In the latest installment of our occasional conversations with Fort Worth leaders, Aliza Hirani, director of behavioral health clinical services at Texas Health Arlington Memorial Hospital, discusses how the COVID-19 pandemic has affected youth mental health. The conversation and audio have been edited for length and clarity. 

Where to get help for suicidal thoughts:

The National Suicide Prevention Lifeline’s number is 1-800-273-8255.

The Crisis Text Line can be reached by texting HOME to 741741.

Alexis Allison: We know that, on Dec. 7, the U.S. Surgeon General issued an advisory about how the pandemic has affected the mental health of young people. Before we jump into the report, can you tell us, what exactly is a surgeon general’s advisory? 

Aliza Hirani: Absolutely. A surgeon general’s advisory is a public statement that calls the attention of the American people to an issue at the time. It provides public health guidelines, recommendations and awareness for the general public.

Allison: And I see that this is a 53-page report. Could you give us a high-level summary of what the report says?

Hirani: The report is addressing not only the background on mental health pre-pandemic, but it’s addressing the mental health concerns during the pandemic. The 53-page report goes over different sectors in our community that can provide support and solutions for making sure we curb and treat this mental health crisis for the adolescent population.

Allison: The report indicated that young people had already been experiencing mental health struggles before the pandemic began. Between 2009 and 2019, for example, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40% and the share creating a suicide plan increased by 44%. So how did the pandemic affect the problem? 

Hirani: The pandemic increased isolation during these times. Many students were experiencing life from the comforts of their home. They were going to school online. They didn’t have their normal support systems. And so the pandemic really took adolescents out of their normal environment and put them into something that was completely new to them. 

If you look at adolescent development in general, adolescents require a lot of support to have healthy development, whether that’s familial support, peer support, spaces to learn and thrive in school. All of those were taken away from adolescents. And so those issues exacerbated existing mental health concerns during the pandemic. 

Allison: For example, in early 2021, emergency department visits in the U.S. for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to the same time period in early 2019.

Can you tell us about how else mental health is measured?

Hirani: Yeah, absolutely. So a lot of mental health is measured through self-assessments provided to adolescents. For anybody, there are general anxiety disorder assessments, there are depression assessments and a lot of those are self reports. 

The way those can happen are in the school systems through counselors, they can happen in your doctor’s office. Other systems of reporting are national surveys and then hospital reports. 

Allison: And what can we do about this problem? 

Hirani: That is such a big question to be able to answer, right? What was interesting about this report is that it summed up six possible actions for us to be able to do as a collective. 

Some of the basic ones are recognizing that mental health is an essential part of overall health. When you have symptoms of the common cold or flu, if you have a sore throat, if you have a stuffy nose, if you have a fever, you go take care of it either through medicine or having a routine visit with your provider. But we don’t do the same with mental health right now. We don’t look at, “Oh, if I, you know, I’m having a decrease in my hygiene, increased hours of sleeping or decreased hours of sleeping, food intake, feelings of helplessness, hopelessness.” We don’t look at that and treat it the same way we would a common cold, but we should. And so I think one thing that we can do is recognize that your mental health is a key component of your overall health. 

We want to empower families and youth to be able to learn how to recognize, manage, and learn from their difficult emotions, right? Whether it’s pre-pandemic, or now, this has become our new reality. And so, it’s really important that we learn how to recognize signs and symptoms, but also be able to self-regulate, and then ask for help and being able to empower families and individuals with those necessary tools. 

Looking at the different sectors, there is media, there’s schools, there’s governments, there’s family, there’s community organizations. There’s 11 different sectors that are addressed in this report and each one of them has a social and moral responsibility to do better for our adolescent population. I think one of the most important parts of this report is, we’re still in that pandemic era, but what this report addresses is, we don’t want to trade one pandemic for another. We don’t want to trade one crisis for another. 

And so we all have an obligation of looking at, what are the different areas and sectors that we could do more in? If we’re looking at schools, can we implement more social and emotional learning in the classroom from early childhood all the way to high school? What does that look like to have social and emotional support through the classrooms? Can we improve on how many counselors each school has? What are funding opportunities that the government can increase for communities and schools? Those are all really important aspects for us to take a look at.

Allison: And if there are families listening or friends of young people who might be struggling with their mental health, can you give us maybe some language to use or a method for approaching young people to ask them how they’re doing?

Hirani: I think one of the most interesting things about this generation is they’re one of the most self-aware generations when it comes to mental health that I’ve ever seen in my profession. One misconception that I think people have is talking about suicide or talking about mental health might implant ideas into their heads. They’re aware of these ideas already happening. We want families to be as direct as possible, especially if you’re noticing any signs and symptoms — your child being withdrawn or your friend being more withdrawn than normal, reaching out and having a conversation of, “Hey, I’m noticing X, Y and Z things. Are you OK?” 

That simple question can do a lot for an adolescent. They want somebody to check in on them, right? We all do. By design we all want attention and support in one way or another. And so it feels good to have somebody ask us, “Are you OK? What do you need? How can I help?” And those are the three basic questions that families should start off with asking. 

And then beyond that, to add a couple of more layers to it, asking, “Do you feel depressed? Are there issues happening? Is there bullying happening at school? Is there something in the home that’s bothering you?” Being comfortable asking those questions and asking your child, “Do you want to go to therapy?” 

I think therapy is one of those tools that is so powerful, but we “otherize” it, and I’m hoping we can really, truly move toward an era where we can normalize therapy. Similar to going to a doctor’s appointment, we don’t shy away of saying, “Oh, I’ve got a doctor’s appointment, I’ve got to leave school or work early.” I would love for families to be able to use that just as comfortably with therapy: “Got to take my child to therapy, got to take myself to therapy.” 

Families being a role model and introducing therapy as a tool that is used that’s courageous and brave to utilize. Because you’re treating yourself — you’re taking care of your health and that should be celebrated and not discouraged.

Allison: If a family wanted to pursue therapy, how would you direct them to get started?

Hirani: Absolutely. That’s a fantastic question. There are multiple ways you can do that. There’s your basic online searches that you can definitely do. But sometimes you don’t know what it is that you or your child might need when it comes to starting off with therapy. There’s a lot of apps out there nowadays that will do online therapy, but my best recommendation is to go to an organization. 

Even in the local area, whether it’s something like Texas Health Resources, that is a hospital that provides free assessments for families, and in that assessment, you have a licensed professional that can listen to what you’re experiencing and then match you with the level of care that’s most appropriate for you and find you a therapist that can address your needs. 

And then there’s other local resources like My Health My Resources. Those are local mental health providers that can also do the exact same — provide assessments and that initial assessment is really important to be able to see what your needs are and how a therapist can meet those needs.

Allison: Thank you. And are there any other local resources that you’d like to highlight or anything else that you’d like to add about this topic?

Hirani: The only thing that I’d like to add about this topic is to not take mental health too lightly. To go from having just a few symptoms to your child possibly experiencing suicidal thoughts or plans — it’s a very fine line, and you never know where your child might be. And so, have those conversations early. Don’t shy away from them. Be a role model for your child and seek services for yourself and try and normalize mental health and therapy. 

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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