Sound Familiar?
"Nobody could possibly understand how I feel." "If I start to cry I'm sure I'll never stop." "I'm so bad that no one could ever like me." "If I don't hit something I'm going to explode." "If people knew what I was thinking they would say that I'm crazy." "I try as hard as I can but I just don't understand things like I used to." "My family is driving me crazy!" "I just don't enjoy anything anymore." "I wish that I could just stop feeling."

Adolescent Mental Illness

Canadian adolescents, like teens throughout the world, are at high risk for mental illness. Research has shown that in Ontario alone, about one out of five 4 to 16 year olds suffer from some type of psychiatric disorder.

In the U.S., adolescents represent the only age group where there continues to be an increase in mortality rate. Combined, the top three causes of death - accidents, suicide and homicide - account for 75% of the deaths among adolescents.

Professional mental health care resources reach no more than 1 out of 6 children and adolescents in Canada. It is important to better understand what is going on with our youth, why they are at risk, and how we can try to better address the needs of adolescents with psychiatric disorders.

What Is Mental Illness?

Mental illness and mental disorder are not terms easy to define. Misunderstandings lead to misuse and abuse of the terminology and help reinforce myths and even prevent people from getting help when it is really needed.

In general, mental illness refers to clinically significant patterns of behavioural or emotional functioning that are associated with some level or distress, suffering (pain, death), or impairment in one or more areas of functioning (eg., school, work, social and family interactions). At the basis of this impairment is a behavioural, psychological, or biological dysfunction, or a combination of these.

Myths and facts

A number of myths surround child, adolescent and adult mental illness. Society can go a long way to destigmatizing mental illnesses by having a better understanding of the mental health issues.

myth: People with a mental illness are psycho, dangerous and have to be locked away.

fact: Many individuals with a mental illness can have difficulty coping with day to day living. When in great distress, such individuals are at greater risk of harming themselves than others.

myth: People with a mental illness never get better.

fact: With the right kind of help, many people with a mental illness do recover and go on to lead healthy, productive, and satisfying lives.

myth: You can tell if someone has a mental illness by looking in their eyes.

fact: Although there are many signs and symptoms for when someone may be developing a mental illness, diagnosis is a difficult task best undertaken by health professionals. Quick judgements and stereotypes are poor substitutes for comprehensive assessments by professionals.

myth: Only crazy people see shrinks.

fact: People of all ages and all walks of life seek help from a variety of mental health professionals including psychiatrists. Seeking out and accepting help are signs of coping and of preventing situations from getting worse.

myth: If you talk about suicide, you won't attempt it.

fact: Suicidal comments have to be taken seriously as they often lead to plans, attempts, or completions.

Youth And Mental Illness

There are different kinds of mental illness that are commonly seen in adolescence, all of which have significant effects on a teen's day to day living. Some of these include:

adolescents and depression:

Many teens feel down and blue at times, but for some these feelings do not seem to go away. The symptoms can be there day and night and life can become a chore. These teens may not realize that what they are experiencing are symptoms of a potentially treatable disease.

adolescents and suicide:
Suicidal thinking and behaviour often go hand in hand with depression in adolescence. Suicide is the second most common killer of Canadian teens. While some suicidal behaviour may be impulsive, all indicators of suicidal thoughts and actions should be taken seriously.

adolescents and anxiety:
Many physical symptoms (eg., headaches, stomach aches, racing heart) can be associated with anxiety in adolescents. Feelings of fear and dread can become so intense that they keep you from going to school, from being in a group, and from many activities that would not be a problem otherwise. Anxiety can be tied to a past trauma (eg., car accident, incident of abuse), an identifiable source (eg., snakes, heights), or present in everything one does.

adolescents and risk-taking behaviour:

Accidents represent the number one cause of death in Canadian teens and much of this can be traced to different types of risk-taking behaviour. Risk taking is a broad category of behaviours that includes among others: alcohol and substance abuse, unprotected sex, thrill seeking, and delinquent behaviours. Such behaviours are often symptomatic of various mental illnesses and may result in some of the real tragedies of adolescence. As well, if a person engages in one risk-taking behaviour they are likely to engage in more than one.

