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Helen: Welcome to Notes from the Backpack at ���ϳԹ���podcast, I'm Helen Westmoreland.

LaWanda: And I'm LaWanda Toney. Notes from the Backpack is bringing you something new, you're listening to our first ever mini series, focused entirely on our family's mental health and social, emotional wellbeing.

Helen: So some things are the same. We're both still here, virtually, chatting with experts, bringing you some tips and strategies and information you need to know.

LaWanda: But, one thing that's different is we're releasing all five episodes all at once. So you can listen, however you like feel free to savor them, binge them, whatever you prefer, but however you listen, be sure to leave us a review on Apple podcasts once you're done.

Helen: So, for our first mini series LaWanda, I have to say, I feel like focusing on wellbeing and our healthy minds is super appropriate. How about you?

LaWanda:  Yeah, I agree. A hundred percent.

Helen: It's important that we have these conversations both to address some of the serious mental illnesses our kids and families may be experiencing, but also because we know now more than ever, how important it is to proactively build good skills and supports for mental health.

That's why we are turning to parents to hear more about your experience and to our experts, as always, to give us some great advice.

LaWanda: That's right. Today, we're inviting Dr. Doreen Marshall, the Vice President of Mission Engagement at American Foundation for Suicide Prevention, also known as AFSP, to share her advice.

Dr. Doreen Marshall is a psychologist with nearly 20 years of experience in local and national suicide prevention work. Since joining AFSP in 2014. Dr. Marshall has, expanded their menu of educational programs, and improved their organization's program delivery through a nationwide network of chapters.

Dr. Marshall, thank you for coming. We are excited to have you on the show today.

Doreen Marshall: Thanks for inviting me.

LaWanda: So, let's start off with you telling us a little bit about the American Foundation for Suicide Prevention and the work that you do.

Doreen Marshall: Our work and our mission really, is focused on preventing suicide and bringing hope to those impacted by suicide. We represent people or family members of those who struggle, those who have lost someone to suicide, and those who are currently struggling themselves. We have chapters in all 50 States. So, it's very much community driven work, where we're trying to be responsive to the needs at the community level. We do lots of school-based work in terms of education programs, and also have an advocacy area where we advocate for legislation that advances mental health and suicide prevention efforts. And then finally, we're the largest private funder of suicide prevention research in the United States.

Helen: That's incredible. So thank you so much for being here. I know your organization expertise is around suicide prevention, and I think one of the things that people think of first, when they think about that is depression.

And so, I had the pleasure of talking to a mom named Ana to tell us a little bit about, honestly, some of the heartbreaking story of what her daughter went through, and it continues to go through combating depression. I'd love for you to listen a little bit to what Ana had to share with us and to get some of your thoughts.

Ana: My name is Ana and I am a mom of two daughters here in Maryland. And, I have been the Mental Health Liaison for our high school's ���ϳԹ���for the last two years. In my family, we have some mental health issues throughout. I personally have had some struggles with depression and anxiety as well, but it was really when my youngest daughter became a freshman in high school and she started exhibiting some pretty severe signs of depression and some anxiety that I really was engaged to learn more and figure out how to support her.

Well for her, it was definitely the end of her sports season in the fall, she was brand new freshmen at high school, she was doing really well with school really well with sports. And, when that season ended, she started getting very lethargic and obvious signs of some typical depression. But it's hard too, because teenagers are moody and it's hard to figure out. So, we did talk a few times leading up to the holidays and I asked her if she wanted to see a counselor and she said, yes.

Unfortunately, because it was right around the holidays, it took about a month to get an appointment. And during that time she started self-harming. So, I wish that I had been able to catch it a little sooner and get her in for help a little sooner. By the time she started seeing someone she was already well into the self-harming. So, a couple of months went by of pretty severe issues. And we ended up in the hospital, which sent her to an inpatient hospital for eight days. And, a different kind of journey since then with different counselors and learning DBT and support groups for teens, things like that. So it's been a long journey.

Helen: So Dr. Marshall, I was really struck talking to Ana just about honestly, her and her family is bravery even talking about this, 'cause I think, as parents, we sometimes see issues in our, in our kids, but there is a stigma around mental health. I'm wondering if you could talk a little bit about Ana and her daughter's experience in light of what you know is typical and common in America with teens. How does that story resonate with you, compared to the work you do at AFSP?

Doreen Marshall: Well Helen, Ana's story is so moving and it's so much of what we hear from parents across the United States. They're experiencing this day after day with their children. This is not, unfortunately, uncommon. I'm also a parent of two, and I think the conversations around mental health, most parents, aren't really sure where to start.

