Youth Mental Health: How to Help Young People through the Lingering Pandemic

0:00:13 William Moyers
Hello and welcome to Let's Talk, a podcast series produced by Hazelden Betty Ford. I'm William C. Moyers, your host. My guest today is Dr. Sara Polley. Dr. Polley is the Medical Director of Hazelden Betty Ford's National Substance Use and Mental Health Treatment Center for Adolescents and Young Adults in suburban Minneapolis. She is board-certified in Adult Psychiatry, Child and Adolescent Psychiatry, and Addiction Medicine. She joined Hazelden Betty Ford earlier in 2021. Welcome, Dr. Polley.

0:00:45 Dr. Sara Polley
Yeah, thanks for having me!

0:00:47 William Moyers
This pandemic has affected all of us. But it has probably had a particularly harsh effect on young people. How so?

0:00:55 Dr. Sara Polley
Yeah, well that's good that you bring that up because you know part of the developmental task of a teenager and a young person is to sort of emerge from their family out into the world—

0:01:05 William Moyers
Mmm.

0:01:06 Dr. Sara Polley
—And figure out who they are. You know, it's normal for young people at that age to have their friendships and their opinions of the people out in the world to be more important than the opinions of the people that are in their house. [chuckles] And it's not always like that, it kinda comes back around when people get older. And so, you know, I think what the pandemic has done is it has taken away the opportunity for a lot of teens and young adults to be out in the world, to have in-person interactions with their friends, with other adults, to really be able to explore who they are outside of their home. And so I think, you know, the result of that is that we're seeing a lot of kids struggling with mental health difficulties. You know, a lot of family conflict. Things that I think you could expect having had that sort of developmental task be sort of stunted or delayed, kind of keeping kids in the home. When really their main goal and drive at that point is to not be in the home and not kind of be with their families.

0:02:00 William Moyers
What about wearing masks, I mean—

0:02:02 Dr. Sara Polley
Yeah.

0:02:02 William Moyers
—It's a controversial issue. We're not gonna discuss the pros and cons 'cause we know that masks are a good deterrent.

0:02:07 Dr. Sara Polley
Yes.

0:02:08 William Moyers
But the fact of the matter is that wearing a mask is—it blocks our ability to communicate with each other. How does wearing masks affect young people?

0:02:17 Dr. Sara Polley
Yeah that's a good question. You know I think it's actually interesting. So generally speaking, a person when they're communicating uses the eyes much more than they use the mouth. Which I always found that to be so interesting—

0:02:29 William Moyers
Mmm-hmm. Yes.

0:02:28 Dr. Sara Polley
—Because they're actually finding that even in young kids that struggle with communication and verbal abilities, they're not actually as far behind as we thought they might be. Watching people in masks talk. Because we actually use the eyes so much more than we use the mouth. When we're talking. And so you can hear my voice and you notice as we're talking, right, we're making eye contact with each other—

0:02:47 William Moyers
Right.

0:02:48 Dr. Sara Polley
—We're not looking at each other's mouths. [Both chuckle] So it's—it's actually, you know, what I see happen more is that you know I think teens and young people are frustrated by all of these new stipulations and rules that have to do with the pandemic. And, you know, not only is that society, teachers, schools coming up with these rules, but then it's parents.

0:03:09 William Moyers
Yes.

0:03:09 Dr. Sara Polley
And parents all have different levels of comfort with the pandemic, right? And so some are gonna have a lot more rules or regulations for a child than others might. And I think teens hate that inconsistency. Well, my friend's dad says that he can go to the movies, why can't I go to the movies? [chuckles]

0:03:25 William Moyers
[chuckles] Interesting, yes!

0:03:26 Dr. Sara Polley
And so I think that comes out with mask wearing too. Because, you know, because it's on your face it's something you can control. And so I see a lot of teens who, you know, will be wearing the mask all funky, down, you know [gestures]. And you kinda laugh about it and you're like, 'What are you doing, why are you wearing your mask that way?!' [Both chuckle] And I think honestly it's an expression of how crappy they feel about this whole situation. And it's like I can't do what I wanna do with anything else, I'm gonna do—I'm gonna wear my mask the way I want to. But it's very sweet actually, usually I'm just like, 'Well come on! Like, you know, I wanna wear mine, I want you to be safe,' and the majority of kids I think'll be like 'Oh, okay.' [chuckles] You know and put it the way it's supposed to be.

