What Is The #1 Mental Health Issue Affecting High School Students in the Bay Area?
G. Julie Xie, Ph.D.
“I sit in my seats at school – gripped with fear. I ask myself, ‘How can I attend college when all I can think about is how worried I am about everything?’ My mind is racing and I hope I am not called on – every part of me tingles and I am waiting to involuntarily jump out of my chair. I feel like I will pass out.” – A.W.
“Not good enough, I always think. I constantly force myself to reach for something beyond my grasp, further and further. It happens when I fail–when I pound my head against my desk for half an hour incapable of finding a solution to a calculus problem … I berate myself heavily … I fall prey to a vicious cycle where I am dragged along into the insidious plot of beating myself into the ground, deeper and deeper. ” –E.W.
“A saint too constantly crushed by opinion and criticism, she should soar beyond the sphere of shallowness. Only, she does not realize. No academic distinction or kindness seems to be enough for her to feel loved and appreciated. Standing before the distasteful sight of her flaws, she dashes blindly in a pursuit to transform into perfection itself. For a young lady with a spectrum of artificiality but no confidence, physical attraction becomes self-destruction.” – R. X.
Every night between May 19 and June 3, 2013, I read while being deeply touched by essays from students of dozens of schools in the Bay Area as they answer the question “What Is The #1 Mental Health Issue Affecting High School Students?” They are participants of Culture to Culture Foundations’ scholarship contest to raise mental health awareness among teenagers. As a school psychologist over the past 13 years, I am humbled and honored to be one of six judges for this project.
Thanks to our community’s support, 127 entries were received between March and May 2013. We were deeply touched and inspired by each and every one of them, which shared experiences and observations on teenagers’ mental health challenges from different angles. Here are my thoughts and questions after reading the essays.
First of all, how much do we really understand our younger generations? Many writings mentioned that either the authors or their friends cried in bathrooms, cut themselves or attempted suicide while hiding their pain from the world. As one student described:
“She constructs a fragile facade everyday, keeping her emotions to herself and carefully gluing a smile on her beautifully broken face. She is only sixteen-years-old yet she carries with her an aura of infinite sadness.” — A.V.
This is consistent with my fear. While working in my local high school, once I saw a junior being pushed into my office by her best friend. The student was well known for her good grades, outgoing and helpful personality, as well as strong leadership skills. It’s hard to imagine when she shared that she had suffered from anxiety for several years and had tried overdosing herself twice. When I mentioned how flawless her smiles and outfits were whenever I saw her on campus, she told me that she always dressed herself the best on the days when she felt the worst just to cover up her true feelings. What’s more shocking was that she and her mother never mentioned anything to her father because, in her own words, he “tends to overreact.” Her mother, though by her side during those incidents, never took the time to discuss with her what had happened, nor did she seek help on her behalf.
When was the last time that we talked with our children about how they feel, not about what grade they received on a test or what project is due next week?
Do we know their passion or dreams?
Do we understand their worries, fears or anger?
I feel deeply indebted to those brave participants who put their inner voices in words and raised those questions for us.
Second, a theme that repeated itself in about 75 out of the 127 entries is on depression or anxiety caused by stress over expectations, comparison, and perfectionism. Students talked about how they experienced first-hand how stress negatively changed their attitude towards “learning” and as a person.
“Before I began sophomore year, I was an enthusiastic student who looked forward to school … That all changed, however, after I kicked the year off with a D in AP Chemistry – my focus went from learning the wonders of science to frantically trying to raise my grade. Soon after, education became a drag. … I had begun to live for the sole sake of seeing crisp, printed A’s running down my report card come January and June. … The stress had built up to the point where I detested school, and hated doing things in general …The stress had caused my attitude towards others to take a turn for the worse; I became so fixated on my own issues that I lost in touch with the feelings of those around me. … I pushed everyone away.” — S.F.
If you don’t believe that those 75 participants are representative of the general population, here are some findings from nearly 5,000 high school students in the Bay Area who took part in Stanford Survey of Adolescent School Experiences (Galloway, M. K., Conner, J. O., & Pope, D., 2009):
¨ 54% of high school females and 32% of high school males reported 3 or more symptoms of physical stress in the past month.
¨ 62% of Bay Area high school students surveyed said they always or almost always work hard in school, but only 10% always or almost always enjoy schoolwork.
Partnership for a Drug-Free America found in 2007 that 73% of students listed academic stress as their number one reason for using drugs, yet only 7 % of parents believe teens might use drugs to deal with stress.
National Sleep Foundation found in 2006 that 80% of teens don’t get the recommended amount of sleep (9.25 hours per night); at least 28% fall asleep in school, and 22% fall asleep doing homework.
I was not only touched by many authors’ heart-felt description of stress but also encouraged by their great insights into their mental health challenges. Here are more excerpts with permission:
“There are certain factors in our society that play a large role in causing teenagers to succumb to the unhealthy state of comparing to others. Teenagers constantly face blatant and subliminal messages regarding what it means to be successful in life.
