they genuinely believed in helping others. These people inspired me to work harder. With the help of my friends, I wrote and published my first book. I joined a virtual exchange and met people from around the world. I conducted interviews with change-makers in their fields. I was chosen as a representative for the American Battlefield Trust, a non profit organization that seeks to protect and preserve American’s battlefields. I also joined VOICES youth leadership team in Indianapolis, a partnership with the Commission on Improving the Status of Children in Indiana. Through this program, I spoke with over 400 legislators on mental health in schools and received an offer to create a proposal for a state senator.

I found these projects exhilarating and proved to me that I wasn’t lazy. I was actually the opposite: the moment I find something I like, I throw myself at it and achieve results. Because I finally found things I like to do and people who brought me up rather than tear me down, my depression and gloom started to recede and disappeared altogether.

I am currently experiencing the best time of my life. Now, there are some nuisances like college applications, but I cannot remember other times when I wasn’t deeply miserable. This is certainly a result of doing things I love, but I could have never gotten here if I hadn’t changed my perspective. And I wouldn’t have changed my perspective if I hadn’t gone to therapy. It is for this reason that I believe more schools should have mental health professionals, more awareness of mental health clinics, and mental health training for teachers and school administrators.

We Can Ignore Mental Illness, But That Doesn't Mean It Goes Away

From my experience with my peers and local community, I understand that talking about mental illness and even mental health can be taboo. However, just because we ignore it, doesn’t mean it goes away. Mental illness is a widespread condition among everyone, even with teens. According to the CDC, 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety (“Data and Statistics on Children's Mental Health”). A 2019 study found that 1 in 6 US children between the ages of 6 and 17 have a treatable mental health disorder such as depression or anxiety (Whitney and Peterson, “US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children”). A 2005 paper found that 46 percent of Americans will meet the criteria for a diagnosable mental health condition sometime in their life, and half of those people will develop conditions by the age of 14 (Kessler et al., “Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication”).

It’s Personally and Financially Detrimental

I have experienced severe mental illness. I hallucinated in school and randomly broke down in tears in the middle of class. I self-harmed and regularly thought about suicide. My two years in therapy changed my life. All I needed was someone to believe in me. If my parents had just ignored me like everyone else, I probably wouldn’t be here today. Many people experience a decrease in their quality of life because of mental illness. It is severely damaging from a personal viewpoint.

More than that, it’s also detrimental on an educational and financial level. In a 2013 survey, 16% of the adults who experienced emotional and behavioral disorders were expelled from high school compared to the national average of 3% (Wynne et al., “Adult Outcomes for Children and Adolescents With EBD: Understanding Parents’ Perspectives”). In a 2010 review of 115 studies looking at poverty and mental health across the world, researchers found that 73-79% of studies reported a positive correlation with poverty and common mental health disorders (Lund et al., “Poverty and common mental disorders in low and middle income countries: A systematic review”). A 2019 Forbes article states that “Mental health and substance abuse cost US businesses between $80 and $100 billion annually” (Sime, “The Cost Of Ignoring Mental Health In The Workplace”).

School Counselors and Teachers Are Not Suitable Replacements for Mental Health Professionals

There is this tendency for people to rely on overworked teachers to manage children. Some expect them to also deal with mental health issues. This is an unreasonable task. According to the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases (two manuals that most mental health professionals use to identify mental illnesses), there are officially 223 different types of mental disorders (“Symptoms & Treatments of Mental Disorders”; “ICD 11: International Classification of Diseases 11th Revision”). Furthermore, symptoms for mental illness vary based on age and even sex (Riecher-Rössler, “Sex and gender differences in mental disorders”). A child with depression will usually express this mental illness differently from an adult (“Mental Illness in Children: Know the Signs”). Expecting teachers or counselors who are trained for other things to have a basic understanding of major mental illnesses--how they manifest across ages, signs, treatments--is unrealistic.

Most teachers and counselors are overworked and not at all trained to identify, let alone understand or handle, mental illness. Teachers are trained to teach children a specific curriculum in a specific field. Counselors are trained to help students prepare for the transition to post-secondary education and help them adjust their schedules. The only mental illness training they receive is suicide training (“State Certification Requirements”). This was also corroborated by my own counselor.

Training aside, it is hard for a teenager to trust a counselor they rarely meet or a teacher for that matter. The American School Counselor Association recommends that schools have a 250:1 student-counselor ratio. Indiana’s ratio is 543:1 (“State-By-State Student-To-Counselor Ratio Report”). In my experience, I’ve met with my counselor about 3 times a year. Most of the people I know from around the state only meet their counselor about a handful of times. Expecting a teenager to speak about panic attacks, suicidal thoughts, or something as deeply personal to a veritable stranger is unrealistic. In some cases, students might believe that their problems will be a weakness. One of my school’s counselors once sent my friends and I an offer to partake in a research study that would look at ‘why students underachieve in school’. They did not send this study to everyone; they sent it to students they deemed as ‘underachieving’.

Teachers are also not necessarily a good route either. I have friends who talked about mental illness with their teachers who subsequently told their counselors (those teachers said that they are legally obligated to). These students never spoke about their problems again with those teachers. Trust was broken. I know of someone who was ridiculed by their teachers because they said they had mental illnesses. One of their teachers said, “Teenagers can’t have depression”. Teachers are not trained to identify, work with, or even understand teenagers with mental illness.

It's Not Safe to Assume Young People Can Find Help Outside of School

It is possible that parents won’t believe their children or just outright ignore them. My parents could tell something was wrong with me but they assumed teenagers were more emotional. They believed that it was ‘just a phase’. So they told me to pray or meditate. I needed to ‘get over myself’.

