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Youth more open about mental health, but barriers remain | Health


Mia Flegal is telling some middle-schoolers about her bouts of anxiety and depression and the toll mental illness can take on children and teens, when a student raises her hand to ask a heartbreaking question:

“What do I do if no one believes me?”

When children are struggling with their mental well-being and mental health, it can look different than in adults — and the distress signals can show up in ways that are subtle or easy to write off.


Flegal, who just finished the 10th grade at Nashua High School North, said she first experienced symptoms of her generalized anxiety disorder when she was about 8 years old. She started having trouble sleeping and began noticing that worrying made it hard to breathe.

“It starts out with this pit in my stomach,” Flegal said. “That pit in your stomach starts to creep its way up to your chest, and it feels like someone is compressing you.”

She remembers waking up in cold sweats when she was 10 on a trip away from home. Ella’s mother, Sheelu Flegal, remembers picking her up early from a slumber party when Mia, usually outgoing and talkative, felt locked in by her anxiety.

Her classmate at Nashua North, Aarika Roy, said she remembers her anxiety starting as stomachaches when she was a fifth-grader.

Erin Murphy, now finishing 11th grade in Windham, recalled when she came home from middle school and found herself shaking, unable to stop crying and hyperventilating.

“It’s hard to tell if this is a growing-up kind of phase, or is this growing into something,” Flegal said.

Even if it’s upsetting to think about elementary and middle-school aged children struggling with anxiety, depression or other mental illnesses, Flegal said, it happens. Being able to talk about bad feelings can help.

“It can’t be a topic that is super hush-hush,” Flegal said.

The pandemic and rolling panic about social media have spotlighted the enormity of the mental health challenges children and teenagers are dealing with today.

According to a survey from the US Centers for Disease Control and Prevention, about one in three high schoolers reported poor mental health during the pandemic. Half said they felt persistently sad or hopeless. (

Generation Z, born between 1997 and 2012, is gaining a reputation for more openness about mental health, but Flegal still isn’t sure her peers are comfortable talking about their mental health in a serious, earnest way.

“A lot of what Gen Z does is making a joke about it. But making a joke about it isn’t the same thing as asking for help,” Flegal said. “If jokes are the first step, that’s fine, but eventually we need to encourage people to reach out for help.”

mia flegal

Mia Flegal at her Nashua home on June 10, 2022. She has struggled with anxiety and is now helping younger students with mental health.

help wanted

More resources are coming online to deal with acute crises, like New Hampshire’s new “rapid response access point” for people who need help in a crisis, and the national crisis line, 988, which will be activated July 16. And the state hopes to open more beds this fall at Hampstead Hospital, for children and teens who need more intensive care.

The state’s community mental health centers can connect people with treatment and make connections to help other aspects of someone’s life.

Rik Cornell, vice president for community relations at the Greater Manchester Community Mental Health Center, said the center has been able to place staffers in almost every city school to work with students and train staff, and is placing similar help at summer programs.

“For so many years, mental health has sat back and waited for people to come to them. That’s not what we’re doing anymore,” Cornell said. “We can’t just keep picking up the pieces. We have to prevent these pieces from falling apart.”

Still, there are barriers to actually getting help.

When Aarika Roy, Flegal’s classmate at Nashua North, had a bad bout of anxiety two years ago, Roy said her family tried calling therapists all over New Hampshire and Massachusetts for the better part of two years, but they were never able to get an appointment with a psychologist.

Cornell said there’s a dire and worsening shortage of psychologists, therapists and all kinds of other health care workers — but he said families with plenty of money have an easier time getting therapy and other mental health care.

Many therapists are reluctant to accept health insurance, because it can be difficult to persuade insurance companies to pay for their services. Cornell said some therapists are accepting new patients — as long as those patients can pay cash.

But Cornell said New Hampshire’s 10 community mental health centers ( can help people who find they can’t access mental health care.

“Give us a call,” Cornell said. “We’ll see what we can do to get you in.”

Coping on their own

Unable to see a therapist, Roy said she found other ways to deal with her anxiety — leaning on her family’s Hindu spirituality and even perusing YouTube for videos about breathing and meditation.

Flegal said she has found ways to cope as well.

She started journaling after bouts of anxiety, working through her thoughts. In the middle of an attack, when she’s stuck in a cycle of hyperventilating and crying, she counts her breaths, or grabs a couple of ice cubes and squeezes them to sort of “shock” her body out of the cycle.

Those coping mechanisms have evolved over the years, Flegal said, but she said having people to talk to — her family, her friends, trusted teachers — helps her stay on top of things.

In the pandemic, though, Flegal said, much of that support network dropped away — an experience shared by many children and adults.

Isolated from friends, with limited chances to interact with teachers as Nashua remained in remote learning for much of the 2020-21 school year, Flegal said she would roll out of bed a few minutes before a Zoom class and sit taciturn in front of her computer with the camera off. When she got out of class, she would get in the shower, turn on music and cry.

“I was stuck in a hole,” she said. “You didn’t see an end to it, and it’s so hard.” She worried about asking for help, worried she would somehow be a burden on her family or increase tensions at home.

But when she did acknowledge those feelings of hopelessness, Flegal said, her family listened, cared and helped.

“Reaching out for help does not make you weaker, and it does not have a negative effect on those around you,” she said.

Feeling less alone

Family members, teachers, coaches — anyone who gets to know a child or teenager well — can keep an eye out for changes in behavior and ask about them, like changes in sleep or hygiene, said Diana Schryver, clinical coordinator of the children’s department at the Greater Manchester Mental Health Center.

Adults can ask questions about the behavior first, gently, and from there open a conversation for a young person to talk about their emotions and mental well-being.

“One of the things we talk about helping people do is to build their noticing skills,” Schryver said. “It might not be a crisis, but it might be a building crisis.”

Murphy, the Windham student, remembers an eighth-grade teacher pulling her aside one day, when she came to school in pajamas and with snarled hair, to ask how she was doing. That conversation gave Murphy the space to admit for the first time that she wasn’t doing well.

“He asked me are you OK, and the answer was no,” Murphy said.

She’s grateful that teacher made the effort to check.

Feeling safe to talk about feelings — especially difficult feelings — is important even for younger children. Flegal said she has been working with community groups to develop programs where she can speak to younger people, talking about her mental health history and trying to help other children feel comfortable talking about their own feelings.

Flegal said she’s open about her difficulty with mental health because she wants other people — especially younger children — to see it’s safe to talk about their mental health. To that girl who asked what to do if no one believed her about struggling with mental health, Flegal said to keep talking.

Schryver said the same thing.

“To that young person I would say, don’t stop talking. Don’t stop asking for help, until you feel like you’re getting the help that you need.”




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