Mental Health Matters: Youth mental health

We did not have a television in the house that I grew up in until I was somewhere around nine or 10 years old. When we did get a TV, it was because my paternal grandmother had moved from her home into a nursing home and could not take all her belongings with her. We ended up with the TV.

Since then, I have looked forward to the Olympics every four years. I loved watching the coverage, albeit much different from today’s high-tech, almost 24/7 access, almost anywhere across the globe. My first memories, as far as I can recall, also included the tragic games of 1972 covered by anchor Jim McKay. The stark contrast between the usual joy and celebration and the hostage takeover was hard to make sense of.

More recently, there has been a growing focus on the mental health costs of the pressure and exposure young athletes face. Many of these athletes have been in serious training since a very young age, with families often sacrificing at great lengths to give their children a chance at athletic success. After years of competition, Michael Phelps took a great risk to his career when he began to open up in 2015 about his struggles with severe depression, anxiety and suicidal thoughts. He described severe “crashes” after each Olympic experience, feeling lost and wondering about his identity outside of swimming.

Indeed, after one reaches the pinnacle of their career, it can be very disorienting to figure out what to do next.

Another voice joined the growing choir in Tokyo in 2021 when Simone Byles made the decision to sit out several events. She recognized that she was losing her physical orientation with what has been called “the twisties.” Media attention afterwards included repeated questions about her fitness and future intentions to compete. Naomi Osaka also joined in the cultural shift toward open discussions about mental health, with the growing recognition that mental wellness is essential, rather than separate from peak performance.

At the just-completed Milan Olympics, the world watched as “the Quad God,” Ilia Malinin, 21, took to the ice for the men’s free skate competition. His performance was both painful for him to complete and to watch as a spectator. Upon finishing eighth, he appeared stunned, saying, “This is definitely something I wasn’t expecting…. but this is not like any other competition.” Later, he talked about what he described as crippling anxiety and invisible battles, surely made worse by the very high expectations he faced, given his remarkable skills and energy. He also spoke to the “vile online hatred and negativity” that contributed to the “noise” in his head, clouding his focus.

I thought about my own children at the age of 21, facing that kind of pressure and the social media scourge, and my heart aches for them.

These afflictions suffered by young world-class athletes are also commonly experienced by athletes in our high schools and colleges. The most common are anxiety, depression, burnout and eating disorders experienced by approximately 35% to 60% of young athletes. Over 60% of student athletes report moderate to severe stress. Keep in mind that with the stigma around mental health in general, but specifically with this population, the problem is likely underreported. At the collegiate level, student-athletes also experience a lack of access to an adequate supply of food and nourishment. Out of all these concerns, only 10% seek help.

What fuels conditions like this in this group of young people? Commonly reported are issues of identity loss after injury or competitive loss. Many identify high-stakes competition, perfectionism, the struggle to balance academics with intense training and being forced to funnel into such distinct specializations at such a young age. This is often to the exclusion of developing other parts of their identity.

Of course, there are risk factors. Developing the “athletic identity” can often exclude other balancing factors. In a sense, they are placing all their eggs in one basket. Many of these athletes are also perfectionists, with few coping skills to help them in high-stress environments. This can also lead to a higher risk for injury. The risk for suicide is also increased due to a developmental factor. Teens are at higher risk for suicidality to begin with, as they are cognitively less likely to see other solutions to these stressors.

In general, South Carolina faces a critical youth mental health situation, with our youth suicide ranking as the leading cause of death for youth ages 10 to 17. The data indicate that this number grew significantly between 2007 and 2021, with 141 deaths in 2021 alone. As a state, we rank 13^th in the U.S. for intentional self-harm deaths among adolescents ages 15 to19. Roughly 77% of South Carolina youth with major depressive episodes do not receive treatment, well exceeding the national average of 60%. On average, 21 emergency department visits and six hospitalizations for self-harm occur weekly among South Carolina youth. This data was gathered from The University of South Carolina, South Carolina Department of Health and Human Services, America’s Health Rankings and South Carolina Department of Public Health.

