Back-to-School Mental Health Tips

“Kids are watching us all the time, so how we talk about someone who’s struggling with depression or anxiety, how we jump in to help, the words we use, and how we talk about how we’re feeling is going to be super helpful for them to be able to begin to identify their own feelings and to be able to articulate them to other people so that they can advocate for themselves.”

–Dr. Khadijah Booth Watkins, The Clay Center for Young Healthy Minds

 

 

Back to School is an exciting time of hope and promise, but for some kids it can also be a time riddled with anxiety. According to the Centers for Disease Control, 1 in 5 kids aged 6 to 17 experience a mental disorder in a given year. Some experts, including our guest today, say it may now be as high as one in four.  An estimated $247 billion dollars is spent each year in the US to manage and treat those issues.

As we start another school year in a pandemic that just won’t quit. I wanted to learn what we can do as families, as a community to meet kids where they’re at and help as best we can.

My guest today is Dr. Khadijah Booth Watkins. She’s a child psychiatrist and associate director for the Clay Center for Young and Healthy Minds at Mass General Hospital. She specializes in anxiety disorders, ADHD, and overall student mental health and suicide prevention. Dr. Booth Watkins, thank you so much for joining us.

Dr. Khadijah Booth Watkins/MGH Clay Center 

Thank you for having me. I’m excited to talk with you today about our kids and what’s going on with them. 

Ally Donnelly 

Yeah, so much. Right. Give us a sense of the state of child mental health right now.

Dr. Khadijah Booth Watkins/MGH Clay Center 

Our kids are facing a mental health crisis, there has been alarms rang by the Academy of Pediatrics and of child and adolescent psychiatrists and children’s hospitals. And then shortly thereafter, the Surgeon General also put out this morning saying that we’re in the middle of a mental health crisis for our for our children and adolescents. They are really struggling with we’re seeing an increase in depression and anxiety, suicidal thinking, and loneliness. And the even scarier part is that much of this started well before the COVID-19 global pandemic.

Ally Donnelly  

Yeah, yeah. You know, there’s data all over the place, right. But one, data point from the CDC said 44% of high school students said they experienced persistent feelings of sadness or hopelessness with girls and the LGBTQ plus community reporting the highest levels of poor mental health and suicide attempts. You know, as kids think about going back to school on top of what they’ve already experienced, you know, from the pandemic, from pre pandemic, think about bullying, peer pressure, school violence, fears, relationship building anxiety, you know, what’s going on for kids as they think about heading back.

Dr. Khadijah Booth Watkins/MGH Clay Center  

So they are, they probably have a lot of thoughts going on. And many kids are excited to go back and they’re looking forward to going back and then their kids who are dreading going back their kids who actually never liked school. So there are some kids who are more vulnerable. They they struggled with attending school for various reasons, whether it’s learning issues, whether it’s anxiety, whether it’s social, social challenges, but they’re worried about, you know, how they’re going to perform, are they going to be accepted? Are people going to like them? Are they going to be able to make friends depending on whether your kid is going from a major transition from elementary to middle or middle to high school or even from high school to college, really just finding their place and and making sure that they feel secure and welcomed. They’re worried about those things. And they’re still many kids still worried about being healthy and staying healthy and possibly bringing back something to their, to their home. Maybe they have a vulnerable parent or living with a vulnerable grandparent. So there’s, there’s tons of things swirling around in their heads. 

Ally Donnelly 

Yeah, you know, I know, we’re all trying to get back to some level of normalcy in a COVID pandemic world. I know, for my own family, my kids, sunk deeply into screens and social media as I was trying to work in the pandemic, and, and that’s lasted even though you know, we’re, many of us are back to work, but we’re home and back to work. How, how much are we still dealing with those kinds of issues?

Dr. Khadijah Booth Watkins/MGH Clay Center 

Part, I think part of it is that we have to help them with their fantasy that everything is gonna go back to normal, because I don’t know that anyone thinks at this point, that thing is gonna go completely back to the way they were. So I think helping them reconcile that and helping them kind of see what things will be preserved and what things are going to be changed probably more indefinitely. And also trying to, as we think about things going back to normal in school, how do we begin to normalize some of our routines and our, our structures and our expectations really, of ourselves and our kids? Because I can agree that working from home with children was not fun. And I have a have a newfound appreciation for the work that teachers did and do. Because it was a challenge. And I have an older child, and it was still a challenge. Because like they see you, but you want to say to them pretend that I’m not here, but that’s really not possible.