0:04:03 William Moyers
Can we talk a little bit about the mental health implications—

0:04:06 Dr. Sara Polley
Yeah.

0:04:06 William Moyers
—Of being a young person in this pandemic, post-pandemic world?

0:04:12 Dr. Sara Polley
Yeah! Well I think there's a couple of things that we're seeing. I think kids that have underlying mental health difficulties are seeing an exacerbation in those symptoms during these pandemic times. And I think the reason for that is increase in general family stress. You know, we know that the majority of mental illnesses for a person do better when they're in kind of a lower chaos, lower conflict environment. And for a lot of families, this pandemic has been amazingly stressful. You know, financial hardships, physical health concerns, worries about physical health. A family member—sometimes loss of family members—from COVID or other illnesses that weren't managed. [Moyers nods} And so, you know, I think we're seeing a lot of exacerbation of underlying conditions for kids.

0:04:54 William Moyers
Mmm.

0:04:55 Dr. Sara Polley
I think kids who may have been, you know, maybe wouldn't have had a diagnosable anxiety disorder or a diagnosable depression have now, because of the added stress, sort of moved from maybe being like sub-threshold what we would say or at risk to being now having a diagnosis. And you know I think people weren't accessing treatment as much as they were previous to the pandemic initially.

0:05:17 William Moyers
Yes.

0:05:18 Dr. Sara Polley
I'm hoping now that that's changing a little bit with access to televideo services—

0:05:22 William Moyers
Mmm-hmm.

0:05:22 Dr. Sara Polley
—Which have been, you know, a lot of places have gotten those online really quickly for people, with the pandemic, for mental health treatment. But there were periods of time there where people stopped taking their medicine, they stopped seeing their therapist, and I think that caused worsening. You know so I yeah I think we're seeing a lot of struggles coming from young people and from families in general with the pandemic.

0:05:43 William Moyers
[nods] Let's talk about substance use issues—

0:05:45 Dr. Sara Polley
Yeah.

0:05:45 William Moyers
I mean on the one hand, with people being confined or young people being confined for as long as they have been, and not interacting like they were, you would like to think that maybe they can't—don't have access to substances like they did before.

0:05:55 Dr. Sara Polley
Mmm-hmm.

0:05:56 William Moyers
But that's not true, right?

0:05:57 Dr. Sara Polley
Yeah well and I think initially at the very beginning of the pandemic, I think that's what we saw. And I saw that clinically too. I mean I had patients who because of everything kind of going into lockdown, I mean we saw this with nicotine use too--is that right like the convenience stores and the like cigarette shops were closed. And so people couldn't go and get their cigarettes. And so then they would not be smoking quite as much or they'd be trying to save the ones that they had and kinda tapering them down. But pretty soon after the beginning of the pandemic, I think that that affect stopped and then people went back to either their previous levels of use or, you know, I think and we're seeing the data for this is still just coming out, you know?

0:06:34 William Moyers
Right!

0:06:34 Dr. Sara Polley
But I think that what we were seeing was that people who were already using substances saw worsening of their substance use in the same way that people who already had depression or anxiety saw worsening of that. I don't think that there were—and this is reassuring I think that people who were not previously substance users didn't, you know, all of a sudden start to become substance users. But those that already had a pre-existing struggle with that, it was exacerbated.

0:06:57 William Moyers
What should parents be looking for with their young daughters or young sons?

0:7:04 Dr. Sara Polley
Yeah well so, you know, I always tell the parents that I work with this is that they know their child much better than any professional or teacher is going to know their child. And so, I think you know there's—some parents will have an instinct, right, like something's different about my kid. And they might not know exactly what that is. They might think well are they depressed, are they anxious? You know, they're not interested in the same activities they used to be interested in. They used to love, you know, fashion design and now they don't care. You know, their sleeping habits are all over the place. They didn't use to be a kid that was up at 3 A.M. outside of the house for some reason. [chuckles]

0:07:38 William Moyers
Right.

0:07:38 Dr. Sara Polley
And now all of a sudden they are. You know so I think unusual behavioral changes in your child is really kind of one of the first things you'll see. You know, academic decline now that once we're getting back to school I think kids that previously were good students that now don't seem to care. Or just are not getting the kind of grades they used to. I think that's something else to take a look out for. And I think, you know, keeping an eye on your kids' social media is also really important. [Moyers nods] And I know a lot of kids don't want their parents to keep an eye on their social media but I think that that, you know—

0:08:08 William Moyers
Mmm-hmm.

