By Rachel Sams
This article contains information about how to identify and respond to signs of mental health issues and suicide risk in young people.
Have you ever looked into the eyes of a young person your nonprofit serves and seen that they were hurting?
What did you do? If it hasn’t happened yet, what would you do?
Any nonprofit employee who works with youth will confront a tough question: is this young person’s behavior a natural response to the developmental challenges of growing up, or is it a sign that they are experiencing a mental health challenge?
Youth-serving nonprofits are more likely to face that question now than ever before. An increasing number of young people faced mental health issues even before the pandemic, studies show. The isolation of COVID took a toll on more young people’s mental health. Many youth-serving nonprofits are restarting or rebuilding programs scaled back or shuttered during COVID. Those nonprofit providers might be the first to spot youth mental health issues that didn’t get noticed at home or school as caregivers and educators faced their own challenges.
It’s especially important now for youth-serving nonprofits to watch for and respond to signs that young people they serve experience mental health issues or thoughts of suicide. Youth-serving nonprofits face risks if they don’t respond appropriately to warning signs that someone on their watch may harm themselves or others. Nonprofits that serve youth also have a powerful opportunity to help create community and individual supports that can assist young people in building positive mental wellness.
For all young people, adolescence brings heightened risk for mental health issues. As youth approach adolescence, they face huge developmental changes. They must navigate the changes in their bodies, forge their identity, and build a value system. And youth face challenges from peer pressure to substance misuse.
The risks to young people mounted in the 21st century, including new threats from cyberbullying, declining family and social support, and the pressures of social media, according to a study by Holly R. Farley published in Nursing2022. All that took place even before the COVID pandemic, which early studies show took a toll on young people’s mental health. U.S. Surgeon General Dr. Vivek Murthy issued an advisory in December calling for a swift and coordinated response to the nation’s youth mental health crisis.
Stressors on youth mounted during the pandemic. More than 140,000 American young people have experienced the death of a parent or grandparent caregiver due to COVID, according to the American Academy of Pediatrics. And young people of color faced up to 4.5 times the risk of losing a caregiver to COVID, compared to other children.
A Kaiser Family Foundation study found that parents’ income insecurity and poor mental health during the pandemic may have hurt children’s mental health and could be associated with a possible rise in child abuse. Families of color faced more economic setbacks during the pandemic: Hispanic women and immigrants faced the highest impact of job loss, the Pew Research Center found.
Reports of child abuse and related emergency room visits dropped during the pandemic, but experts note that cases may have gone unreported while schools and nonprofit programs were shut down or virtual. School personnel and others who work with youth play key roles in identifying and reporting child abuse.
Nonprofits that work with young people face a unique set of risks and responsibilities. As the mental health risks to young people have mounted, so have the risks youth-serving nonprofits must consider. If a young person harms themselves or others due to a mental health issue while under a nonprofit’s supervision, the nonprofit could face legal and reputational risks.
Youth-serving nonprofits can’t anticipate every issue that could arise for young people under their supervision. But they can and must develop and follow clear guidelines for how to recognize and respond to signs that young people they serve are in mental distress. This work is essential to youth-serving nonprofits’ mission to provide support and understanding and make a difference in the lives of the young people they serve.
How to identify mental health warning signs in youth
It can be especially difficult to know when younger children struggle with their mental health. But the National Institute of Mental Health (NIMH) says if these symptoms persist and interfere with a child’s daily activities, they should see a health professional:
- Frequent tantrums or intense irritability
- Frequent talk about fears or worries
- Regularly complains of stomachaches or headaches with no known medical cause
- Constantly moves around and seems unable to sit quietly (unless they’re watching videos or playing video games)
- Sleeps too much or too little, often has nightmares, or seems sleepy during the day
- Doesn’t show interest in playing with other children or has difficulty making friends
- Struggles academically or experienced a recent decline in grades
- Repeats actions or checks things many times out of fear that something bad may happen
NIMH says older children may benefit from having a health professional evaluate their mental health if they:
- Lose interest in things they used to enjoy
- Have low energy
- Sleep too much or too little, or seem sleepy throughout the day
- Increasingly spend time alone and avoid social activities with friends or family
- Diet or exercise excessively, or fear gaining weight
- Engage in self-harm behaviors (like cutting or burning their skin)
- Misuse substances (like smoking or using alcohol or drugs)
- Engage in risky or destructive behavior alone or with friends
- Have periods of highly elevated energy and activity, and require much less sleep than usual
- Say they think someone is trying to control their mind or that they hear things other people can’t hear
- Have thoughts of suicide
Identifying and responding to suicidal ideation
Suicide is the leading cause of death among school-age young people, according to the National Association of School Psychologists (NASP). But as NASP points out, suicide is preventable. Staff at youth-serving nonprofits might be the first to notice a child is struggling. When they do, they must alert caregivers right away.