Ally Donnelly  

Yeah. And not a great message for a kid who’s struggling. Right, right. You know, the Biden administration recently announced $500 million to expand mental health services in schools. And, you know, that’s on top of what there has already been some fed and state money. I know, Hingham has hired more counselors system wide, they have an emotional support dog at the high school that, you know, they’re taking a lot of steps to lean into social and emotional health. But I’d love for you to talk a little bit about how you see the role of schools in helping to shoulder this mental health crisis for kids. It’s I mean, I would think it’s a necessity on a level. 

Dr. Khadijah Booth Watkins/MGH Clay Center  

Yeah, kids spend so much time at school. And so it is, it’s amazing that it’s taken us to get to this point before this has become a priority for schools or or at schools are able to be funded to make this a priority, because I’m sure schools have wanted to do this. But they do spend so much time at school, they’re spending time learning, there’s been a time socializing, you know, they’re spending time kind of also discovering who they are, what their interests are. And so it makes sense to have mental health support in school. But I think above and beyond that, it’d be really important if we can really began to talk about mental health, and educate about mental health so that we can really break down the stigma that still is so strong as it relates to mental health and treatment for mental health. School is a place where it can really be normalized, because this is where place where you go every day. And if we’re talking about it on a regular basis, if their counselors and psychiatrists and other mental health providers present, it becomes more normal and less scary, less taboo. So I think that’s a great idea, it really is just going to have to be that it’s going to be need to be well thought out, we have to think about what the qualifications of these people are, that are going to be in the school is going to be super important to have a diversity of, of counselors and therapists of diverse ethnic and cultural backgrounds, so they can kind of reach the kids and meet the kids and connect with the kids where they are. And also kind of thinking about if we bring them into the schools, then what happens in the summer because some kids still need therapy and treatment throughout the summer months. And so how do we bridge that gap? So I think it’s going to have to be thoughtful planning around this?

Ally Donnelly  

Yeah. Yeah. I mean, it’s interesting because it feels like oftentimes, or traditionally, perhaps in the traditional model, a kid’s having a mental health issue or struggling anxiety, there’s so to speak. And I don’t mean this in a punitive way, but sent down to talk to a counselor. Are you saying that you’re you would love to see more mental health kind of woven into the school day and as part of the curriculum?

Dr. Khadijah Booth Watkins/MGH Clay Center 

Absolutely is part of the the curriculum like the you know, the mental health providers are more like ever present. They might give some classes they might pop into the gym, you know, doing some observation and doing some real time in the moment teaching and taking advantage of teachable moments when they see things happen. Talking again, talking about mental health and talking about some of the challenges in struggles and making it okay to say, I’m not okay. And can I talk to someone as opposed to having to be sent down to the counselor’s office, you feel now comfortable advocating for yourself, you’re aware that you’re having these feelings that are not okay with you. And you’re now taking yourself down, there’s a choice as opposed to you being directed, which is has a different feeling, you know, there’s a different there’s a level of competence that you feel a master that you’ve taken charge of something that is important to you, and that’s going to help you as opposed to being almost feeling having it feel like a reprimand because sometimes that’s what it feels like for kids.

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Let’s take a quick break here to thank our fabulous new sponsor, The Derby Street Shops. We all head to Derby for everything from groceries to clothes to cocktails, but it’s also a great spot for activities and events for the whole family! Coming up, they’ve got a Boos and Brews family-friendly event at the Untold Brewing Beer Garden, trick-or-treating for the kids, and a Yappy Hour celebration for the furriest member of your family. Oh, and I almost forgot the best part, Hingham’s first Shake Shack and Pottery Barn are opening this Fall. Enjoy your Derby Days and be sure to check out derbystshops.com, that’s derby st shops dot com to see what’s new and now. Okay, back to our conversation with Dr. Kadijah Booth Watkins and some tips on how to normalize the conversation about mental health with your family.

Ally Donnelly  

Yeah, yeah. You know, you touched on this earlier for a bit. But you know, you talked about taking control, control is a tough word, right? Because we’re all trying to get control of our lives and our, our headspace. But as families, what can we do to help kids manage what’s happening for them, or, you know, if we struggled to even, you know, you talk about normalizing the conversation, you know, some families are just not comfortable in this arena. So help us as fit as family members, or those who care for kids to figure out ways to talk with them to get at the root of their feelings, and to try and support them. I’d love some pointers.

