Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Ryan McQueen, M.D., Chief of Behavioral Health and Medical Director for Adolescent Services at Riverside Mental Health & Recovery Center
Below is the transcript from this episode.
Frankye: Hi, Dr. McQueen. How are you?
Dr. McQueen: I'm doing fine, how about you?
Frankye: I'm doing well. I'm really excited to have you join us today. Dr. McQueen is the chief of behavioral health services and medical director for adolescent services at Riverside Behavioral Health Hospital. Dr. McQueen, I want to talk to you little bit about mental health and just first have deeper discussion around adolescents and mental health and all of the things that have really come to the forefront over the last couple of years as it relates to behavioral health and some of the stigmas associated with behavioral health diagnoses. How does that sound?
Dr. McQueen: It sounds good to me.
Frankye: All right. Dr. McQueen, talk to me a little bit about why you decided to pursue a career in psychiatry.
Dr. McQueen: When I went to medical school, that's been a long time ago, but it feels like it was a little while ago. I know when I went to medical school, we had to do, at least at mcv, we had to do, I think it was like nine or 10 or so, rotations in our third year to see which ones we liked. Um, and I kind of settled between either OB gyn and psychiatry. So I decided to go back and do another, um, kind of a short rotation in psychiatry just to see how I liked it and just to be sure that was what I wanted to do. And at that point, absolutely fell in love with it. Worked at their, um, outpatient, well, not outpatient facility, was an inpatient facility for adolescents. And at that point just completely fell in love with it. Um, able to get the information outta kids trying to figure out what it was that, you know, they needed to do to get themselves better, what it was that was making them feel the way that they were and just trying to keep people from harming themselves or taking their own lives. You know, it was just, it was something that was kind of powerful about it. And I decided to go into psychiatry at that point.
Frankye: Okay. Mm-hmm. Um, what is mental health and what does it look like as it relates to adolescence compared to our adult patient population?
Dr. McQueen: Right. So mental health is a person's condition, um, kind of in regards to their psychological and emotional wellbeing, right? In kids, it can look a little bit different, um, because, you know, kids feel like they're going through things that adults or their parents haven't gone through before. So a lot of times, let's say that you and I got depressed and we were didn't want to go to work the next day, we didn't necessarily have to go to work the next day, we could call out, right? A lot of kids, them themselves, if their parents say, no, you know, you can't sit in bed all day, you need to go to school, or you need to go to practice, or you need to get up and do your homework, then they generally have to do that stuff. So a lot of times for kids mental health, um, if there's an issue with it, it'll show up as not only sadness, but it can show up as like irritability, agitation, um, but coming, withdrawn, that kind of a thing.
Frankye: Okay? Mm-hmm. So it, it sounds like people can be very functional, but still be dealing with mental health.
Dr. McQueen: Right. Some people can be, some people can be functional, other people are made to be functional right now, just kind of depending on their surroundings and what's going on around them.
Frankye: Right. I know, I, I have a, um, a young person as well mm-hmm and over the last three years, you know, he, some of the major milestones occurred for him. But the way those milestones looked changed due to the, the pandemic, so things were virtual and I could see him really struggling from the social aspect. Some people need that, um, connection. And I know my, my own personal life, I saw him struggle with depression.
Dr. McQueen: Right here on our inpatient unit, adolescent unit, we saw the same thing. Um, during the height of Covid, I honestly thought that we wouldn't have that many kids come to the hospital, but we actually had quite a few, our numbers really didn't go down that much, if at all. Cause those kids, like you're saying, missing that socialization, um, missing just being in school and being around other people. It was, it was huge. And like you said, in those milestones, missing graduations and things like that, it was huge.
Frankye: Absolutely. Are there some other conditions that are more prevalent to adolescents? I talked a little bit about my son in depression, but are there others that come up, come to mind as it relates to that patient population?
Dr. McQueen: Yeah. A lot of the things that we see in the hospital, and depression of course is big. We see a lot of anxiety, um, in kids. We see panic attacks in kids. We also see what's called adjustment disorder, where there's a stressor that happens and the kid's just not able to adjust to that stressor. So we saw that a lot during covid. We see that a lot now with, um, kids sometimes having their cell phones taken away, or, um, maybe not doing well on a test or an assignment or something like that. So we do see that, um, quite often. And we're also seeing some drug use in the hospital as well. So, um, we have a few kids who have come into the hospital and they're using substances and sometimes either become more depressed because of it, or maybe even they're hearing and seeing things that other people don't see in here cause of drug use.
