What is Mental Health?

Mental health (like our physical health) is a resource for living. It allows us to learn, work, play and find enjoyment in life. It helps us through tough times.

From a child or teen’s point of view, mental health means…

• I feel like I have things to live for
• I feel that people care about me
• I feel hopeful and good about the future
• I feel in control of my life
• I like myself
• I’m satisfied, content or happy with life

What is Mental Illness?

People have mental health problems or mental illnesses when problems with thoughts, feelings or behaviours get in the way of functioning at home, school or work.

Everyone feels sad or upset from time to time. But when these feelings are so strong that it’s hard to carry on at school or home, then there may be a mental health problem.

From a child or teen’s point of view, mental health problems (or mental illnesses) can mean some or all of the following:

• I feel sad, irritable, worried or angry a lot
• I don’t like myself
• I feel powerless, and not in control of my life
• I don’t feel good about the future
• I feel that others don’t care about me

Mental health and mental illness: can we have them both?

Yes. It may sound strange, but we can have an illness and still have health. Do you know someone with heart disease? They may need a special diet, exercise plan and medications, but they can still feel ‘well’, and do the things they need to do. This is also true for mental illnesses. A teen with depression may need regular ‘talk’ therapy and medications. She may need help learning to cope with stress, or how to handle her emotions. But when the depression is under control, she can feel well, enjoy school, friends and activities.

Sometimes though, an illness can be very serious. Even though people do their best and follow their treatment carefully, they may have to live with limitations. The same is true for people with mental illnesses or brain conditions. Some mental illnesses are more serious, and people may have to live with some limitations. But we still need to accept and support people whether they have heart disease or a mental health problem.

How common are mental health problems in children and youth?

Mental health problems are more common than most people realize. In Ontario, 1 in every 5 children and youth have some type of mental health problem.

But most who need professional help will not get it. Just 1 in 6 children and youth get the help they need. Just imagine if only 1 in 6 people with broken bones got treatment.

Mental illnesses have a powerful impact on children, youth and those who care for them. Death by suicide is the second leading cause of death in youth 15-19 years (the number one cause of death in this age group is unintentional injury, or ‘accidents’).

What causes mental illness?

Both mental illnesses and physical illnesses are caused by a combination many things, for example:

• Genetics: How we turn out depends a lot on the ‘genes’ that we’re born with. And we have no control over the genes we get from our parents. Just like some children develop cancer (through no fault of their own), some children have a greater chance of developing a mental health problem.
• Family history: If a family member has had depression or anxiety, children and youth have a greater chance of developing these problems too.
• How we care for our health: Do we eat right? Exercise? Abuse alcohol? Express feelings in a constructive way?
• Our reactions to experiences: Stressful events can trigger mental and physical illnesses. A child who grows up in a stressful family situation, or where there is abuse or neglect, has a much higher chance of having mental health problems.
• Our resources: Do we have enough money? Satisfying work? A decent place to live? Opportunities to grow and develop? Friends and family to support us?

Can mental illnesses be prevented?

Just like we can prevent physical health problems, we can also reduce our chances of developing mental health problems. We can do things to promote our physical health, by eating healthy food, exercising, not smoking or wearing a seatbelt. But even if we do all these things, we sometimes still get sick or hurt. It’s just the same for mental health.

To promote our own mental health we can:

• Get enough sleep, exercise and eat healthy food
• Spend time with family and friends
• Spend time doing things that make us feel good
• Be in touch with our feelings, and talk with close friends and family about how we feel
• Be aware of our stress levels at home and work
• Face stress and deal with it in a positive way
• Try to see things from other’s point of view
• Use healthy ways to solve problems

To promote mental health in children and youth, we can:

• Be positive role models. Children need to see us express our feelings, talk over a problem with our partner, or see things from someone else’s point of view.
• Promote a healthy lifestyle. Give healthy food, make sure children and youth get enough sleep and exercise.
• Ask children and youth how their day went. Let them know when they’ve done something well (like trying hard, being patient or kind, or getting better at something). Focus on the effort, not always the result. If something is bothering or stressing them, ask if they need help to solve the problem.
• Ask children and youth how they’re feeling about things. Some children may not know how to express themselves. Help them with language to ‘name’ and express feelings (“Oh,that must have been frustrating to have to wait so long…”)Help them see things from another’s point of view. Children need to see us do this (“My boss was in a really bad mood today, but she’s been going through a rough time caring for her mother”)
• Teach children how to reach out to others when they need help and support.
• Always take children’s concerns and worries seriously. Children and youth may believe that their feelings don’t matter if we dismiss their feelings.
• Spend positive time with them, to build a good, trusting relationship.
• Help them face stress, and cope with it in a positive way.
• Have appropriate expectations, limits and consequences for behaviour.

But even if we do a lot to promote mental health, we, or our children, can still sometimes have a mental illness.

What mental health problems are most common in children and youth?

Children and teens with mental health issues are usually having such a hard time that they may not be able to ask others for help. So it’s really important that parents, teachers and friends watch for signs that a child or teen needs help.