Dr. Khadijah Booth Watkins/MGH Clay Center  

So just like, you know, you don’t want to be sent into the principal’s office or sent to the counselor’s office and have these big conversations, we want to try to have conversations on a regular basis, and small chunks, you know, finding natural opportunities, whether we’re taking a walk, riding in the car, you know, watching something on TV, but really began to incorporate these conversations into our everyday life and our day to day routines. That I think is where it will begin. And so in that way, you’re asking them about how they’re doing, what they’re feeling, what experiences they’ve had, and also getting from them collaborating with them, how can we work together and help you and it doesn’t feel like the talk, like we’re not having a big talk because something is wrong, or something didn’t go? Well, we’re having a normal talk. Because in this family, we talk about our feelings, we talk about, you know, our experiences, and we we work together to make things better. And I think that is going to be key to really any any of these discussions that are that are going to be had as we’re trying to help our kids is that it doesn’t feel like it doesn’t feel like it’s something out of the blue. It doesn’t feel like it’s something super special. But it feels like this is just what we do. And so I think normalizing conversations is going to be important, modeling for them, how we talk about feelings, and how do we express feelings, in the way that we do it and also in the way that we respond when other people kind of share with us how they feel. That’s that’s also like kids are watching us all the time, even when they win even when we think they’re not. And so how we talk about someone who’s struggling with depression or anxiety, how we jump in to help someone who’s struggling, you know, how we the words we use, and we talk about how we’re feeling is going to be super helpful for them to be able to begin to identify their own feelings and to be able to kind of articulate themselves to other people so that they can advocate for themselves.

Ally Donnelly 

Yeah, yeah. You know, at our dinner table, we do rose and thorn. So give us a rose of your day. Give us a thorn of your day. I wonder if there’s a way to try to tailor that to get at more kind of headspace questions.

Dr. Khadijah Booth Watkins/MGH Clay Center  

Yeah, I love rose-thorn. And you know, we do you know, the peak in the pit of your day. I think, you know, even with the rose Thorn, you can talk about the bud and the gardener, like you went over to someone who’s helped you. Other things I think that can be helpful is when you’re watching something or you see something on TV that maybe relates to children and mental health or something that someone is struggling with. Kind of make it a conversation. Oh, you were watching a kid being bullied? I want Has that ever happened to you in school? Or have you seen anything like this happen to anybody that you know, do they talk about bullying, I think just using these everyday kind of experiences and things that we’re exposed to to, to make a bigger conversation can be really helped because it feels natural. Like we’re watching TV and now we’re talking about it. Those are the those are some of the things that that I think make for really productive, fruitful discussion. Also, like when we hear about things in the media and on the news, depending on how old your kid is like you could use some of those examples to talk about, you know, when Naomi Osaka took some days off because she just didn’t feel like she was able to kind of compete and also maintain her mental health stability. What did you think about that? Have you ever felt like you you needed to take some time off like, get them talking about how they see the world, how they see how people kind of navigate the world and how it fits into their view and what how they see that fitting into what they might want to do or not want to do?

Ally Donnelly 

That’s great advice. I’d love some practical tips. I mean, if somebody came into my house right now, they’d be horrified. You know, kids are sleeping til noon, and then they’re getting up and they’re, you know, they’re on Snapchat and every other horrific social media platform. You know, school is a great time for reset. And again, I you know, I talk about my family a lot, my kids are constantly complaining, because I think all things can be fixed with like water, pooping, or hydrogen peroxide, but I’d love some tips about schedules about screens, physical activity, nutrition, sleep, I just, you know, kind of some of those basics, I’d love to hear what your thoughts are on kind of September reset.

Dr. Khadijah Booth Watkins/MGH Clay Center  

All those things are so important. And it’s all about doing it in moderation. And depending on how old your kid is, it’s really going to be in your best interest and in their best interests, doing it together, kind of thinking about what this reset will look like what this kind of returning to a school schedule looks like. Because when they do it with you, they they’re they’re more likely to buy in and and follow it. I think it starts with can identifying also what things negotiable and what things are not negotiable. So you might feel like in the summertime, you can have your phone in your room. But when school starts back, you can’t or maybe that’s never a thing that’s allowed, but identify in advance, you know, what’s negotiable and what’s not. And then find the space where you can kind of be flexible. Really, I like to just kind of think about like this, let’s start with getting up close to normal waking sleep schedule. And then we kind of build the schedule from there. You know, what, what is our after school time gonna look like? So what do we want to do about homework time, you know, physical activity, and being outside is still super important. So that needs to be in the schedule as well. Are you going to have any extra curricular activities, are you going to be hanging out with friends or just thinking about all of the things that might happen after school and just begin to think about where they might fall into the schedule. And knowing that we’re building the schedule, and as we begin to really live it, it’s going to need to be tweaked. And being flexible about that as well. But, but just being open going into make recreating a schedule being open. As it relates to screen time. Again, I think it’s really important for us to model how we kind of put the phones down, put the computers down, put the tablets down and engage just one on one or as a family. It also is really helpful if we’re all going to go out and take a hike or we’re all going to go out and you know, go for a swim, as opposed to saying you need to go outside and be active. But giving them something to do instead of being on the screens is going to be helpful in that being successful and kind of cutting down the screen time. I don’t love the idea of defined time as an okay, time it really to me boils down to is your child making their social, emotional and academic goals? Are they engaged? Are they doing well in school? Are they still spending time with friends? Are they still healthy and active. And if they’re doing those things, and they’re still able to have screen time, then you strike the right balance is is has been reached is when the screens get in the way of those things, screens get in the way of them being able to go to sleep or wake up in the morning. They prefer to be on their screens and to go to a birthday party or go to a to a game or social event, that’s when it becomes a problem. And I don’t know that there’s a number that you can put on that.