We are in a stage in our lives where we naturally long to conform to social norms and we are searching for a guide to follow. We become preoccupied with accomplishing the goals created by other people. This often leads to low self-esteem, misery, and envy that can develop into a more pressing condition like mental or emotional instability.” — C. Z.
“In these tumultuous teenage years, we are constantly shaped by who we meet, though there is one fatal downfall: trying to meet social expectations. … With every hasty decision, every wrong turn, we fall victim to deprecation and discontentment. What affects us in the end is not only hurting ourselves, but also being forced to be worth something. However, in the process of finding identity, we climb through aberrant routes to reach where we are, whether in conforming with the malicious or in turning an icy heart to the world. ” – R. X.
“Teenagers are masters of playing the comparison game. However, comparing can be destructive, and teens can develop negative self-images and unhealthy misconceptions of their worth and identity.” — C. W.
Evidence from the World Mental Health Survey of World Health Organization (WHO) suggests that U.S.A. has the highest annual prevalence rates (26%) for mental illnesses among a comparison of 14 developing and developed countries. For example, absence from work due to depression is estimated to be in excess of $31 billion per year. The onset of depression is getting younger. According to the National Institute of Mental Health, about 11% of adolescents have a depressive disorder and 8% have an anxiety disorder by age 18. While suicide was the tenth leading cause of death for all ages in 2010, it is the third leading cause of death among children aged 15-24 years (Centers for Disease Control and Prevention). About ninety percent of suicide deaths involved mental health factors.
Being aware of emotional needs is the first step to take control. I am very encouraged to see how many high school students demonstrated their ability to recognize their needs for support to mental health development.
Last but not least, I am inspired by some writers’ recognition that the worst thing for mental health is not to do anything about it. For example, one wrote:
“I live in a world where the blame lays in the hands of the bystanders- the ones who remain silent despite their clear eyes and loud voices. The ones who have the innate ability to change a life, yet hold back in their own fear, denial, and ignorance. We are one of the most dangerous things to adolescents suffering from mental health issues.” – A. L.
StanfordUniversity’s Mental Health and Well-being Task Force concluded that this generation of students is experiencing what the task force called “a silent epidemic.” From chronic sleep deprivation, lack of free time and more, there is “abundant evidence that this generation suffers from increased emotional and mental health challenges” in spite of their academic successes. Research demonstrates that students experience these challenges well before they enter college.”
While the services for mental health in the U.S.A. have seen significant progress from the American asylum movement in 1843 to the community support movement in 1975, the stigma on mental illness continues to exist. According to National Alliance on Mental Illness (NAMI), of children ages 9 to 17, 21% have a diagnosable mental or addictive disorder that causes at least minimal impairment. Half of all lifetime cases of mental disorders begin by age 14. Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment. In any given year, only 20 percent of children with mental disorders are identified and receive mental health services.
It is encouraging to see that many school districts start to recognize teenagers’ increasing needs for support to mental health development. For example, my local junior high and high school will fund more counselors in fall 2013, improving the ratio of counselor to students from 1:700 to 1:550. Many elementary school administrators also work with the PTA and fund counseling services with interns from private agencies.
In addition, it is inspirational to see that some high school students initiated activities to support each other in difficult times. For example, when a classmate committed suicide in Palo Alto in spring 2009, two friends spontaneously reached out to grieving peers. Soon they teamed with another friend and formed a group called ROCK, which worked with the National Peer Helpers Association to provide better peer support after their community was shaken by four more suicides in the next six months. It was reported that ROCK’s message has inspired students at other high schools to set up similar support groups.
Culture to Culture (C to C) Foundation, a nonprofit organization, has been working tirelessly to raise awareness for the importance of mental health and provide better access to culturally competent mental health services among the Bay Area’s Asian-American population. In the past, C to C has organized many mental health workshops and given scholarships for adults. This year, Ms. Chia Chia Chien, founder of C to C, recognized the growing needs among our younger generations and extended the scholarship to high school students.
Besides depression and anxiety, the submitted essays covered a wide range of topics on mental health that touch teenagers’ lives everyday, from Eating Disorder caused by excessive worries over body image to stress over family situations, ADHD, identification crisis and cultural maladjustment.
It is an understatement to say that it was very challenging to pick out the winners for this essay contest because every participant is a winner to us with their courage to share personal pain, keen observation of peers’ suffering or passion to make changes for our community. In the end, ten writers were selected to receive the $500 scholarship while another eleven as Honorable Mention with $100 scholarship.
Mental health generally refers to “a state of well-being which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO). That’s what we wish for all of our younger generations.
Research conducted by Mental Health America found that the more educated the population, the lower the percentage of reported unmet mental healthcare needs, the better the state’s depression status. In addition, the more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services.
We understand that we still have a lot more to improve on mental healthcare for teenagers. However, like one old Chinese proverb states: “the journey of a thousand miles begins with a single step.” The ultimate goal for this essay contest is to raise awareness of the importance of mental health in high school students. Two projects are planned to follow up with this scholarship: one is a publication of the writings or excerpt with permission, the other is a short film on teenagers’ mental health needs in the Bay Area. It is C to C’s hope that those seeds will grow into a forest of community support to our teenagers’ mental health development in the near future.