What to watch for:

• Talk about suicide or feeling hopeless
• Mood problems like irritability, anger, rage or extreme sadness
• Poor grades or missing school
• Marked changes in sleeping or eating habits
• Many physical complaints (such as headaches or stomach aches) that doctors can’t find a cause for
• Withdrawal from regular relationships and activities
• Any behaviours or symptoms that prevent a child or teen from doing everyday activities

Common mental health problems in children and youth

Anxiety Disorders

• Does your child or teen:
  • Worry a lot?
  • Have worries so severe that they get in the way at home, school or with relationships?
• Everyone gets nervous and worried from time to time. But with an anxiety disorder, the worry is so intense that it gets in the way of life. Types of anxiety disorders include Generalized Anxiety, Separation Anxiety, Phobias, Panic Attacks and Obsessive Compulsive Disorder.

Eating Disorders

• Does your child or teen:
  •   Worry about being fat?
  • Skip meals, exercise too much or have extreme weight loss?
• Anorexia is an eating disorder where people starve themselves to the point where they are physically ill and unable to function.
• Does your child or teen:
  • Binge (eat massive amounts of food at one time) and then purge (by throwing up or using laxatives)?
  • Go to the washroom right after meals (to throw up)?
• Bulimia is an eating disorder where people binge on large amounts of food in a short period, and then purge (usually by making themselves throw up).
• Behaviour problems (Oppositional Defiant or Conduct Disorders)
• Does your child or teen:
  • Have severe problems misbehaving?
  • Have a lot of trouble following rules?
  • Often act impulsively?
• Children and youth with Oppositional Defiant Disorder have difficulty following basic rules for behaviour, and they often act impulsively. There are many reasons that a child may be oppositional. Professionals can help determine those reasons to help the child and family.
• Does your child or teen have a persistent pattern of behaviour that violates other people’s rights?
• Examples of this include:
  • Behaving aggressively toward people or animals
  • Destroying or vandalizing property
  • Stealing or lying
  • Breaking rules like staying out past curfew or skipping school
• Conduct Disorder is a very serious behaviour problem where a child violates either the basic rights of others, or major rules and norms of society. If not corrected, children with Conduct Disorder face the risk of having future problems with the law.

Depression (or Major Depression)

• Is your child or teen sad, moody or irritable to the point where s/he has  problems with:
  • Sleep, appetite, energy or concentration?
  • Functioning at home or at school?
• Children and youth with depression have such difficulty that it’s hard for them to go on with their everyday lives.

Schizophrenia

• Is your child or teen:
  • Behaving in an odd or unusual way?
  • Seeing or hearing things that others can’t?
  • Fearful about being followed, harmed or spied on?
• Psychosis happens when a person has troubles with hallucinations (hearing or seeing things), or delusions (thoughts that don’t make any sense). Psychosis can occur in different conditions, like schizophrenia.

Substance Use Problems

• Has your child or teen:
  • Changed friends (to a ‘drug using’ group)?
  • Left drugs or drug paraphernalia around the house (needles, rolling papers, bongs)?
  • Often been drunk or high?
  • Been very secretive about friends?
• Youth with substance use problems misuse alcohol, street drugs or prescription medications to the point where they experience physical, social or emotional problems. They may also become physically dependent on alcohol or drugs, and experience withdrawal if they are without alcohol or their drug of choice.

Learning Problems

• Many conditions can cause troubles learning, like:
  • Attention problems
  • Learning disorders (or learning disabilities) like non-verbal learning disability
• These problems can also make it hard for children and youth to cope outside of the classroom.

Developmental Delay and Intellectual Disabilities

• These conditions cause problems with cognitive function. Children and youth with developmental delay or intellectual disabilities have problems with:
  • Learning, memory and problem-solving
  • Daily living, communication skills or social skills
• Children and youth with these conditions need extra support at school and home. Many different conditions can cause developmental delay, like Down Syndrome or fetal alcohol syndrome. In the past, the term ‘mental retardation’ was often used to describe severe developmental delay, but for many reasons, we no longer use this term.

ASDs (Autism Spectrum Disorders)

• Conditions like Autistic Disorder and Asperger’s Syndrome make it hard for children and youth to understand and relate to other people.
• Other conditions:  Other conditions like sensory and auditory processing problems can also make it hard for children and youth to cope. Children and youth with these conditions can have a greater chance of developing other mental health problems.

What should we do if we think our child has a mental health problem?

If you are worried about your child’s moods or behaviours:

• Talk to your child about it. You might say something like:
  • “I’ve noticed lately that _____, and I’m worried because that’s not normal for you.”
  • “How are you doing?”
  • “How have you been feeling? You seem really down lately.”
  • “What’s been bugging you these days?”
  • “What’s been stressing you out these days?”