Frankye: Is there a, uh, family history or association of prevalence with, uh, addiction as well as, uh, mental health disorders?
Dr. McQueen: Yeah, there is. There is. So a lot of times you'll see that there's a family member somewhere, um, that has a mental health issue or a mental health condition similar to what the child has. Sometimes you'll see, you know, mom or dad or sister or brother has depression, so that kid may have depression. Um, grandparents may have alcohol use disorder or maybe a substance use disorder. And we'll see those things trickle down into kids as well. So there is a genetic kind of what's called predisposition towards those issues.
Frankye: Okay. Great. What are some signs and symptoms of mental health issues in adolescence?
Dr. McQueen: So one of the things that you can see is irritability. You can see agitation, pay attention to sleep. If kids aren't sleeping well, sometimes that'll indicate depression, or if they're sleeping too much, that can indicate depression. Um, changes in, um, interest. So if they're not wanting to hang out with friends or don't want to do, or they don't want to do, um, afterschool activities or participate in activities of, kids are talking about guilt, um, changes in energy either increase energy or not enough energy. Sometimes you see changes in attention and concentration, changes in appetite. Sometimes you'll see kids and even adults too, that just feel like they're dragging around more than they usually do. Or if they're talking about their arms, legs or their head feels heavy. Other kids with anxiety disorders, um, sometimes you'll see them, they're talking about feeling shaky or like butterflies in their stomach. Um, heart racing changes in appetite, that kinda thing.
Frankye: Ok. And there's so much focus on body image. Oh yeah. Are you seeing eating disorders?
Dr. McQueen: We do, we see that on occasion. Um, anorexia, bulimia, sometimes just kind of unspecified eating disorder, but we do see that at times just coming through the adolescent unit. Um, those sometimes can be difficult to treat, but medications can be helpful for some, and of course psychotherapy can be helpful for just about everything.
Frankye: We talked a little bit about this early on, but how do you feel covid impacted the mental health and wellbeing of adolescents?
Dr. McQueen: Yeah, I think it was a little bit different. So you can look at it from both sides. So let's say that you had a kid who was in school feeling like they were being bullied often. Um, they had a lot of social anxiety, um, around other kids, or anxiety around test taking or being in school made 'em depressed. Some of those kids throbbed when school closed, um, because of Covid. So you saw that subset that was there. But most kids, like you said, they needed that socialization. School was their outlet. A lot of those kids didn't do as well, um, because they weren't able to be around their friends, they weren't able to talk to their friends. They couldn't go, go over to their friends' houses as an outlet. So, um, it did, it changed, it changed quite a bit. It seems like things are kind of going back to normal, some now, but during covid things were, things were different, you know, for a lot of kids and a lot of adults.
Frankye: Great. That's great feedback. Um, what should a parent do and or adolescent who needs help?
Dr. McQueen: Right. Well, the first thing that you wanna do is that you wanna talk to your kids. Um, always talk to them, try to see what's going on. If your kids aren't talking to you, then one thing that you can do is kind of watch their behaviors, like we were talking about before, if they're isolating more, if you notice that their music that, that they're listening to is music that seems to be more sad, um, then sometimes that'll give you a hint. Um, what parents should do is, of course, is reach out to a mental health professional. Of course, you could always come to Riverside. We can do an evaluation here to see if somebody needs to be admitted or not. And then if they don't, we can give resources to go outside in the, uh, community. Um, can also call, um, any of the hotlines that can help with mental health as well. And of course, somebody else that you can reach out to as a pediatrician or a primary care provider, they can always kind of point you in the right direction.
Frankye: All right. So just to add to something we touched on a little bit earlier, over the coup last couple of years, the stigma around mental health, um, is still exists, and definitely in certain ethnicities, it's more prominent around the stigma associated with, uh, uh, behavioral health. Um, why is this important and what should we do to continue to encourage and support within our communities to overcome this?