Ally Donnelly  

I know I’m like an screentime jailer. I’m gonna take a new look at that.

Dr. Khadijah Booth Watkins/MGH Clay Center  

And every one has a child who’s different who has different needs, and we know our kids best and maybe some kids do do better with a with a defined limit. And you just have to know and try sometimes it’s a little bit of trial and error. But I think as a bar knowing when there’s too much because it’s getting in the way and that’s what it usually boils back down to you know, what’s what’s impairing?

Ally Donnelly  

Yeah, yeah, I have to take a look at my own, like control needs there. I hope my teenager isn’t listening to this, but trying to you know, control everything. And I gotta, I gotta ease up. You know, you talked about Naomi Osaka and my kids are constantly talking about like, how mean I am and how other parents let their kids take mental health days. And I’m the daughter of a teacher. So I’m super, I’m super strict about where do you stand on letting kids take a mental health day if they think they need it? Or well see, I just don’t you know, again, like, again, I guess it’s a control freak me it’s like, I worry that if I let them have one they’re gonna want 15. And then then where are at? 

Dr. Khadijah Booth Watkins/MGH Clay Center  

That is a little bit. That’s a little bit tricky, I think to read and also to kind of answer in a straightforward way. Yes, it’s good. No, it’s not. The way I think about it is if we set expectations that are reasonable for our kids, then we should we should hold on to that and make sure that they are doing what they need to do. If if they’re needing to take a mental health day, then we have to take a step back and think of About are our expectations reasonable. And as I think about kids, you know that the expectation that they go to school is reasonable. However, if they’re not well, then then that’s, then that expectation is no longer reasonable. But instead of taking the mental health day, my my focus and approach would be about, we’ll be be looking at how can we get them back to a place where this is a reasonable expectation, because that they just need to go to school, you know, take showers every now and then eat and wear clean clothes. So there’s not a whole lot of expectations that are just the basic expectations, and if they’re not able to meet them in the way that is set up for them to meet. And we think it’s reasonable that I think we have to think bigger than should the take a mental health day because it’s bigger than the mental health day. What’s going on as you can get to school? 

Ally Donnelly 

Yeah, I think you you touched on a point there about recognizing what you know, the difference help us understand how to recognize the difference between you know, having a bad day, or kids being mean, or, you know, the difference between stress or anxiety and a more significant mental health issue.

Dr. Khadijah Booth Watkins/MGH Clay Center 

So the way I think about stress, stress is as it can be time limited, although anxiety is also in general fickle, because some things make us anxious, and other things don’t. So we can be anxious in one setting and that in another, but stress differently, typically is a lot more short lived. mutability typically can identify like a stressor or trigger that made you stressed. The difference when I think about like in terms of anxiety, and anxiety disorders, is how persistent and pervasive it is how much it gets in the way and going back to that word functioning. And impairment, how much is it getting in the way of your ability to function? And do well? So are you not able to go to school? Are you not able to like engage in group projects are you not able to speak out in class is your anxiety making it that you won’t go to the cafeteria, you rather sit in the library by yourself because you don’t want to be around other people? Is your anxiety giving you such physical complaints as you’re constantly feeling sick, when it’s when it’s has reached this level that is kind of persistent. And that is impairing to you is when it’s more of a disorder. And we should think about what how we can help you, as opposed to stress and anxiety, you know, we need coping skills and strategies to manage them. So stress can lead to anxiety for sure. And both of those can respond to coping skills and how we, in terms of us being able to manage it, but but really, when I think about more of a disorder is really more pervasive.

Ally Donnelly 

Okay, okay. You know, school counselors are in short supply nationwide, therapists are overbooked. A lot of people paying out of pocket, which can get very expensive. Do you have any kind of advice or tips on how to how to handle getting help for your child when help can be in short supply?