They don't know what's typical of their teen or their child, and there's the sense that these are conversations that, we have to have a certain amount of bravery in approaching. YI think that's changing. I do think that people are starting to understand that suicide can be prevented and that mental health plays a huge role and that there are things we can do to get ahead of it,. And so, these conversations I think, are happening much more now than ever, but it really takes, some openness and transparency and a willingness to be vulnerable because these can be scary conversations, for sure.

LaWanda:  I'm sure parents are dealing with this type of thing on different levels and, I'm just curious. What would you say if Ana had to do this over again?

Doreen Marshall: It's a great question. And maybe I should start by saying, as I was listening to her share while my, my heart was going out to her. I was also wanting to applaud her for what she did do.

LaWanda: Absolutely.

Doreen Marshall: I think these are very hard conversations to have. I think getting treatment can be really challenging, and I think most people, when they intervene in a situation where someone's at risk for suicide, have this sense of wondering, am I overreacting to this? And, what we want people to do is actually have the opposite instinct, to tune into, like, if your guts telling you something doesn't feel quite right here to not wait. And so, the thing she did, right, she didn't wait. She understood that her child was going through some transitions. She paid attention to what she was noticing that was not usual or typical of her child.

Those are all really important things, and she didn't wait to reach out to get some professional help. Doing this over, I don't know. I think in all of these situations, you really are kind of doing the best you can with the information you have in the moment. So, if I were to say something more broadly to parents, it would be, don't wait until you're in this situation to learn some things about mental health and suicide and, if you bring your own family histories to this, like many of us do, to know that that also is going to bring some things with it too.

It may bring misinformation. It may bring kind of some raw feelings and to give yourself some space to work through all of that before you actually are in a crisis with your child. But, but I think Ana did a lot of things right. And I think if more parents, you know, would tune into what they're noticing and not be afraid to bring in outside support, I, I think we'd be in such a great, a much better position to address mental health head on.

LaWanda: That's great. Thank you for sharing that. And, I think that that helps so many people to be aware and to not wait and, and even what she talked about when she mentioned that, it's hard to decipher with a teenager because they're moody. Like, so when do you know when to step in? So, it's good that you said stay in alert keep paying attention.

Doreen Marshall: I often talk about mental health and suicide prevention, ultimately as a health issue. If we can remove some of our stigma and our sense of we don't know how to navigate this. If we can put that aside and think of this as a health issue.

If my child was complaining about a sore arm, I might kind of think, okay, is this serious, let's keep an eye on it. But, let's say their sore arm was starting to impact their ability to do things, or let's say they were complaining that it was hurting them nonstop and it was keeping them awake at night I would tune in, you know, that something may be a little more wrong here and need some outside support.

I think with mental health, we don't always do that. Like we notice stuff, but we try and explain it away versus giving it kind of the center of our health, and think about this is a health issue, just like everything else. [RB1] And, just to your point, LaWanda, I do think that these conversations can be hard, but they don't have to be.

And, if we can kind of center ourselves in, we're addressing this, just like we address all other health issues with our children. the things that we're vigilant about with their health, have a lot to do with how those things are impacting their day to day functioning.

Helen: That's great advice. And, I think very well taken that this is it's health, right? Health is health is health.

[Helen: We’re going to take a quick break; Healthy Minds Ad Placement Here]

Helen: I want to go back a little bit to something you, and LaWanda we're chatting around this issue of teenagers and boundaries and understanding those. When I talked to Ana, a lot of her questions for you, Dr. Marshall revolved around some of that. So, I think she knew she felt comfortable taking that first step. Let's hear what she had to say about navigating some of those boundaries about where to be involved and where to step back and get your thoughts on that.

Ana: As a parent, I struggled with how much I should push my child to talk to me even when she was in therapy, because I knew certain things were better, she was more comfortable talking to her therapist than she was me as a parent, obviously. But, I still wanted to know what was going on and I kind of didn't know often. Certain days, certain nights just being here at the house, if I noticed any little thing, I wanted to ask her, but I didn't want to like jump in and intrude or nag her. And, I found myself consulting with the counselor because I didn't know what was the right thing to do, like how much should I push her to talk to me versus how much should I leave her sessions with her therapist, between the two of them and stay out of it.

So, I would love to know from a professional, what their advice would be as how much does a parent push to get their child to talk, versus how much do you put your hands up and say, this is between you and your counselor?

Helen: So what do you think about that question?

Doreen Marshall: Gosh, that's such a great question. To some degree, I think it's more important that your child is talking to someone who can help, rather than it be you as the parent. If my child was engaged with a mental health professional, I would probably worry less about how much they're directly sharing with me.

I think where I get more concerned is when there's not someone who's in a position of help who the child is talking to. So, teens like to talk to one another. It's good that they're talking to other people, but they need to be talking to someone who's in a position to help, if it's not the parents. So, the fact that they have a mental health provider involved here is terrific.