Since I ended up slitting my wrists open, their advice clearly didn’t work.

Therapy has done wonders for my psyche but also for my relationship with my parents. My parents had never really encountered mental illness or learned about it. It’s a complex subject that is not talked about in East Asian society, let alone school curriculum. I’m just glad that one of them believed my diagnosis in the beginning. Some are not so lucky. In a study, William M. Cruickshank noted that some parents would bring their child to multiple physicians to get multiple diagnoses until they found one that ‘coincided with their beliefs’ (qtd. In The Free Library 252). It is, after all, difficult for a parent to accept that their child has a disability. However, ignoring it will only make it worse.

Mental illness is a taboo topic for many immigrant communities. For Asian American and Middle Eastern American communities, cultural beliefs that seeking mental health treatment will bring shame and dishonor to the family leading some people to internalize their symptoms instead of seeking therapy. Assuming the parents believe their children, some simply don’t trust the medical community. Black and Latinx families may, understandably, have difficulty trusting mental health providers due to experiences of discrimination (Modir, “Understanding the Role of Cultural Stigma On Seeking Mental Health Services”).

If You Can Find Mental Healthcare, It May Not Be Affordable

Assuming that a child was taken seriously and could find treatment, there are also logistical problems. Teens can’t drive by themselves until they’re 16. Some parents might not be able to drive their child to a clinic across town if they’re working. It’s also just difficult to find a provider. According to a 2017 survey conducted by the National Alliance on Mental Illness, 34% of people reported difficulties finding any mental health therapist who would accept their insurance (“Continuing Disparities in Access to Mental and Physical Care”).

Therapy is expensive. The average cost of therapy is $100-200 (“Cost and Insurance Coverage”). I went to therapy every week for about a year. It was a cost for my family but we could handle it. I know others who are not so lucky. I was also lucky enough to not need medication. Going to a psychiatrist for medication costs a lot more time and money than therapy. I knew someone who drove to another city because our relatively urban town didn’t have the mental health professionals they needed to get their medicine. Individuals who seriously consider suicide are supposed to meet their therapist on a regular basis.

These are the main reasons for why there needs to be something done for youth mental illness. The next section consists of my suggestions for what can be done.

SOLUTION: More Mental Health Clinics In Schools

This would consist of schools leasing space inside their buildings to mental health clinics (Dikel, “Providing Mental Health Services in Public Schools- What Educators Need to Know”). When my group and I presented our points in a summit to over 200 legislators, we were told that having mental health clinics in schools was a common occurrence. Besides one member in our group, none of us had mental health clinics in our schools (we range from rural to urban cities in Indiana). I believe having more schools include a mental health clinic would be a beneficial addition for students and school staff. For one thing, a mental health clinic would be a separate legal entity from the school. The students would also be able to find help without working with non-professionals (teachers and counselors). They could receive help without judgement from their teachers, counselors, and community.

SOLUTION: Raise Awareness in Schools about Mental Health Resources

I outlined the distrust between students and educators in their schools. I think my school is a great school; it’s actually one of the highest-ranking schools in the state. I know that the community in my school is tamer and more open than surrounding areas but there is still a clear gap between educators and students. If one of the best schools in the state has this problem, it wouldn’t be a far stretch to say that most schools across the state experience a similar thing.

Because of this gap, I believe there should be ways for students to learn about the mental health/illness resources their schools offer without admitting to having concerns for their mental state. This could be done by starting online campaigns (ex: social media campaigns) and working with data scientists to safely understand where help is needed while protecting student privacy. There could also be flyers and brochures sent out to community centers and schools. On a school level, schools could send emails to students, include mental health resources in posters and bulletins, mention them on school social media, and include these resources in the announcements.

SOLUTION: Basic Training on Mental Illness for Teachers, School Administrators, and Counselors

I have already gone over the reasons why students can’t trust the staff at their schools. It doesn’t have to be this way. I believe that if there was some sort of training, these educators would be more patient and perhaps be seen as more trustworthy. I don’t believe this should be done in person due to cost and lack of evidence of its effectiveness but I think trying an online training and evaluating its effects would be a good start.

***

I went to therapy for two years before I was told by my therapist that I would no longer need to schedule regular appointments. I haven’t scheduled a session in almost half a year. The reason why is because I am so happy and more confident in my abilities than I used to be. This is because I understand my self-worth and I have proven to myself that I am capable of great things. This came because of one person who believed in me. If one person can affect such change in someone’s life, imagine what you can do. I ask that you do something...because if you don’t, who will?

Tiffany Yeung is a high school senior in Indiana. Under the pseudonym C.M. Yeung, she is the author of Verge, a sci-fi adventure novel. She is also a YES Fellow, co-founder of storytelling site PeopleLifeCo with fellow YES representative Rachel Labi, and part of the American Battlefield Trust Youth Leadership Team. In October 2020, Tiffany joined 15 other YES Fellows as presenters at a Youth Policy Summit co-hosted by VOICES and the Commission on Improving the Status of Children in Indiana. Tiffany and her team proposed a bill concerning mental health/illness education and treatment in schools, sharing it with Representative Vanessa Summers who then shared it with the Indiana General Assembly. 

Do you know of a youth-led policy program we should learn more about? Tweet @mollygmartin and share using the hashtag #YouthAmerica.

Do you want to learn how to develop or grow a program in your hometown? Reach out to Kia Wells at VOICES at kwells@voicescorp.org.