Factors that increase a child’s risk of having suicidal thoughts include mental health issues and substance misuse; family stress or dysfunction; environmental risks, including firearms in the home; and crises like the death of a loved one, physical or sexual abuse, or family violence.
Young people who have suicidal thoughts probably won’t seek help directly, NASP says, but caring adults or peers can spot warning signs and take immediate action to keep the child safe. Those signs include:
- Changes in behavior, appearance, thoughts, or feelings
- Preoccupation with death
- Making arrangements like funeral planning, writing a will, or giving away beloved possessions
- Threats of suicide, either direct (“I’m going to kill myself”) or indirect (“I wish I could fall asleep and never wake up.”)
- Suicide notes or plans, including online postings
- Previous suicidal behavior
If a child under a youth-serving nonprofit’s supervision shows signs that they might be considering suicide, staffers should remain calm and ask the child directly if they are thinking of suicide, NASP says. Show that you’re concerned for the child’s well-being and don’t make accusations. Listen. Let them know they can get help for what they are going through and they don’t have to feel this way forever. Supervise the young person at all times and ensure they aren’t alone. Remove any possible means for self-harm. Never agree to keep a child’s suicidal thoughts a secret. Inform the child’s caregivers right away. Call the National Suicide Prevention Lifeline and get immediate help from mental health or medical professionals or take the child to an emergency room.
How to address mental health risks of working with youth
Make a plan. Don’t wait for a crisis to create a framework for how your nonprofit will respond when a youth in your care shows signs of mental distress.
Involve youth, their families, and the community in your plan. Ask the young people you serve and their parents and caregivers for input on how your nonprofit should screen for and respond to mental health issues. This process could start with a prompt as simple as: “If you or your friend was depressed or thinking of hurting themselves, what would you want us to do or not do?” Make sure parents and caregivers know how to connect with staff at your organization, and how to support your mental health screening program if they have the time and interest. Offer training and educational materials on youth mental health to parents and caregivers. Make the interaction you seek serve the schedules of parents and caregivers, and make it culturally sensitive to all. Ensure youth and families have access to multicultural and multilingual staff and training materials.
Meet young people where they are. Build a foundation in non-emergent situations where youth are encouraged to speak openly about difficult topics in their lives, and are not judged when they do so. Engage in informal conversations to help staff understand young people’s circumstances and mental state. In Nursing2022, Holly Farley recommends asking open-ended questions that show interest and build rapport, like, “What do you enjoy doing outside of school?” or, “Tell me about your friends.” Listen and give the young person plenty of time to answer. Let them know it’s okay to struggle and that you’re proud of them for trying their best in hard circumstances.
Understand reporting and privacy requirements. Know who has legal authority for the children in your nonprofit’s care. If a young person threatens harm to themselves or others, you’ll typically need to obtain informed consent from their legal guardian to share information about that threat with others, according to Allied World. And know your state’s regulations and case law – in some cases, a duty to warn of violent threats may supersede privacy rights under state law.
Build a strong community to support youth at every stage of their journey
Working with youth brings unique joys and challenges. Bearing witness to the pressures young people face can feel overwhelming. Nonprofit staff should engage in open conversation with each other about this to normalize the struggles and create approaches and boundaries that decrease the risk of organizational trauma.
But just as nonprofit staff have a front-row seat to the difficulties young people face, they have a powerful opportunity to help build a more supportive world for youth. Many “protective factors” can support young people’s mental health. Youth-serving nonprofits can provide or strengthen protective factors across multiple dimensions of a young person’s life.
For individual young people, positive physical development, academic or intellectual development, high self-esteem, the ability to regulate emotions, good coping and problem-solving skills, and multiple connections with school, peers, athletics, employment, religion, and culture can benefit mental health, according to youth.gov.
Families can help youth by providing supportive relationships, clear expectations for behavior and values, and structure, limits, rules, and predictability. Nonprofits can provide help to families as they work to create these supports for youth.
And schools, neighborhoods, and the community can foster youth mental wellness through mentorship and support to develop skills and interests; opportunities for school and community engagement; positive norms; clear expectations for behavior; and physical and psychological safety. Psychological safety means an environment in which a child feels they won’t be humiliated or punished for speaking up about something.
Youth-serving nonprofits constitute one piece of a child’s complex world. Within that space, you have the possibility for great influence.
I’m so proud of you for telling me you’re going through a hard time.
You don’t have to feel this way forever.
People care about you and want to help.
Your nonprofit’s words and actions matter. Build the foundation now to navigate challenging situations when they arise.
If you or someone you know is suicidal, get help immediately via 911, the National Suicide Prevention Lifeline at 1-800-273-TALK or the Crisis Text Line (text “HOME” to 741741).
Rachel Sams is a Consultant and Staff Writer with the Nonprofit Risk Management Center. Reach out to her with questions or feedback on this article at 703-777-3504 or rachel@nonprofitrisk.org.