What Teens in a Mental Health Crisis Need From Their Parents

Hi, friends. As our kids get older, the mental health challenges can grow right along with them. Mental illness among teens has risen sharply: depression, ADHD, gaming addiction, phone addiction, OCD. For her book Zwischen TikTok und Therapie (“Between TikTok and Therapy: How Teens and Young Adults Overcome Mental Health Crises”), Ulrike Bartholomäus spent a year and a half following 25 teenagers.

These young people let her see deep inside their lives. She had in-depth conversations with their doctors, therapists, and parents. The result is a compassionate, many-layered portrait of people who tell how they got through their crisis, and what made them stronger. Here she shares what she learned.

Ms. Bartholomäus, you’ve been walking alongside teens in mental health crises for 25 years. Which case from the past few years has stayed with you most, and why?

Georg was 13 when he lost his footing completely. He’s a grown man now. He comes from a totally ordinary middle-class family. For seven years he was lost in drug addiction. He fought his problems, his ADHD, his panic attacks, his depression, with weed, pills, and cocaine. He stole, he dealt, he spent time in a psychiatric hospital for detox.

His family stood by him, even though for years there was a lot of incomprehension. On the advice of psychologists, he went to live in a youth group home, where he found a social worker he could confide in about all his frustration and everything he was struggling with. He says she saved him. He did an apprenticeship, which earned him a vocational diploma that qualifies him for college-level study, and for the past few years he’s been enrolled at a university of applied sciences.

He’s incredibly smart, remarkably approachable, and a really interesting person to talk to. It’s astonishing that he found his way out of a situation that seemed completely hopeless, one where almost nobody believed in him anymore. But the social worker, his parents, his siblings, they were there for him. A story like that gives you hope.

How have teens’ problems changed over time?

Childhood has changed dramatically. Free, unsupervised play has largely given way to overscheduled free time and school days that are far too long. But kids’ brains learn much faster through play than through supervised learning. Kids practice their social skills and figure out how the world works by playing.

They find friends and spend time with them, they grow into inwardly strong people, they become resilient. They develop an inner voice that tells them they can handle things, because play builds self-confidence. And it all happens on the side, no class required. At the same time, the stability in families is eroding, for many reasons. Parents separate, both parents work long hours, there’s little time for family, and weekend rituals are missing.

A lot of people are very wrapped up in themselves, parents and teens alike. But togetherness, a sense of belonging, and shared experiences shape kids and teens and make them stronger. On top of that comes social media like TikTok, endless messages to answer, excessive gaming, streaming, and YouTube until their eyes glaze over. TikTok turns teenage brains into ground beef.

What would you tell a teen who can’t stop scrolling TikTok?

That probably describes a lot of them. Some of the young people in their early twenties I interviewed deleted the app in that situation. Most of them realize they can’t limit their time any other way. They also notice that it makes them feel bad. Younger teens, though, are afraid of losing their social connections, because TikTok is how they live and express themselves.

This is where parents come in. According to experts, parents have the legal authority to decide where their kids spend their time, online too. Why do we let this company wreck our teens’ attention, their ability to concentrate, their satisfaction with life?

And what if my child stops eating? Do you work with the parents in that case, too, since it affects the whole family system?

No. That definitely belongs in the hands of doctors. My sister is a pediatrician in private practice, so I know the process for eating disorders from her.

Pediatricians are the first stop on this issue. They can help figure out whether the food avoidance or refusal is just starting, and how parents can get their daughter, and it’s mostly girls, to eat better again. Or whether the disorder is already far along. Girls with eating disorders are masters at hiding it. That’s part of the illness. They have to lie in order to avoid taking in calories. That’s how they described it to me, anyway.

The family is always affected by an eating disorder, and that includes therapy for the girl herself if the family doctor’s guidance isn’t enough. If a girl, say at age 12, isn’t so severely underweight that she has to go to a clinic, parents can still help with a lot of time and patience. Sometimes that takes drastic steps.

A doctor might, for example, advise a parent to take a sabbatical for a few months, to cook fresh food the teen actually likes and to sit at the table with plenty of time for meals. If a child has already become so underweight that her condition poses life-threatening health risks, she’ll be admitted to the hospital anyway.

What would you tell the mom of a boy with ADHD who games all night, doesn’t leave his room on weekends, and approaches school with a “showing up is all that counts” attitude?