But, I think this kind of question about how much do you push. There's a couple of things I would encourage parents to think about as kind of a rule of thumb here. One to realize this is a process. So, it's more about communication over time. Particularly following a hospitalization or particularly following a big disclosure, that your teen may not want to be open all the time at the level they were in that one moment so, it's more about creating space for that, letting the teen know that what you're going to do as a parent when they tell you stuff. So, it's good for them to know you're not going to freak out. And, if you have a history of kind of reacting very strongly, as all of us do, these are scary things.

I think sometimes that sends them a message that I can only share this when mom or dad are in an okay place, right? And so, figuring out, how to be transparent with your child about what you want them to share. What, if they're not going to share with you, you want them to share with their counselor and under what circumstances the counselor is going to be notifying you as a parent.

I think the second thing I would say is that, if you're worried and you know your child is talking to a counselor, you can always call the counselor and say, let me share a little more of what I'm seeing. As somebody who's a mental health professional, I can tell you those are always welcome calls that I may see your child for an hour a week sometimes less. And, I'm not going to have the picture you have. So, anytime you can also open up communication where you're sharing, what you see that I may not see in an hour session with your child or what the school is reporting, that they're seeing. That helps the mental health professional know what to explore with your child, what to ask more about. And, they often don't have that information, or they may not be getting it willingly from the child.

And then I guess the third thing I would say, These can be such scary times for parents that are our tendency is going to want to be really bit vigilant.

Helen: Yeah.

Doreen Marshall: And you do want to be vigilant, but you don't need to communicate everything about your vigilance to your child either, right? So, it may be that you're just noticing things, making sure you're communicating it to the professionals and others involved comparing notes with the school. But, I also feel like sometimes we want to check point with our child the whole time and that's not always necessary. You know, I think as much as you can keep communication open, great. But, also to know that your instincts as a parent, the things you're seeing also have merit, that you don't always have to check in with your child about whether they're accurate or not. If you're seeing them and you're worried about them, chances are pretty good there's something to be concerned about.

LaWanda: So trust your gut.

Doreen Marshall: Absolutely.

LaWanda: Yeah. Yeah.

Helen: But don't tell your child how much your gut is going into overdrive all the time.

Doreen Marshall: It's a natural instinct that we have, and I have two children and as a psychologist, I'm always worried about their mental health and, so I check in with my kids a lot, probably more than most people. And, my daughter one day looked at me and said, you know, mom, I really am fine. You don't have to ask me as often as you do, whether I'm fine. I really am. And, it was a moment where I realized my asking the question constantly, was actually kind of concerning her. Like, are you seeing something that I'm not experiencing?

So, it is a balance of trying to keep the dialogue and the communication open, but it's also about trusting your gut as a parent. And, knowing that if you're seeing something to check it out with a professional, with the school, with others that are involved in your kid's life.

LaWanda: Yeah, that's great. That's I think that's really great advice.

Can we pivot just a little bit? One of the things that Ana mentioned during her interview with Helen was the resources. So, when she went to find help, it took over a month. And she has a question for you, I'd love for us to play that now.

Ana: I did go to the school in the middle of all of this as well, and they did give me a couple of leads. You know, here are some lists of psychologists or whatever in the area, but number one, I found it incredibly difficult to get any appointments, timely. It seemed like everybody was booked and it took weeks, if not months to get appointments at places. And then, yeah, I felt like I was left dangling to figure things out for myself.

One of the things I would like to know is having the experience that I've had as a parent, going through this myself, what can we do within our community to make it easier for other parents and other students who are struggling figure things out without feeling so alone and feeling like they have support and learning quickly, how to help their child or help themselves through a situation like this?

Doreen Marshall: Yeah, this is so important. What she experienced, I think is typical of how most schools respond, where they may have a resource list or something, but then the work of navigating that and trying to find a provider who has an appointment for some people it's almost like a part-time job, how much they're having to make these calls.

A couple of things I would remember is that, while it may be hard to find the exact right mental health professional for your loved one, your goal early on is to get an assessment to get someone's trained eyes on what's happening with your child and to get some support around that. And, that can happen with a primary care doctor with a pediatrician. So, often parents have established relationships with a pediatrician or other healthcare provider and in the early going, that's a great first step.

I think her question about how can we support people at the community level. Anything you can do to learn about mental health and particularly suicide risk is going to help. Our chapters at AFSP do a lot of programming around this, free community programs. Other organizations like NAMI, National Alliance for Mental Illness, and other groups are doing this kind of programming.

And I think the more parents can get informed and learn, it will also help them on the end of talking with mental health providers about what's needed for their child. So she mentioned, finding a specific therapy, the more you know about what's out there and the more you go into these discussions informed, I think the easier it is when you're at the point where you're having to find someone.

