Youth Voices on Pediatric Mental Health

According to the 2023 Healthy Kids Colorado Survey, 28% of students reported experiencing poor mental health for most of the past 30 days. Youth who are associated with marginalized groups, including transgender, lesbian, gay and bisexual students, are nearly four times more likely to attempt suicide than their straight, cisgender peers. Two youth consultants with the Children’s Hospital Colorado Pediatric Mental Health Institute, Suyash and Annika, share their perspective on this challenging issue and get input from Children’s Colorado providers. 

Given the ongoing mental health crisis in the U.S., it's crucial to assess whether current practices genuinely support and include youth from diverse backgrounds in building resiliency. In a landscape where 80% of pediatricians have had a patient attempt or die by suicide, we have to take the time and ask what young people (like the youth writing this article!) are saying about their experiences with primary care providers and what are some strategies providers can implement based on their feedback. 

Recommendations for primary care providers from youth 

When we started researching this topic, we connected with young people associated with the Youth Council on Mental Health for their perspective on reaching out to their primary care provider about mental health. Reviewing these responses revealed a critical misalignment since most respondents shared that they see their pediatricians as a point of escalation rather than an accessible support resource. One youth shared that when primary care providers aren't speaking directly to the patients, they miss an opportunity to establish a trusting interpersonal connection. These perspectives shed light on the reality that although Children’s Colorado has declared a state of emergency for youth mental health and adopted the Zero Suicide framework, many young people still don’t view primary care providers as trusted sources for mental health support. 

Some additional actions that youth would love to see their providers add to their clinical practice include: 

• Lead with empathy 
• Validate emotions 
• Be authentic  
• Follow-up with patients  
• Be aware of your body language and paraverbals 
• Keep in mind that many young people have increasing concerns about data privacy that could impact screenings 
• Remember that every person is different  

As a provider, you may ask how you can develop this level of mutual connection with your patient population? The answer is reenvisioning how we approach risk assessments today. While current practices often have primary care physicians administer screeners and ask clinical questions, there is room to improve how we set the stage for those conversations along with encouraging deeper reflection and evaluation of personal protective factors. This includes offering more context around confidentiality and asking about a young person's life, family dynamics, school experiences and how those factors might connect to deeper questions about identity. 

Questions to consider asking when trying to get to know your patient better:  

• What is going well?  
• Who are the people that you feel connected with?  
• Where do you feel understood? 
• Where are you getting information from to make informed and healthy decisions? 
• What makes you feel good

Recommendations from Children’s Colorado healthcare providers 

We also spoke to two providers at Children’s Colorado who are excellent examples of working to build trust and empathy with their patients: Natalie Finn, MD, and Brian Pitts, MD. One suggestion from Dr. Finn is to create a welcoming and inclusive culture for LGBTQIA+ youth and youth from different cultural backgrounds, such as placing visuals on your badge, on your intake paperwork, and even displaying culturally relevant magazine articles or pride flags in the clinical space.  

Both providers emphasized the importance of routine screenings with a focus on empathy. According to Dr. Pitts, "Rigidity is not always your best friend." Rather, gaining a complete holistic understanding of the young patient, which focuses on understanding factors in their lives that affect both their physical and mental well-being, was clearly echoed in both interviews. Dr. Finn explains that “we want to normalize that [holistic understanding] as a part of practice. We want to know who you are and that then gives us an opportunity to consider how else we can support you or if you need support.”  Dr. Pitts also noted the importance of constructive and frequent follow-up communication, something that really resonated with the young people we surveyed. Whether they are small, casual interactions or additional in-person appointments, taking the time to establish a pipeline for communication is very beneficial, especially in times when a crisis situation does materialize for a patient. It can be easy to assume this work is just the concern of therapists or psychiatrists, but being a person who reliably checks in with your adolescent patients can even help set more practical long-term goals with them. 

Having an impact on youth mental health 

As a pediatrician, you have the opportunity to shape how young people feel about their care. Even small, thoughtful changes can make a big impact. Making your practice more welcoming, taking time for honest conversations and building trust can help young people feel safe and understood. Addressing or talking about suicide can be difficult for both the providers and patients, so we urge you to approach these moments with authenticity, empathy and openness, treating each patient as an individual. We encourage you to look into integrating even just one of the suggestions above to adequately support the youth you serve by improving their mental health and lowering the chances of suicide.