To support myself when I was in college in Texas, I got a job at Boys Ranch, a residential community serving teens. It seemed like a sensible way to gain some experience and insights to complement my studies in community mental health. 

Pursuing that job turned out to be one of the most important decisions of my life. It set me on a course of professional and personal growth that continues today. My experiences at the ranch helped me see both the clinical and personal sides of the youth mental health system, spurring me to consider where and how I might be able to make some small difference. 

Fortunately, I’ve landed in a number of roles during my career that put me in a position to help break down barriers to accessing mental health services, especially for young people. 

This is the time of year when we should all be a little more aware of the mental health challenges young people are facing. Back-to-school time can be exciting for some teens, but for others it can elicit feelings of apprehension, anxiety, or isolation.

Parents may find themselves worrying about their children’s lives at school. Do they have friends? Are they happy? Teenagers are just learning how to process emotions and find their interests. And today’s teens are dealing with more than the average set of growing pains. 

The effects of social isolation during the pandemic years still linger. Social media has become more widespread, an area of increasing concern – as highlighted in a US Surgeon General’s advisory on social media and youth mental health (PDF) – given we don’t know the full extent of its impact. For adolescents, this is all happening during a critical development stage where identities, self-worth, and relationships to peers are changing. 

Here in North Carolina, the statistics tell a concerning story:

• 1 in every 5 high school students has considered suicide, according to NC Department of Health and Human Services (PDF)
• More than 4 in 10 teens report that they feel hopeless or sad every single day, reports NC Institute of Medicine (PDF)
• Data from UNC show 62% of youth with depression did not receive treatment due to lack of access in 2023
• Duke University reports a 60% increase in youth mental health ER visits when school starts, versus when students are on break
• There is just 1 school counselor for every 316 students in the state, according to the American School Counselor Association (PDF)

The gap between the needs of teenagers and their inability to access care makes it imperative for parents to keep the lines of communication open and be on the lookout for signs of a problem before it escalates. 

Here are some tips based on information from American Academy of Pediatrics, Mayo Clinic, and National Alliance on Mental Illness on how to help your children – and you – navigate the year ahead.

Emotional changes:

• Losing interest in things they used to enjoy
• Expressing thoughts of suicide
• Feeling excessively sad or low for longer than 2 weeks
• Being consumed by worries and “what ifs?”
• Demonstrating dramatic mood swings, from despair to euphoria
• Experiencing difficulties perceiving reality or having hallucinations
• Displaying frequent disobedience, aggression, or outbursts

Behavioral changes:

• Dieting or exercising excessively
• Changing eating habits in unhealthy ways
• Smoking, drinking, or using drugs
• Engaging in risky behavior or heightened rebelliousness
• Having difficulty sleeping
• Sleeping for long periods of time 

Physical changes:

• Weight changes not explained by a medical cause
• Evidence of self-harm such as cuts, bruises, or burns that your teen hides or won’t explain
• Appearing sleepy or “out of it” during the day
• Needle marks or other physical signs of drug use

Social changes or withdrawal:

• Spending increasing amounts of time alone
• Canceling plans with friends
• Socializing with new friends who they won’t introduce you to
• Not being able to cope effectively with stress in social settings
• Suddenly quitting activities they love

Academic struggles:

• Overwhelming or constant worry about grades
• Obsessed with a certain goal to the point where their happiness hinges on it
• Failing grades, especially in subjects that were once easy and enjoyable
• Frequently skipping school 
• Confused thinking or problems concentrating and learning
• Giving up quickly on challenging tasks

Consider these points and resources that can guide you on how to talk to your teen. 

To start talking about emotional well-being with less pressure, find a time when conversation flows naturally. For example, while preparing dinner or taking a walk together. Setting aside a more formal time to “sit down and talk” may put your teen on guard.

Explain that you want to give them an opportunity to share anything they’re dealing with. Do not try to correct, persuade, or admonish them – simply listen. Creating a nonjudgmental, supportive space allows them to feel safe in expressing themselves freely and honestly.

If your teen is having difficulty in openly talking about their struggles, you can ask conversation-starter questions like: 

• What do you think about a lot?
• What makes you feel happy?
• Are there any worries on your mind lately?
• What’s the best part of your day?
• What’s the hardest part of your day?
• Are there any questions you want to ask me?

Sometimes teens can be unaware of their own behavioral changes. Starting conversations with observations like, “I notice you aren’t spending time with your friends,” can open the door for them to talk about their feelings. Likewise, sharing stories about yourself, friends, family members – or even one of their favorite authors or artists – who have experienced similar challenges can help them feel less alone.

The truth can be scary. It’s okay to tell your child that you’re concerned, but do so in a way that doesn’t heighten their own fears. Let them know that their feelings are valid, and their struggles can be overcome. Keep your own emotions in check and resist the urge to blame, minimize, or debate.

Most parents are not mental health experts, but they are experts in knowing their child. If you sense there is a serious issue, do not ignore the warning signs. Seek help right away. Your teen’s pediatrician or primary care provider can be a good place to start. Use hotlines like HopeLine or 988 Suicide & Crisis Lifeline if you feel your child is on the brink of a crisis. If your child is already experiencing a crisis, call 911 or take them to the nearest emergency room. If you’re not sure where your teen is on the mental health spectrum, check out our guide on connecting with the right care for mental health.

Blue Cross and Blue Shield of North Carolina's (Blue Cross NC) commitment to improving mental health among young people includes:

• Providing Behavioral Health Rapid Response to make access to care easier, including on-demand services for customers who need urgent, same-day mental health service. Behavioral Health Rapid Response also alleviates capacity issues in mental health care by providing alternatives to emergency room visits. 
• A 20% increase in in-network behavioral health providers since June 2022 with the addition of nearly 7,000 providers, making it easier for all members to find and receive mental health care when it is needed most.
• Expanded access to counseling services for youth and increased mental health resources, including virtual care. 
• Behavioral health tools and programs that help members and their primary care providers quickly and easily connect to behavioral health professionals.
• Bringing Youth Mental Health First Aid Training to all 100 North Carolina counties. Blue Cross NC will leverage its employees and partnerships with youth-based organizations to train 3,700 people, including 1,000 youth and 10% of its workforce in Youth Mental Health First Aid Training by the end of 2025. This training equips adults who regularly interact with young people with the skills to identify and respond to mental health challenges, using a five-step action plan for both crisis and non-crisis situations to foster a safe, supportive environment. 
• Blue Corps, the Blue Cross NC skills-based volunteerism program, to support community partners, particularly in their work around mental health.

With enhanced services available in communities, fewer teens and parents across the state will have to navigate mental health and emotional well-being alone. Our commitment to this issue is enduring, and we will not rest until North Carolina’s youth are happy, healthy, and thriving.