What should we be looking for if we want to help? Indicators of mental health struggles are numerous. Changes in sleep or eating behaviors are important. Mood changes can include persistent sadness, hopelessness, intense irritability or explosive anger. All of these indicate a struggle with mood regulation. Behavior changes include withdrawal from friends, family or activities they normally enjoy. Another red flag involves physical changes such as unexplained changes in appetite or weight, trouble sleeping and/or excessive fatigue.

We might see problems with concentration, memory or difficulty thinking clearly. Others may experience a decline in academic performance, declining grades, wanting to avoid school or new and intense conflict in relationships. An increase in physical complaints can include unexplained headaches or stomach aches. Some teens experience an increase in risk-taking behaviors, such as starting or increasing use of alcohol or drugs.

What can we do for preventive measures? There are several things, many of which can be called habits, that come to mind. We can spend regular time with our children talking about them, their day, their concerns and their experiences of the world around them. Begun early enough, this routine will mean that as they enter the tween and teen years, the habit of sharing about their internal life will be well established.

The truth is that it takes a community to raise and protect our children. Every child should have at least one grown-up who thinks the moon rises and sets around that child, which is a prevention effort. Someone in that community needs to know that child well enough to recognize when something is amiss. Coaches, parents, teachers, pastors, church family, bus drivers, custodians, neighbors, all have a role to play in the health and well-being of all our children. When we know a child well enough, we will more likely recognize when they are struggling with any kind of health issue. We are created to know and be known. Both in our best and our worst moments.

We can start early in their lives by including socio-emotional language in our family conversations. This simply involves identifying and understanding different emotions and feelings. Early exposure to this language means that they will be comfortable coming to us when things get complicated. This also means that, as adults, we need to feel comfortable with our own emotional lives.

We can demonstrate through our own actions and practices how important mental health is to us, the adults in their lives. Prioritizing our own therapy and being able to talk about our own points of mental health pain can open the door for our children to see this as an important part of our lives, and therefore, for their lives as well.

We can make sure that home and family are safe places to talk about hard things. When that safety is established, it is set in place for any kind of hard things that come our way. Children need to know that someone has their back no matter what. It is important to keep the focus on understanding and emotional safety, rather than finding someone to blame for whatever our circumstances may be.

Another strategy involves making sure that our children are supported by some kind of community involvement. This can be a church family or a neighborhood community. Of course, we want to know that the adults surrounding our children can be trusted. Increasingly, church and community groups, to name just a few, require that adults working with children complete a background check. Even so, we each have a responsibility to keep a keen eye on our children and who they interact with.

We can help keep our children’s lives balanced. Many world-class athletes describe childhoods where every spare moment was devoted to training and practice for their sport. When children can develop a wide range of experiences and skills, it is less troubling to lose a game or to not qualify for state-level competition. They have a band concert coming up at the end of the month. They have multiple opportunities to demonstrate growth and skill.

On a bigger scale, we can each become advocates for mental wellness and mental health education. When we communicate our concerns to our representative, they will listen. They work for us, their constituents. Over half of all lifetime mental health conditions are well underway by the age of 14. While South Carolina has made commitments to several mental health initiatives, these are typically quite fragile with changes in leadership and competing budget initiatives. Watch political campaigns for the attention they pay to these issues. It is imperative that we continue to invest in public mental health awareness and education.

If you haven’t had the chance to watch the Milano Cortina 2026 Figure Skating Exhibition Gala just performed on Saturday, Feb. 21, take some time this week to watch that amazing performance. All the performers/athletes put on a beautiful exclamation point to the already breathtaking skating competition. Using his platform to bring awareness to the issue of mental health, Ilia Malinin gave a powerful and descriptive performance to rapper NF’s “Fear.” Using advocacy to shed light on the mental health pandemic. I hope you get a chance to watch the Gala in its entirety.

Fear

Hello darkness my old friend (Hello)

Knocking at my door again

Beggin me to come outside

Let you back into my life

Now usually I’d be strong enough

To lock the doors and keep ‘em shut

But not today, I’m desperate (desperate)

So go ahead and come on in

So go ahead and come on in

So go ahead and come on in…

-NF

Have questions you’d like to ask Shirley? Message her at oasistherapyservices@gmail.com.