Supporting our youth: Key insights from a behavioral health expert

Dr. Caroline Fenkel, DSW, LCSW

We recently had the opportunity to talk with Dr. Caroline Fenkel, DSW, LCSW, co-founder and chief clinical officer at Charlie Health, about how to recognize when a young person might be struggling and how to best offer support. Charlie Health provides virtual mental health treatment to adolescents and young adults who are experiencing a crisis and need more comprehensive care.

Regence: What factors do you think contribute to the increase in youth and young adult suicide rates?

Dr. Fenkel: I don’t think you can point to one thing and say this is what caused the youth mental health crisis. We know a growing number of young people are grappling with mental distress and that we need better solutions. At Charlie Health, our immediate focus is getting people in crisis the care they need to survive.

Regence: What are some common signs that parents, teachers and peers should be aware of when it comes to identifying potential behavioral health struggles or suicidal thoughts in young people?

Dr. Fenkel: For most teens, one sign is a decline in grades. However, there are also other warning signs, some not so easy to spot, including:

• Avoiding friends, family or social activities. If your child starts to avoid their friends or activities that used to bring them joy, they may be struggling with anxiety, depression, low self-esteem or another mental health issue.
• Unexpected changes in moods. It's normal for teens to experience mood swings. However, it's important to monitor if these mood swings increase and begin to affect a teen's ability to continue with everyday activities.
• Changes in sleep and eating habits. Sudden insomnia, increased napping throughout the day and wanting to stay in bed all day could all be signs of a more significant problem. Similarly, changes in eating habits can be a sign that someone is struggling with their mental health.
• Trouble with everyday tasks. For people who are suffering from a mental condition like anxiety or depression, even the most routine tasks can seem overwhelming. If your teen has abandoned habits that used to help them feel their best, including keeping up with personal hygiene or physical activity, they might need mental health attention.
• Self-harm. This can be hard to spot as teens can hide physical signs under their clothing, but they include scars; frequent cuts, burns, bruises, scratches or other physical injuries; making excuses for new injuries; wearing long pants and long sleeves even in hot weather; signs of blood on towels or clothes, or unexpectedly doing their own laundry; taking out their own trash; razor seeking; withdrawing from friends, family or social activities.

Regence: How can we reduce stigma surrounding behavioral health challenges?

Dr. Fenkel: Talk openly about mental health. Social media has become a great space for positivity, but it’s important to remember that it can also play a role in these challenges. Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences. Be conscious of language – remind people that words matter.

Regence: How can parents and caregivers support the mental well-being of their children in today’s challenging environment? Are there any specific resources or advice you recommend?

Dr. Fenkel: It’s so important for parents and caregivers to set the stage for an open relationship where even tricky things can be discussed or handled as a family. Avoidance may let matters evolve into potentially dangerous situations. Some ways to achieve this include:

• Setting healthy boundaries
• Spending quality time together
• Practicing active listening
• Keeping an open mind
• Providing support free of judgment
• Creating a crisis plan that includes coping strategies and resources
• Becoming certified for mental crisis scenarios

Regence: Can you share a success story or example of how Charlie Health has helped young people struggling with behavioral health issues, including those at risk of suicide?

Dr. Fenkel: Charlie Health’s Intensive Outpatient Program (IOP) teaches clients mental health skills that serve them long after treatment is complete. Here are stories from a teen and young adult who’ve learned mental health skills from Charlie Health.

When Ashlyn M., a teen alum of the program started Charlie Health, she was dealing with mental health symptoms that manifested in full-body panic and she was on the verge of self-harming. She told us she had issues finding coping skills, but Charlie Health helped her find some. The most helpful coping skills she acquired were mindfulness skills, a catchall for techniques that help people improve their awareness of the present moment. In Ashlyn’s case, this included mindful walks and guided imagery meditations where she imagined being in nature. “I feel more calm,” Ashlyn said. “I used to hold my shoulders really tense, and I notice they relax more now.”

As someone who dealt with traumatic childhood experiences, Demi G., a young adult client, struggled to regulate their emotional responses. Developing emotional regulation skills, though, is something they learned for the first time during treatment at Charlie Health, which incorporates emotional regulation techniques from therapies like dialectical behavior therapy (DBT). “My stressors are still there, but how I react is completely different,” Demi said. “It feels so good to have agency over my emotions. That’s something I’ve never felt before.”

Regence: In addition to direct services, what resources do you recommend for anyone looking for behavioral health support?

Dr. Fenkel: The JED Foundation's Mental Health Resource Center provides essential information about common emotional health issues. It shows teens and young adults how they can support one another, overcome challenges and successfully transition to adulthood.

SAMHSA's National Helpline: SAMHSA's National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. 1-800-662-HELP (4357)

988 Suicide & Crisis Lifeline: 988 is now the three-digit dialing code that routes callers to the 988 Suicide & Crisis Lifeline (or 988 Lifeline). On July 16, 2022, the Lifeline transitioned away from the National Suicide Prevention Line reached through a 10-digit number to the three-digit 988 Lifeline. It is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by Vibrant Emotional Health (Vibrant).

We’re here to help

If you or your child needs emotional support or mental health care, Regence can help you find the behavioral health care option that fits your needs. Most of our health plans offer virtual mental health treatment options from providers such as AbleTo Therapy+, Doctor on Demand, Talkspace, Charlie Health and more. No referral is needed – you can visit the provider’s website and fill out their intake form for an appointment.

We encourage you to visit these providers’ websites or call us at the number listed on your member ID card to verify which virtual care and traditional behavioral health options are available through your health plan.