And then of course, If someone has made a suicide attempt, or in her issue, self harm knowing that you can utilize hospital emergency rooms, mobile crisis, other community-based resources that are trained to assess what's happening in the moment.

Helen: When she and I were talking, I was really struck. So, I have a brother who suffers from mental illness and the story of just how much work it is as a family member to navigate that system and figure out support, really resonated with me. And I, I feel like there's also something to be said, you were mentioning some of AFSP's chapters and NAMI of being connected to other folks who've gone through that, because it can feel very lonely. And, sometimes just being in a group of people, people where they're like, yeah, it, it might take you four hours. I can help make those calls, or I know such and such, or we did such and such that informal networking, is such an important source of support.

Doreen Marshall: You're absolutely right that some of our best connections to help come from people who have had to go through what we're going through, right? So, you know, if you think about the other health issues we navigate with our kids, it's knowing a parent who's had to navigate the same thing and find a good provider. It actually can help us to have those conversations. I think what's hard is that. we take this really personally, sometimes as parents, if our children are struggling.

And, if we can just kind of take the perspective that this is a health issue, like a sore arm, ora rash that we want to talk to other parents who may have gone through this. And, some of how we know that is just by saying, Hey, this is what we're going through, has anyone been through this?

You'd be surprised that most times parents aren't talking about this with each other, but lots of parents in our community are navigating mental health issues with their children.

LaWanda: Yep, I love how you said that, that just like we think about our child getting a cold or a rash or something, we should think about the same way and not blame ourselves. So, I think that's the first thing that we go to, I mean, If my, see my son being anxious about something like, did I have, make him anxious about that?

Like, or, you know, what did I do to feed into that? How am I responsible? But, I like how you positioned it, it made me feel a lot better. So, I'm sure some of our audience would definitely resonate with that too. So thank you, Dr. Marshall, that's great.

Helen: So we're getting ready to close out before we do, we want to ask you a little bit, Dr. Marshall, just given, not just this conversation, but all your years of experience working on these issues, is there anything you haven't shared or any sort of misunderstandings you frequently hear from parents, that you want to use this platform to clarify?

Doreen Marshall: I would say to remember that the teen years in particular, are years where kids are trying to figure out who they are separate from their parents And so, it's a time where they're navigating that and it's challenging. We see Just differences in mood states, hormone changes, body changes, all of these things are happening. And, , if I were to say one thing to parents it's to recognize that it's developmentally natural for them to turn to their peers, but it makes it really hard for us in terms of being able to bring attention to their mental health and get help for them.

So, I would say, you know, so, you know, if there were one thing that I would want parents to be mindful of is that particularly in the teen years, that this is a time when, you know, teens are trying to find their identity separate from their parents. And they turn a lot to their peers, which is really kind of normal developmentally. But that, it's also a time I think, for us to broaden our efforts to also think about, you know, the other kids they interact with. So, you know, I often ask my child, who of your friends are you worried about? Because, we know they talk to each other, and so, even if your child right now, isn't struggling with a mental health concern, you can really do a lot of good by, by asking your child, you know, which of your friends are you worried about, who in your friend groups seems to be struggling? Because, they often have a lot more information from their talking to each other, which is completely developmentally appropriate. But, we want to get the adults involved, particularly when there's a significant mental health issue or a suicide risk.

Helen: Thank you so much, Dr. Marshall. I think this was an incredible conversation and it gave our listeners a lot of advice and encouragement, if they're facing any of these challenges. And, I also want to thank Ana for being so vulnerable with her and her family story and giving us a real platform to be able to talk with you. 'Cause, it's so much better to it's really grounded in what's really happening with the family. So, thank you.

Doreen Marshall: Thank you.

Helen: So before we go, we just want to give you a chance to plug any resources or social media handles or websites that you would encourage parents to check out if they want to learn more about you or AFSP?

Doreen Marshall: First, our website, which is afsp.org. We have lots of information about our organization's work, but also about warning signs of suicide and things to look for. There's also a campaign that we worked on with an organization called The Jed Foundation, ad council called Seizetheawkward.org.

which has lots of resources targeted toward teens and college age students., I would just say if your following AFSP on social media. You know, we're, AFSPNational is our social media handle.

And then maybe finally, just to be aware of the crisis resources that exist, that aren't run by our organization, but are run by partner organizations, such as the National Suicide Prevention lifeline number, which is the 1-800-273-TALK or the crisis text line, which is texting the word talk, T A L K to 741741.

LaWanda: Thank you again, Dr. Marshall it was great information and great resources. So, we appreciate your time.

To our audience listening in at home, we want to thank you for joining us as well. For more resources related to today's episode, check out notesfromthebackpack.com. We also want to share with you, National ���ϳԹ���has created a mental health resource webpage for parents, students, and educators. Learn more at pta.org/healthyminds. Thanks for tuning in and see you next time.