Student’s artwork dangled from rolling cork boards and the hallway buzzed with a steady hum of relief. Their projects were finally complete, and everyone was able to gaze upon each other’s efforts during their interdisciplinary studies projects. As I weaved my way in between the flurry of students, stopping every now and then to listen to their reflections, I noticed a particular sketch on a piece of paper not much bigger than an index card.
The edges were laced in what appeared to be eyeballs and, in the center, two long, scraggly limbs loomed down from a dilapidated scarecrow-like creature, gripping, and clawing at a folded-up being. The creature clasped the being’s head in its hands, forcing it to look up. Both bodies looked emaciated. As I continued to survey the piece, I noticed the carefully written explanation next to the drawing that discussed the challenges of peer pressure. The student explained how it was easier for them to conform to social “norms” versus stand out.
What to some may appear to be an attempt at getting attention or just an art project and nothing more, could actually be a sign of something more serious. For some, this may be considered in the late stages of a mental health challenge. A mental health challenge is “when: there is a major change in a person’s thinking, feeling, or acting. The change interferes with the person’s ability to live their own life…does not go away quickly and lasts longer than typical emotions or reactions would be expected” (About MHFA, 2022). Therefore, using the term mental health challenge allows for a more inclusive range of difficulties that youth and adolescents experience. When I think about my experiences working with a wide range of age groups, I reflect on instances where I felt the most vulnerable. These times often correlated with being new in a school environment. What do you do if you’re new to a school and don’t have prior information on students that you can compare to? What if the information you received on a student is scarce or falls under the “they have always been like this” category, especially as they get into their adolescent years?
Adolescents have long been thought of as having challenges, with the majority of the focus pertaining to, or perhaps excused by, “just a part of growing up” and puberty. Adolescence is defined differently around the world depending on cultural and/or religious purposes. However, nearly every culture in the world recognizes a period of time where changes from childhood to adulthood occur, with the length of time varying from short-term transitions to many years. For these purposes, I’ll use Sarah-Jayne Blakemore’s definition of adolescence, “the interval between the biological changes of puberty and the point at which an individual attains a stable, independent role in society” (Blakemore, 2018,). These changes involve physical, cognitive, social, and emotional differences. In working with students aged 8 to 14, I see first-hand the variations of development that students experience as they navigate through these formative years. In the many conversations I have had with them, they often ask about what’s happening to their bodies, with one of the biggest questions being about their minds and “the emotional rollercoaster.”
The National Council for Mental Wellbeing defines mental health as, “a state of well-being in which an individual: realizes their own abilities, can cope with normal stresses of life, can work productively, and can contribute to their community” (About MHFA, 2022). It is also important to understand the cultural nuances of where someone lives, what they identify with, and how they intersect with the other identities they hold, as well as the identities of the adults working with them. Cultures and belief systems around the world play a key role in someone’s identity and it can help shape how they view and receive (or don’t receive) support for mental health. It’s likely that many adolescents have already shown warning signs that have gone unnoticed and unsupported due to these challenges.
In fact, research suggests that many youth go undiagnosed, which then leads to adults with mental disorders due to the lack of early prevention and appropriate treatment (NIMH » Child and Adolescent Mental Health, n.d.). Here in Thailand, people are fortunate enough to have access to different mental health resources, despite many stigmas that may still be present within a family or community. This is not always the case in other countries where mental health may seem like a sin or a detachment from the body. These beliefs, along with minimal resources, can accompany and or perpetuate stigmas and lead to more difficult mental health challenges and disorders if left untreated.