0:08:09 Dr. Sara Polley
—Often times kids—you'll see things on social media that are sorta like, 'Hmm, what is that? Why is my kid in that picture with these other kids that are doing these things?' And that can just be a place that you could use that as a starting point to talk with your child. Like, 'Look, I saw this on Instagram,' or wherever your child is on social media and say, 'Can we just talk about that, what was happening?' [nods]

0:08:29 William Moyers
Parents do have a responsibility to monitor their children's social media presence, yes?

0:08:32 Dr. Sara Polley
Yes. Yes. Oh I—yes a hundred and fifty percent agree with that. And I think that it's hard, it's challenging, right? Because of course your young person does not want you as a parent to do that. And so I think it's a struggle as a parent to balance what you need to do as a parent—

0:08:47 William Moyers
Mmm.

0:08:47 Dr. Sara Polley
—And what your kid kinda wants you to do. And you don't—you don't wanna kinda have that conflict. And so I think that, you know, it's easy to kinda avoid it or not do it.

0:08:55 William Moyers
Mmm-hmm.

0:08:55 Dr. Sara Polley
—But yes I agree with you, I think social media is such a—I know this is not about social media, but social media is such a challenge for young people to navigate. [nods]

0:09:03 William Moyers
So what do teachers—what role do they play in I don't wanna say monitoring but observing the well-being or the lack of well-being—

0:09:14 Dr. Sara Polley
Mmm-hmm.

0:09:14 William Moyers
—With young people who are coming back to school?

0:09:16 Dr. Sara Polley
Yeah. Well so I think what I'm thinking we'll see happen is that there'll be a chunk of kids, right, who go back to school and they just do fabulously. They're excited to be back, you know, they've been looking forward to this, they start to achieve at the same levels that they were always achieving. Maybe they struggled more during the pandemic because they couldn't stay on task or they weren't super committed to the work when it was distanced. But now that they're back, everything's great. And then I think we're gonna see a chunk of kids where maybe previously, they had always sort of been great at school and really excelled. And then now when they're coming back, they're maybe just not quite the same kid. And so those—to me that would be a place where parents may need teachers to reach out to them or to staff at the school to say, 'I'm worried about your kid,' you know, 'Your kid is previously honor roll, really interested in doing theater, on chess team, and now they don't seem to really be interested or they seem to have really shifted friend groups, I don't see them with the same kinda kids they were with before.' Because parents may not necessarily be aware of that and this might actually be—

0:10:15 William Moyers
Hmm.

0:10:16 Dr. Sara Polley
—The first time this is kinda out in the open in the community. So yeah, so I think teachers and staff at schools could really serve a good role in you know notifying parents if there are differences or things that they're seeing.

0:10:27 William Moyers
Mmm.

0:10:28 Dr. Sara Polley
Or if kids just aren't showing up for school, right?

0:10:29 William Moyers
Right. Hmm.

0:10:29 Dr. Sara Polley
'Cause that's a concern I think that I have too is that, you know, and every year we get kids in treatment who fail to go to school, right? Because of either mental health or substance use, they just don't show up. And the district gets involved with, you know, is your kid truant, what is happening here? And so I'm thinking, you know, we may unfortunately see groups of kids who just don't show up for school again in the fall. And so for schools to take note of that and reach out to families to see if there is something happening and then getting kids connected with care and help if that's what they need. [nods]

0:10:57 William Moyers
We only have about five minutes left, we could go on for another hour. [Both chuckle] Your knowledge, your perspective, are invigorating and insightful. But in the few minutes that we have left, let's talk a little bit about what we were discussing off-camera. Which before we recorded which is what appears to be the reluctance of parents to address their young person's substance use or mental illness.

0:11:23 Dr. Sara Polley
Mmm-hmm.

0:11:24 William Moyers
What is your message to parents who have children that have been struggling or will be struggling in the times ahead?