adolescents and eating disorders:
Two psychiatric eating disorders, anorexia nervosa and bulimia, are on the increase among Canadian teenage girls. They also occur in boys but much less often. Both disorders are characterized by a preoccupation with food, and a feeling of lack of control over aspects of one's life. The teenager with anorexia nervosa is often perfectionistic but suffers from low self-esteem and an irrational belief of being overweight, regardless of how thin he or she becomes. Teenagers with bulimia binge on huge quantities of food and then purge their bodies of dreaded calories by self-induced vomiting, laxative use, and often excessive exercising.

Eating disorders can have fatal consequences, and adolescents with these disorders are typically very good at avoiding being discovered. Denying the presence of their problem delays much needed help.

adolescents and conduct disorders:
Conduct disorders are a complicated group of behavioural and emotional problems in adolescence. These teens have great difficulty following rules and behaving in a socially acceptable way. The major problem is in the expression of anger. They are often aggressive to peers and adults, and may lie, steal, destroy property and be sexually inappropriate.

Risk-taking behaviours are common in this group, including the full range of suicidal behaviour. They frequently have other contributing problems including school failure and negative family and social experiences. Conduct disorders can co-occur with adolescent depression and attention deficit disorder.

Mental Illness Is A Family Affair
Many of the major psychiatric illnesses commonly seen in adults surface during adolescence. Although not directly linked, there is a strong predisposition for mental illness within families. Some families can also operate in such ways as to trigger mental illness within its members, especially those more vulnerable members.

Family awareness, early identification and prevention are often the first steps to effective treatments. Relatives can play a key role in the identification and treatment of the teen with a mental illness, with family members themselves often needing help and support.

Don't Ignore The Signs
Parents, teachers, and friends are usually the first to recognize that an adolescent may be having significant problems with emotions or behaviour. The following are a few signs to look for in your teen, student, brother, sister, classmate, or friend that may indicate that a psychiatric evaluation will be useful.

marked drop in school performance or increase in absenteeism

excessive use of alcohol and/or drugs

marked changes in sleeping and/or eating habits

many physical complaints (headaches, stomach aches)

aggressive or non-aggressive consistent violations of rights of others: opposition to authority, truancy, thefts, vandalism, etc.

withdrawal from friends, family, and regular activities

depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death

frequent outbursts of anger and rage

low energy level, poor concentration, complaints of boredom

loss of enjoyment in what used to be favourite activities

unusual neglect of personal appearance

intense fear of becoming obese with no relationship to actual body weight

uncharacteristic delinquent, thrill seeking or promiscuous behaviour

marked personality change

comments about feeling rotten inside, wanting to end things, and soon no longer being a problem for others


What Does "Help For Mental Illness" Include

The cornerstone of successful help for a mental illness is a comprehensive assessment by a child or adolescent psychiatrist, and/or other qualified professionals who coordinate information from parents, educators, and other relevant sources.

Treatment can include psychotherapy (individual, family, group), skills programs (learning, social skills, behaviour), and psychiatric medication, and be provided in a variety of inpatient, outpatient, or day treatment settings, including special schools, residential placements, hospitals, private offices, or community clinics.

Effective treatments depend upon the strong partnership between patient, family and professionals.

Where To Go For Help
Research shows that a teen is most likely to tell a friend about concerns that they have regarding symptoms of a mental illness. Unfortunately, that friend may be a great listener but may not be the best person to get help. You can be a better friend by looking for signs and symptoms of mental illnesses and helping someone you know reach out to some of the following people:

family doctor or paediatrician

teen health clinic

school counsellor or teacher

parent and other family member

psychologist

psychiatrist

social worker

help line, or

emergency department


This brochure was prepared for the Canadian Psychiatric Association by Dr. Simon Davidson and Dr. Ian Manion, Department of Psychiatry, Children's Hospital of Eastern Ontario. The authors wish to acknowledge the "Facts for Families" series, from The American Academy of Child and Adolescent Psychiatry in the document's preparation.