Ask a Professional: Complex Mental Health

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We asked Psychologist Linda to answer some questions about how parents and carers can best support their teens to navigate complex mental health. We'd love to read your comments and hear about any questions you'd like answered in the future! 

Can you give examples of ways I can role model healthy communication and emotional regulation? 

The good news is, there are probably already times when you are role modelling these skills! If you haven’t focused on this area before, you might not always be aware of the times you are using emotional regulation skills or healthy communication skills.

Some ways of communicating to look out for are:

1. Letting others know your feelings, needs or expectations
2. Showing interest in another person’s point of view and listening when they talk
3. Providing positive feedback to others and letting them know you care about them

Emotional regulation skills are all the things you might do to help minimise big ups and downs in your emotions. This can include:

1. Things you regularly do to look after yourself - for example exercise, going to bed/getting up at a consistent time, eating well, taking time to do things you enjoy, socialising with other people
2. Things you do to cope when feeling overwhelmed - for instance counting to ten or taking a moment to breathe deeply, or things you might say to yourself which make you feel calmer
3. Noticing your emotions, and how they influence your behaviour

These are just some examples, not a complete list, and not everyone uses the same strategies, or does everything all of the time. If you notice that there are things on this list that you are doing that’s great, and if you’ve identified some gaps where you’d like to do more, that can also be a good place to start. 

Role modelling isn’t about being perfect - it can actually be really helpful when a young person sees you trying something new, or improving over time, because it shows them that they can also start with small steps and get better over time.

How do you help a teen who refuses any support offered? 

It can be both frustrating and worrying when you can see that a teen would benefit from support, but they are not willing to accept the support you are offering. Often when parents ask about this, there are a number of approaches they have already tried - I want to acknowledge that because my response is general so might not fit your exact situation.

It can help to consider why your teen is refusing support. Often, there may be different understandings about what this would involve (for instance, they may think if they talk to someone they have to tell them everything right away, or think that they will just be told to do things differently), or they want to be able to manage on their own, or they want a different type of support. If your teen is open to having a conversation, being genuinely curious about how they feel about the support offered (whether this be support from you or from a professional) and what they would find helpful can be a first step in working together to identify a way forward. 

Of course, this isn’t always possible. If your teen is not open to having a conversation at the moment, focusing your energy on maintaining or building a positive relationship with your teen is important. This can’t just be a means to an end of having them accept support, however. Being genuine with your teen is vital to having a positive relationship. 

Building the relationship can include identifying times when you are getting along better, and doing more of what is working - in particular, looking for opportunities for positive interactions can be really helpful. This might be doing a shared activity, noticing when they do something well and acknowledging this, letting them lead the conversation, or even giving them some space and independence. The specifics depend on you and your teen.

When it comes to teens accepting support, a really common experience is that it is a process which takes time. If your teen declines at first, letting them know that the option is always there gives them a sense of control, but also communicates that you care. It may take a little while for your teen to be ready to take that step, and there could be a process of ‘two steps forward, one step back’ instead of a smooth journey forward.

Sometimes, when a teen is at an acute risk of suicide or hurting themselves, parents do need to take action even if their teen isn’t willing to seek support. Generally speaking, arranging for medical care without someone's agreement is only possible in a crisis, and not everyone gets to this stage. It can be helpful for you to be aware of your local services so you know what to do if your teen ever does experience this type of crisis - for instance by talking to your GP or your local mental health team about what services are available. This can help you feel more prepared.

I would also encourage you to consider what type of support you need. This is helpful for a couple of reasons. Firstly, you’ll be better able to support and be present for your teen if you’ve got support. Secondly, watching someone they know access support and benefiting from it demonstrates the value of support in a way that is much more powerful than simply being encouraged to seek support.

After years of visits to the emergency department, countless appointments and attempts to find help for my son, I am completely exhausted emotionally, mentally and physically. I struggle to put myself first. What is your advice for a parent who has nothing left to give? 