• Talk to the school. Talk to your child’s teacher, who is able to see your child at school and compare how your child is doing compared to other children. You might ask about:
  • How your child is doing in school
  • How your child is getting along with teachers or classmates
  • Any concerns the teacher has
  • If school staff has noticed something wrong, they may be able to offer support. School social workers, guidance counsellors or psychologists may be available to help. The school may also be able to refer you to other helpful community resources.
• It’s possible that the problems that you have noticed either don’t show up at school, or haven’t been noticed at the school. Often children and youth are able to “hold it in” until after school, especially if the problem isn’t yet serious. But it’s still important to get help for your child or teen, even if the school hasn’t noticed a problem.
• Include friends and other parents. Get to know your child or teen’s friends. Encourage your child to have friends over, and make friends feel welcome (allow reasonable privacy and lots of food!). Be friendly with your child’s friends, and take an interest in them. But don’t come on too strong. You want to create a situation where a friend would feel comfortable sharing concerns about your child or teen with you (research studies have shown that youth with a mental health problem are more likely to tell a friend than an adult). Make an effort to meet other parents at school or sports events, or when dropping kids off. You may be able to ask other parents if they’ve noticed anything about your child, or if their child has shared a concern.
• Take your child to see a family physician or pediatrician. Your child’s doctor can further explore your concerns, and also help make sure that there are not any medical problems (such as hormonal imbalances) that are contributing to the problems. The doctor (or the school) may recommend additional local community supports to help your child.
• Have your child seen by a mental health professional, like a:
  • Counselor/therapist
  • Psychologist
  • Social worker
  • Psychiatrist
  • Hospital mental health services or community mental health agencies should also be able to help you. Many people hesitate about seeing a professional, because they worry that that their child will be prescribed medications right off the bat. In most cases, there are many other ways to help. Medications should not be the first treatment for a mental health problem. But they can be very helpful, when other treatments are not successful.

Stigma and Discrimination: Negative Attitudes about Mental Illness

People often feel ashamed, guilty or embarrassed about having a mental health problem (or having a child with a mental health problem). People may believe that the illness is a sign of weakness or that they really have no good reason to feel the way they do. Parents may feel guilty, that they’ve done something to cause a child’s mental illness. And others may blame or judge people who have a mental health problem. This kind of ‘stigma’ makes things even more difficult for children, youth and families coping with mental health problems. And it’s one reason why people don’t get the help they need.

Changing attitudes about mental illness

You can help to change attitudes about mental illness (including your own!) by:

• Trying to think about mental illness and physical illness in the same way.
• Ask yourself, “Would I take my child to the doctor if she had stomach pain?” “Would I feel guilty if my
• child was being treated for cancer?” “If a friend’s child had diabetes, would I think the parents caused it?”
• Talking openly about any of your own personal experiences with mental illnesses.
• If your child has depression, tell your child if you’ve had similar struggles. Share things that helped you and ways to cope. But when talking about your own experiences, emphasize the healthy message that it is good to get help for problems, instead of keeping it all inside.
• Watching your language.
  • Instead of saying, “John is schizophrenic”, say “John has been diagnosed with schizophrenia.” This helps us see the person first, rather than just labelling people by their illness.
  • Don’t call people names like “mental”, “crazy”, “stupid”, “nuts” or “psycho”. It is simply not helpful.
  • If you are upset by your child’s behaviour, express your feelings honestly, but focus on the behaviour, not the child. For example, you might say things like:
    • “I felt really upset when you...”
    • “I’m not happy with the choices that you’re making.”
• Listening and offering support. Ask how you can help. “Thanks for telling me how you’ve been feeling. I’m here for you. How can I be helpful?”

Supporting your child’s treatment by:

• Offering to come to appointments. Even if one parent is going along, offer to come too.
• Being open to the treatments recommended by the health professionals, even if these treatments were not helpful for you personally.

For example, you might have tried counselling and found it didn’t help you. But this doesn’t mean that it won’t help your child.

Or you might not agree with medication treatment. Accept that medication is sometimes needed. Medication is needed for some physical health problems as well as some mental health problems. There is no need to feel badly about this fact. Would you feel badly if your child needed insulin for diabetes? It is okay to disagree with your child’s doctor or care provider. If you have any questions or concerns about your child’s treatment plan, ask to speak privately with your doctor or care provider (without your child or teen present).

References

Davidson S, Manion I. (1995). Youth and Mental Illness. Retrieved Jan 1, 2008 from http://publications.cpaapc.org/browse/documents/20.

Health Canada (1996). Mental Illness and Violence: Proof or Stereotype?

Health Canada (2002). Report on Mental Illnesses in Canada.

Standing Senate Committee on Social Affairs, Science and Technology (2006). Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.

About this Document

Reviewed by the Mental Health Information Committee at the Children’s Hospital of Eastern Ontario (CHEO) and by members of the Child and Youth Mental Health Information Network (www.cymhin.ca). Thanks to the children, youth and families on the CHEO Family Forum, whose comments/suggestions further strengthened this document. Special thanks to Dr’s Simon Davidson and Ian Manion from the Provincial Centre of Excellence for Child and Youth Mental Health.

License

Under a Creative Commons License. You are free to share, copy and distribute this work as in its entirety, with no alterations. This work may not be used for commercial purposes. Contact the Mental Health Information Committee if you would like to adapt these for your community!

Disclaimer

Information in this fact sheet may or may not apply to your child. Your health care provider is the best source of information about your child’s health.