Seeking help for mental health issues has long been a difficult proposition. A range of factors—from a lack of access to care providers to societal stigma surrounding mental illness to personal denial of the need for treatment—have kept many people suffering from anxiety, depression, stress disorders, substance abuse or more intense afflictions from receiving care.

“I would say that mental health has, as we know, historically had such a negative stigma to it,” says Julie Manuel, clinical program manager at the Kettering Behavioral Medicine Center. Often, this results in people resorting to suffering in silence to avoid the taboo of having a mental health issue.

Manuel says that while mental health awareness isn’t where it needs to be yet, she has seen improvement over the last several years.

“I would say that most of that is because people are starting to share their stories,” she explains, “and be a little bit more open to understanding that mental illness is just like heart disease or having diabetes—you have to take care of the symptoms in order to maintain a healthy lifestyle.”

And mental health conditions don’t just stay in the realm of psychology and neurology if left untreated. Anxiety and depression can snowball into consequential physical issues when it causes a person to resort to a sedentary, isolated lifestyle, leading to weight gain and lack of healthy activity—which can, in turn, lead to traditional health issues that come with either—or even self-harm.

Dr. Jonathan Lazzara, who works at the Atrium Medical Center in Middletown, a part of Premier Health’s network, has seen a lot of this firsthand between his work as a psychiatrist and his experience in the Marines. He’s witnessed the effect this reticence has had on men and women in the military.

“A lot of the problems that we have with our veterans’ (mental health) were not problems developed necessarily in combat or the military,” Lazzara says, “but the communities that they grew up in that brought the stigma of going in and getting therapy or utilizing mental health treatment.”

While the societal conversation about suffering from and treating adult depression, anxiety, stress disorders and other mental health conditions has indeed improved, the same destigmatization is lacking for a vulnerable population: teenagers and young adults.

Lazzara points out the gap in regular medical coverage and observation between childhood—where annual or more frequent visits to the doctor are required for immunizations, going back to school or playing sports—and adult coverage leaves this group particularly vulnerable.

“So you turn 18 and you go into college or you go get a job and you don’t have to see a doctor,” he explains, adding how, at that age, most young men and women don’t have much motivation to get health checkups or seek treatment, whether that’s a lack of insurance, resistance to going or just the youthful feeling of invincibility at that age. “And those are the moments where you have these first breaks or manic episodes or your depression or anxiety starts to kick in and you can learn appropriate coping skills or you can get medication on board early at a very low dose to keep it sustained appropriately. And these are the exact times that you fall out of medical coverage and fall out of some form of observation and stabilization.”

This is all the more troubling when looking at how suicide rates have increased among young people. An October 2019 study from the Department of Health and Human Services observed that from 2007 to 2017 suicide rates among people ages 10 to 24 rose from just under seven in 100,000 to a fraction over one in 10,000. Even more shocking is that the biggest jump occurred among children ages 10 to 14, where the rate almost tripled in that same 10-year span.

This underscores the vital importance of families talking about mental health at an early age with their young children, especially as they become more exposed to societal stressors and are developing their own identities.

As Lazzara points out it’s a tough enough time on young folks as they deal with a host of stressful factors, especially for those coming to understand their sexual orientation or gender identity. He says it is imperative for pre-teens, teenagers and young adults to receive healthy support during these ages and that the simplest positive reinforcement can be the biggest difference maker to a young person who may be struggling.

In the same manner, a lack of family support for a child’s mental health can compound their later resistance to seeking treatment, or worse add to those grim youth suicide statistics.

“You would not believe how many times I have gone in a room on a suicide attempt and had a parent tell me, ‘She’s just going through a phase,’ or ‘He’s just going through a phase,’ or ‘I went through this too, (they’ll) work through it, (they) don’t need medication,’” Lazzara says.

Manuel, who leads the Adult Intensive Outpatient Program at Kettering Behavioral Medicine Center, has noticed a lot of participants in that program realize in retrospect that something they had experienced in their youth and dismissed as nerves, a phase or a personal burden they had to deal with on their own was, in fact, a persistent mental health problem for which they could be treated.

The outpatient program at the Moraine facility focuses on creating supportive relationships and interactions for adult sufferers of psychiatric conditions or mood or anxiety disorders who are able to function independently. The three-day-per-week program intends to fit around their work or school schedules, with each group session lasting three hours from 6 p.m. to 9 p.m.

“A lot of times we have people that come into the program and they feel really alone,” Manuel explains. “Like, ‘I’m the only one that’s experiencing this.’ Again, there’s this stigma surrounding it and I think by the time they leave they see that they are not alone, that some of that stigma has gone away, some of that shame has gone away and they’ve developed a really good support system.”

Manuel says one of the telltale signs that someone is struggling with anxiety, depression or other mental health conditions is difficulty functioning at the same level they used to. But seeing that change—which can often be subtle or unnoticeable to those who aren’t intimately close with someone—and starting on the path to getting treatment relies heavily on close friends and family.

“I’ve been talking a lot about post-traumatic stress disorder recently,” says Manuel, “and one of the things that I talk a lot about is that sometimes we don’t recognize it within our own selves and it’s often our spouses or our close friends or our significant others that really recognizes the symptoms because our behaviors start to change.”

Lazzara adds that this necessitates a holistic approach to mental health treatment from start to finish. From recognizing the warning signs to supporting someone receiving regular therapy or medication, it’s vital that physicians, nurses, social workers and a mental health patient’s personal support system all be a part of a treatment plan centered on the individual’s specific care needs.

“Those medical models are where you will see the true success,” he says. “You’ll see faster discharges, a lower rate of recidivism back into the hospital system, you’ll see healthier lives, better diets, better care of themselves, simple hygiene goes up.”