Dr. Khadijah Booth Watkins/MGH Clay Center

We are in a crisis, you know, a mental health crisis for for our children. And there’s a tremendous shortage in the workforce as it relates to providers who care for children and adolescents and to meet their mental health needs. So it is a challenge. And I hear unfortunately, stories of families, you know, making, you know, 40 calls and trying to just find one person who will return their call and be available, which has been been a struggle. I usually refer parents if they’re not already connected to a therapist or psychiatrist to their pediatrician, because the pediatrician is typically or their primary care person is the gateway to mental health treatment. They might have, you know, a network of psychiatrists that they work with or therapists that work with that they can refer you to some some pediatricians depending on where they are, have become quite comfortable and treating kids if there’s a need for psycho pharma to mention. So the pediatrician will be the first place that I go, there are other resources. So we had that place in our we have resources online in terms of that can be helpful as it relates to education. So if you really want to know what’s going on with your kid, what are you seeing, so what, you know what to look for, what to do when you should be worried. So we have a lot of resources on our website. And there are other websites like our website that that can kind of just give you education and guidance, because often it boils down to I don’t know if this is normal, or if this is typical, or is this something that has, you know, crossed over into the realm of I should be concerned and so I think knowing is so important, because if you know, then you can act and react and support your child That Nami is is is, is the website National Alliance for Mental Illness and they have a lot of resources for parents and caregivers, as well.

Ally Donnelly 

NAMI.org

Dr. Khadijah Booth Watkins/MGH Clay Center  25:13

Yes. Those are the ones that jumped out to me, in terms of if I were thinking about and the other, the other alternative is to call your insurance provider and ask them who they have listed, that sees children and adolescents, whether it’s therapist or psychiatrist, and they can get provide you with a list. Unfortunately, you have to go down the list and call see who’s

Ally Donnelly  

Yeah. So, in addition to whatever our own kids are dealing with, what advice do you have to give to kids or teens, who say their friend is, you know, telling them that they’re, you know, having thoughts of self-harm, or you know, self-harming behavior, eating disorders, you know, kids are dealing with so much, so fast, it feels like, what advice do you have to them, if a friend puts a lot on them, and they don’t know how to handle it.

Dr. Khadijah Booth Watkins/MGH Clay Center  

So I tell them, like I tell parents, just like they tell us on a plane, make sure your mask is on before you help someone else. And so make sure that you’re okay, before you try to help your friend. Make sure you are aware of, you know, be mindful of how what your friend is telling you and sharing with you and what you’re being asked to do and how it’s affecting you. Because maybe at first it was okay, and it felt tolerable. But then as time has gone on, it felt more like a burden and too heavy. I really encourage them to not agree to keep secrets because you don’t want to feel bound by my keeping a secret, and you really feel like your friend is in danger. That’s, that’s a tricky place. And I tell them to really try to make sure they have someone else, that they’re sharing what’s been shared with them. So they don’t have to carry it by themselves, because that is what makes it feel incredibly heavy, especially, you know, should things turn or take a turn for the worse. So those are the big pieces of advice that I give to them. And I usually share with them, you know, I have some kids who’ve done this, and they’ve kept it all to themselves. And they really struggled whereas someone else, maybe shared this with one of their parents and allow their parents to kind of help them make a decision when they needed to pull back when they need to get someone else involved. And I validate that it is it is a tricky line to walk. Because this is your friend, you don’t want to, you know, in their minds, get them in trouble. And we want to make sure that we’re doing what’s best for them because we care about them. And if you’re if you’re acting in that way in their best interests, it’s okay if you talk to someone because you’re concerned about them.

Ally Donnelly  28:10

Yeah, yeah. Dr. Khadija Booth Watkins. I thank you so much. Dr. Khadija booth Watkins, I thank you so much.

Dr. Khadijah Booth Watkins/MGH Clay Center  29:17

Thank you for having me. And I enjoyed having this conversation with you.

To learn more about the Clay Center, log on to MGH Clay Center dot org and to hear Dr. Booth Watkins on the center’s podcast: Shrinking it Down, mental health made simple. you can find it on apple podcasts or wherever you listen. 

And…switching gears for a moment to community events. The Free Period Ministry is hosting a picnic under the stars at Gray’s Landing on September 15th. Free, Period, through St. John’s church provides menstruation supplies to people in need. And there are a lot of people in need. It’s pretty stunning, but many public assistance programs do not cover tampons and pads. In the US one out of 5 students does not have access to products. For less than $3 you can help provide products and dignity to someone in need for a month. Learn more and buy tickets for the picnic at freeperiodministry.org

Okay, That’s going to do it for this episode of The Hingham ‘Cast. I’m Ally Donnelly. Talk to you soon.