0:11:32 Dr. Sara Polley
Yeah. Well so I think my message is that, you know, I hope and I wish for your child that at the end of this pandemic, whatever that means, right, your child going back to school—that things for them will go back to normal. But there's a good chance that they won't go back to normal and that your child may still struggle. And so, you know, not to avoid seeking care for your child with the hopes that you're overwhelmed and there's a lot to do and maybe it'll just be fine. But really, you know, not letting something bad happen and really getting your child connected with care. And whatever care seems reasonable for your family, right? Like if you're at a stage where, you know, the idea of your child going to a residential treatment is too much. Like we—I don't know how to pay for that, that seems overwhelming. Even just reaching out to a therapist, getting them connected with outpatient supports, I mean, professionals are all wanting to help kids during these times. And are also very good at assessing risk and need for different levels of care. And so if you get your child involved with an outpatient therapist and they're still struggling and it's not working, then they can help connect you with the type of care that might be a better fit for your family. [Moyers nods] But just making that first step and reaching out is so important.

0:12:43 William Moyers
And your point to me earlier was that it's easier to make that first step now because we have telehealth!

0:12:49 Dr. Sara Polley
Yes! Yes and it's funny too actually with young people I think have really taken up the televideo platform a lot easier. [Moyers nods] You know, I do have patients who say there's something about the in-person connection where I take this more seriously and I'm more honest with you. And at the same time I have kids that—I mean I've had fun. I've gotten to see teens' bedrooms with their posters and their art project that they were doing. And meet their cat. [Moyers laughs] So and I think a lot of them are very used to being connected and open on a televideo platform just from social media with their friends.

0:13:20 William Moyers
Yes.

0:13:21 Dr. Sara Polley
You know a lot of them don't blink an eye and they—it's kinda fun to get to have a window into their life. [smiles]

0:13:26 William Moyers
Before we wrap it up, how have you had to approach your responsibilities, your job, differently, given this pandemic? I mean you're down in the trenches at Hazelden Betty Ford's adolescent site in suburban Minneapolis. And we've got patients there every day who are struggling with a substance use disorder or a mental health problem or both. How have you had to adjust your approach to helping young people?

0:13:53 Dr. Sara Polley
Yeah. Well I've definitely found myself, you know, embracing more of the medical side of my training in addition to the psychiatric side—

0:14:01 William Moyers
Ah.

0:14:01 Dr. Sara Polley
—Meaning that I do a lot of education with kids about the vaccine, about the importance of masking, hand-washing. I actually just recently was part of community groups on our units answering questions people had about COVID, which, I like doing that, it's fun—

0:14:16 William Moyers
Mmm-hmm.

0:14:16 Dr. Sara Polley
—But generally as a psychiatrist, you know, I don't have a day-to-day role in talking about infection disease. [chuckles]

0:14:20 William Moyers
Mmm.

0:14:21 Dr. Sara Polley
And so it—but I—a lot of times I'm the most accessible doctor for a lot of my patients. And so of course I wanna provide them with the knowledge and the education so that they can make healthy choices for themselves about whether or not to get the vaccine and how to take care of themselves during this time.

0:14:37 William Moyers
Mmm-hmm. And you are a psychiatrist with a focus on young people and these are tough times. But, surely you must have a lot of hope for young people. And I know there'll be some young people who tune in to watch this 'cause they wanna know more about this topic. [Dr. Polley nods] What's your message to young people?

0:14:55 Dr. Sara Polley
Yeah. Well, no, I mean, young people are amazingly resilient.

0:14:58 William Moyers
Yes.

0:14:59 Dr. Sara Polley
Their brains are so capable of change. That, you know, people can make dramatic and drastic life shifts if they put their mind to it and they want to. And so, you know, being a young person that's struggling, I mean now is the time to really reach out and get support and help. Because you have the opportunity to have this all be in your past. And kinda have whatever kind of adult life you wanna have for yourself. And so, you know, being a young person is an amazing time of hope. Even with the stress that's going on now, you know? [nods]

0:15:28 William Moyers
Mmm-hmm.

0:15:28 Dr. Sara Polley
Yeah.

0:15:29 William Moyers
Well, thank you for that message of hope and thanks for bringing your expertise, your passion, and your commitment. To people—young people and their families who need and deserve help. Thank you, Dr. Sara Polley. [smiles]

0:15:40 Dr. Sara Polley
Yeah, thank you!

0:15:41 William Moyers
[turns to camera]
And thanks to all of you for joining us. Remember, addiction to alcohol and other drugs doesn't discriminate. Treatment works, recovery happens! So, don't wait if you or a loved one in your family needs help. Ask for help and do it now. I'm your host, William C. Moyers, I hope you'll plan to join us again for another edition of Let's Talk. See ya soon.