Understanding these intersectionalities, “a lens through which you can see where power comes and collides, where it interlocks and intersects” (Kimberlé Crenshaw on Intersectionality, More Than Two Decades Later, 2017), is crucial in providing informed and appropriate support for the students and families. Recognizing our own intersectionalities and biases, as well as what positions of power we may hold in a situation while working with an adolescent, is pertinent if we are to ensure we are providing support when necessary. For example, I was raised in a Western society where discussions around mental health and the amount of resources provided continue to grow. If I weren’t culturally responsive and aware, I might approach a conversation on mental health support with a family who may feel offended because mental health is not discussed with anyone outside of their immediate family. It is also important to note that racism, sexism, ableism, colorism, discrimination based on religion, homophobia, and transphobia, to name a few, can deeply affect a person’s mental wellbeing, especially when those intersect based on their identities and/or perceived identities. Think about who makes up your student population. How many students have been or may be affected by harm in these multiple areas?
More and more studies being conducted are noting and emphasizing the increase in anxiety, depression, eating disorders, and substance abuse, among other challenges. According to the World Health Organization, “globally, it is estimated that 1 in 7 (14%) 10-19 year-olds experience mental health conditions (1), yet these remain largely unrecognized and untreated” (Mental Health of Adolescents, 2021). Some studies suggest that percentage is even higher, one in five (Get Trained, n.d.). When looking specifically at suicide, it is the second leading cause of death among 10–24-year-olds, with youth in the LGBTQ+ community at a significantly higher risk (Facts About LGBTQ Youth Suicide, 2021). In just six months within a school, I had three students come out to me, and a handful of other students share these thoughts on anonymous papers in the health class I teach. All three of the students who I spoke with face-to-face shared personal experiences of trying to navigate their identities in spaces where they were afraid, violated, minimized, made fun of, and/or ignored. The toll this took on their day-to-day life was vast and often felt overwhelming.
These statistics are obviously alarming, and may feel debilitating to some people, especially if they feel ill equipped. Teachers, coaches, parents, and caregivers are often in the greatest position to notice changes in children and adolescents, and they can share these concerns as they see and connect with students so frequently. Therefore, it is crucial for these key stakeholders to be trained to provide initial support for mental health. One such training would be Youth Mental Health First Aid (YMHFA). This is similar to CPR and first aid training in that a stakeholder would be the first person to support someone in need before a professional steps in.
Being trained in something like YMHFA allows the people in an adolescent’s life to support and advocate for their wellbeing. A group of adults at KIS International School in Bangkok, Thailand took part in this training to learn how they could become first responders for youth mental health challenges. This group consisted of parents and caregivers, teachers, coaches, school counselors, private practitioners, school nurses, learning support specialists, and administration, among others from schools in Thailand. After a two-hour pre-work assignment, the group came together for a live training session led by Dr. Stuart Roe, a professor of counseling and coordinator of the International School Counseling Program at The College of New Jersey (TCNJ) in the United States, and his associate Natasha Shabazz, a mental health therapist and TCNJ alumna.
A room full of educators, counselors, parents, and caregivers from around Thailand begin their training on youth mental health from Dr. Stuart Roe and Natasha Shabazz. (Photo source: Eddy Ngoenkaew)
Throughout the training, attendees worked in mixed groups to allow for different perspectives and to interact with the learning opportunities from different lenses. This meant that a parent or caregiver, a coach, and a school counselor, for example, could provide experiences and information from different vantage points. One of the key takeaways from the training was how to be a “noticer.” A noticer is someone who notices and observes signs of behavioral differences in an adolescent that could be considered a mental health challenge.
First, it is important to define the difference between signs and symptoms. Signs of mental health challenges are observable and measurable whereas symptoms are indicators of physical or mental challenges a person can feel. According to the National Council for Mental Health, through their YMHFA training (Get Trained, n.d.), there are ways key stakeholders can observe changes in behaviors of an adolescent to help determine if there is a mental health challenge.
These observable signs include but are not limited to:
- withdrawing from friends or family
- noticeable differences in irritability
- no longer partaking in hobbies or activities they once enjoyed (and not replacing it with a new interest)
- changes in hygiene and self-care
- substance abuse
While thoughts and feelings of an individual could be observable in a sense that they may physically show a difference depending on those thoughts and feelings, they themselves are not technically observable because the adolescent would have to tell you about them in order for you to measure changes. Knowing what to look for with mental health challenges allows for early intervention to occur and appropriate support to be given.