It depends on whether it’s really ADHD, and if so, how strong it is and how it shows up. There are huge differences. If it’s pronounced, I’d advise the mom to take her son to a psychiatrist who specializes in ADHD. Getting an accurate diagnosis is important, and it’s not trivial. Not every behavior that looks like ADHD is ADHD. After that, it may mean combining medication with talk therapy. Medication can help kids enormously in school, but not all of them need it.

At the same time, I’d recommend that he get a chance to burn off energy. Kickboxing, soccer, indoor climbing, basketball, sports where he’s allowed to be loud and wild. That’s hard when all he does is game and withdraw. But maybe something exciting still interests him, something that feeds his need for dopamine: a ropes course, the giant roller coaster at the town fair, a go-kart track, a trip to a lake for wakeboarding, a pool with a huge slide. That’s how I’d try to lure him out.

It’s important that he doesn’t always have to be the “good kid.” I’d also recommend cooking real meals and not serving processed food. I’d explain why it’s important to take the pressure off the school discussion for now. For gaming, I’d use an app to limit his playing time. He can only pull all-nighters if he has unlimited Wi-Fi access.

Parents should know that teens can get around parental controls, so the setup has to be absolutely airtight. And then you have to put up with the anger, which is one of the hardest parts. But a few days of bad moods are better than a young man later who can’t find his way out of the gaming trap. The problem won’t go away on its own.

How can a father respond to his teenage daughter, who smokes weed constantly and is sinking into depression? He wonders whether she’s fighting her panic attacks with weed, or whether the joints caused her mental health problems in the first place.

The first question is: Where does the girl get the money to smoke constantly? That costs a few hundred euros a month. There’s nothing wrong with the occasional joint. Parents could relax about that. It’s less harmful than excessive amounts of alcohol. But if it’s constant, the situation is serious. First of all, the father should cut off her money. No cash. Period.

Does she want to buy something to eat after school? She gets a gift card for the bakery. New shoes? Dad goes along and pays, or she picks them out and he buys them online if he can’t come. But picking them out together is important, too, because it’s also about strengthening the relationship. In the life of a girl who smokes constantly, there can be no money lying around the house, no cash gifts, not even from Grandma and Grandpa and so on, no access to money any relative gives her.

That sounds harsh, but someone who smokes constantly usually doesn’t stop on her own. The father should also try to go with her to a counseling center. Many counseling services are easy to access. Caritas, a big Catholic charity in Germany, offers this kind of help in many cities. There is an alternative to smoking weed. An addiction specialist should talk it through with her. The next important question is what’s going on with the depression. In this case it’s a chicken-and-egg problem, and the father should take it very seriously. The addiction specialist can sort that out, too: whether the depression and panic attacks were there before the constant smoking, or only showed up after she’d been smoking so much.

Usually kids don’t talk about this with their parents, but they might with a mentor. That could be an aunt or uncle, a godparent, or a friend of the family. The girl’s age matters, because the earlier someone starts smoking constantly, the more the brain can be damaged, sometimes irreversibly. Dad should read up on this so he understands how much is at stake. It’s about protecting the girl, the way he protects her from other dangers.
Constant weed use can also trigger psychosis and schizophrenia, and that should be brought up carefully, too.

I feel like we can talk much more openly about mental illness today, and yet it seems like teens need more and more help. How does that fit together?

Being open doesn’t make mental health problems disappear. I saw that openness mostly in the teens, much less in the parents. Nothing is more taboo than a mental illness in your own child. There may be exceptions, of course. And kids rarely talk to their parents about their problems, or don’t at all, because they want to spare them.

What does it take for a mentally healthy adolescence? Which factors matter most?

Resilience comes from a child’s own experience, from parental love, from good, reliable relationships, and from learning from an early age to handle their own tasks and clear hurdles. Kids need time to play and time with their parents. The assumption that teens need their parents less isn’t true, in my opinion.

The problems they face are enormous: social problems with friends, first romantic partners, school, their self-confidence. Especially when teens are pulling away, they need something solid to hold on to. When they get into trouble, they should be able to trust that there won’t be a blowup if they ask their parents for help. That trust doesn’t come out of nowhere. It’s built beforehand.

Creating security and a sense of safety is also the parents’ job.