Do’s and Don’ts of Addressing Mental Health with Teens During Visits with Primary Care Providers

Children’s Hospital Colorado’s Youth Action Board, or YAB, consists of 17 high school students from across the Denver metro area plus Fort Lupton. The members of YAB are passionate advocates for youth mental wellness, aiming to create more caring, connective and supportive environments for themselves and their peers. Physicians across Colorado have asked YAB for some thoughts on mental health awareness to share during the month of May, which is Mental Health Awareness Month. YAB is honored to share their suggestions.

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 make the request themselves for 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 are pleasure related. Explain that your role is to keep them physically and mentally healthy and that you’re here to help them with both.

The gist

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.

YAB at their kick-off picnic last summer