Another key takeaway the attendees learned was what to do once they have observed these changes. If someone notices these changes in behavior, they can use the ALGEE Action Plan. This plan is not linear and, therefore, can be used based on the individual’s comfort level as well as the information gathered about the adolescent.
ALGEE action plan steps:
Approach and assess for risk of suicide or harm. If a noticer is not comfortable with this step, it is okay! This step can be handled by a school counselor, private practitioner, or other professional.
Listen non-judgmentally to what the adolescent is sharing. Try to avoid “why” questions or questions which encourage a desired response, known as leading questions.
Give reassurance and information about appropriate support.
Encourage appropriate professional help
Encourage self-help and other support strategies.
Remember, this action plan is not linear and some of these steps might not be used when navigating a mental health challenge with an adolescent. Knowing what is and is not available in your area for mental health support is important. It is also important for you to learn about the laws within the country you reside in, as well as the cultural beliefs and values around mental health.
At the end of the training, one of the teachers who attended said to me, “This is exactly what every school needs. If we all get trained in CPR and first aid so we can respond appropriately to a physical health issue, why not be trained to help respond to a mental health issue, too?” Other educators from schools around Thailand also agreed that there was an abundance of need for training like this one, and they hoped all educators in their schools could be trained in being noticers and first responders for adolescent mental health. Another attendee, a mother of three at our school, shared how grateful she was for this opportunity and how this allowed her to gain new support tools that would help her be more aware of any changes her own children might experience and how to approach it more comfortably. If all stakeholders were trained in something like this, they would be providing important early intervention for an adolescent suffering a mental health challenge and could help prevent larger mental health issues from occurring later.
When reviewing the information above from the YMHFA program, it is important to remember crucial aspects to consider before supporting adolescents and their mental health.
- What views, information, and biases do you have around mental health?
- How does your cultural and/or religious background affect how you might support someone experiencing mental health challenges?
- What are the cultural and/or religious backgrounds the adolescent (and their family) identifies with?
- What are the general cultural beliefs and values around mental health of where you all reside?
- What resources do you have access to which could support mental health challenges?
As you consider what you’ve read, and where you currently sit on the spectrum of support, consider taking something like a YMHFA course to equip yourself with tools and techniques which will allow for early intervention. Early intervention could help change, or even save, an adolescent's life.
About MHFA. (2022, October 18). Mental Health First Aid. Retrieved March 14, 2023, from https://www.mentalhealthfirstaid.org/about/
Blakemore, S.-J. (2018). Inventing Ourselves: The Secret Life of the Teenage Brain. Doubleday.
Facts About LGBTQ Youth Suicide. (2021, December 15). The Trevor Project. Retrieved March 17, 2023, from https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/
Get Trained. (n.d.). Mental Health First Aid. Retrieved March 17, 2023, from https://www.mentalhealthfirstaid.org/take-a-course/
Kimberlé Crenshaw on Intersectionality, More than Two Decades Later. (2017, June 8). Columbia Law School. Retrieved March 17, 2023, from https://www.law.columbia.edu/news/archive/kimberle-crenshaw-intersectionality-more-two-decades-later
Mental health of adolescents. (2021, November 17). World Health Organization (WHO). Retrieved March 17, 2023, from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
NIMH » Child and Adolescent Mental Health. (n.d.). NIMH. Retrieved March 17, 2023, from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health
Amanda Long is an international educator and school counselor at KIS International School in Bangkok, Thailand. She has worked with children and adolescents for the past 16 years in different capacities, finally finding her passion in counseling. This is her eighth year in education, her sixth year internationally, and her first year as a school counselor. Amanda also finds joy in supporting animals and hopes to someday open an animal sanctuary with counseling services with her spouse, Scott Lassey, who is also a school counselor.
LinkedIn: Amanda Long