I can hear that this is coming from a place of having given so much over the years, of having been selfless and caring, and now just being so tired. Everyone has a limit on how much they can do.

It’s probably a long time since you have meaningfully taken time for yourself, or really focused on your own wellbeing. You mention struggling to put yourself first and this is a really understandable and common experience with parents who are very caring and supportive of their children. It sounds like your son has been your priority and this hasn’t left any space for you to prioritise yourself.

When we spend all our energy on supporting others, eventually our batteries get drained and we come to a point where we don’t have the energy to do more. 

Often, the first step is giving yourself permission to put yourself first for a while. This can be tricky when you are not used to it, it takes time to learn new habits. It can help write out your reasons for looking after yourself so you can refer back to it as needed, or when you are experiencing self-doubt. These might be things like “my needs are important too” or “I need to look after myself to have the energy to look after others.” Choose the words that are most meaningful to you.

It’s also important to realise that the type of exhaustion you describe isn’t resolved overnight, or with simply taking a few minutes for yourself, it will take time and meaningful changes.

You might prefer to start small, setting aside a little time each day to do something just for you, and building from there. It can help to write this into your diary or calendar at a specific time - otherwise it’s easy to get to the end of the day and realise it slipped your mind. If you’re feeling uncertain about where to start, you might want to consider some of the options listed here: https://parents.au.reachout.com/skills-to-build/wellbeing/self-care-and-teenagers

If you’ve tried taking small steps in the past and found it hasn’t worked well for you, or if you want someone who can listen, help you with setting boundaries and help you work out what would work best for you, then talking to a professional is a good option. 

Your GP can help connect you with a mental health professional, and you may also find it helpful to contact the Carer Connections Helpline: https://www.mentalhealthcarersnsw.org/resources-for-carers/carer-connections-helpline/, as they will be able to link you to local services which are designed for carers.

My teens mental health struggles have changed them so much. How can I remain open to who they are becoming while grieving who they were? 

Adolescence is such a time of change. Young people are discovering their adult identity, and this can be a more complex process when they are also dealing with mental health difficulties.

It is common for parents to experience a sense of loss as a young person goes through this transition from childhood to adulthood. There are aspects of the person and the relationship between parent and child which inevitably change, and this can be difficult. This can feel more intense when the teen is also experiencing mental health struggles, because this can result in additional changes in the teen’s behaviour. 

It’s important to be aware that your teen’s mental health challenges are not their identity. Their experiences (including their experiences of mental health difficulties) are only a part of who they are. Sometimes when mental health difficulties are acute they can take up a lot of focus for you and your teen. Deliberately shifting this focus to other aspects of their identity can be a way to connect with your teen and who they are becoming.

It can be useful to consider questions like: 

1. What are they interested in?
2. What’s important to them?
3. What do they believe and value?
4. What are their strengths?

Don’t worry if these questions don’t have clear answers - your teen is still working this out as well, and things like their interests may continue to shift for quite some time. But, staying interested in these areas is a good way to develop a sense of who they are as an individual. It might also be that through this process, you are able to identify some of the things about your teen that haven’t changed - usually, even when someone has changed a lot, if we look closely we can see there are some things which they have in common with their younger self.

As I mentioned above, feeling a sense of grief as a child becomes a teen becomes an adult is common. I also wonder if some of the sadness you feel, in addition to grief around change, is sadness for the difficulties they have experienced, and worry about the future? These emotions can be quite complex, and reflecting on and understanding these feelings can be the first step towards acceptance and being able to move forward.

For some people, processing grief is something that is aided by talking it through. This type of grief, which is not associated with someone passing away, can be more challenging to explore with friends and family - counselling can be a great support because it allows for the process of exploring your emotions without judgement. Other options that people find helpful to express grief are journalling, or making scrapbooks or photo books. This can help create a sense of connection to the past and a way to acknowledge what was lost, and in doing so help you feel ready to move forward in building your relationship with who your child is becoming.