McQueen: So I think stigma, like you're saying, is huge. I think one of the things that's helping to overcome the stigma, celebrities, athletes, they're talking about mental health concerns, mental health issues, more in themselves. Um, even if they're not professional athletes, college athletes, um, younger athletes in the high school, people are talking about it more. And that helps to break down that stigma. And once we can get that stigma broken down, then more people will be willing to reach out for help.
Frankye: That is great feedback. Um, having those resources and the work in the community, and you're absolutely right. There's so much, um, our young folks spend so much time on social media. I know my son, when you talked about sleep patterns, I can't get a grasp for a sleep pattern. He stays up all night on social media or games and then he sleeps all day. So that's something that's good information to look for.
Dr. McQueen: Well one, well one family told me that they did is, and they, they tried to set this up early with their kids when they first bought phones, kind of a, I guess, behavioral modification technique every night at about eight or nine o'clock, they had a basket that they set out for cell phones and electronic devices. And at eight o'clock, everybody turned their devices off, including the parents. So they turned their devices off and put them in the basket, and you couldn't get it a again until the next morning at six o'clock. And the parents would take the basket and put it in their room. So that actually helped the kids to sleep more at night. So some of that behavioral modification can help. And something else that can also help too, is instead of taking things away from kids or adolescents, if you take it away in the beginning when they first get it and let them earn time on it, that can be helpful as well.
Dr. McQueen: So that way they don't always have it. And then it seems like a punishment when you take it away. But if you let them earn time on it, it's like, all right, well, you know, throughout the course of the day you did these things, uh, that you were supposed to do, so you earned two hours on your iPad. So now you have that iPad for two hours. At the end of two hours, then you take the iPad away. It's generally not as much of a fight as it would be if you just let 'em have it all the time and then take it way.
Frankye: All right. I have really enjoyed our conversation. Is there anything else that you think, um, you'd like to add as it relates to adolescents and mental health?
Dr. McQueen: Yeah, just always talk to your kids. Um, or if there's somebody else in the family who's willing to talk. Cause I know kids don't always wanna talk to their parents. Sometimes they'll go to a aunt, a cousin, uncle, grandparents, um, sometimes even a family friend, they'll go talk to those folks. So if there's somebody that can, that can talk to your kid or you can talk to them, just be sure that they're doing okay. Ask them. Don't be afraid to ask 'em if they look like they're, they're down or sad. Don't be afraid to ask 'em if they feel like they wanna hurt themselves or take their own life. You're not gonna give them that idea, but you're trying to save their life, so you wanna see what they're thinking so that you can save their life. Um, so I think that's probably the biggest thing. Communication is, is, is the biggest thing. And then if they are talking to another family member or family friend or something like that, you know, not everything that a kid says that that person that they're talking to isn't necessarily always gonna come back and tell the parents. But if there's something where, you know, the kid's life is in danger, um, or something like that, then you know, guardians need to know about that, so.
Frankye: Right. That's, that's, that's good information. You know, sometimes you'll, you'll, and I'll be in conversation and people will say, well, is is, is mental health preventable? Is it a avoidable, what are your thoughts around that?
Dr. McQueen: I think some things are avoidable in mental health. I don't think everything is avoidable. You know, all those, uh, like psychiatric issues, not everything's avoidable. Cause just like we talked about earlier, there's a genetic component. So there might be somebody in the family who has schizophrenia, and because that kid got those genes, we can't always avoid that kid getting schizophrenia. But depression, anxiety, some of those other things that can have a genetic component if you're talking to your kids, not necessarily always allowing them to do what they want to do, cause that's not the right thing to do, but talking to them, um, and supporting your kids through issues that they're going through, if the depression or anxiety shows up, it doesn't have to be as bad as it as it could be, you know?
Frankye: Right. Um, this came up recently. Is all isolation bad? Some people need to isolate to review, refresh, reflect. What are your thoughts about that around?
Dr. McQueen: No, I don't think all isolation is bad. You know, if, if somebody's had a, had a stressful day and they wanna go sit in their room for a couple hours, I think that's okay. I think when you need to be concerned about is when it's happening consistently. And I would say frequently or all the time, you know, so if you've got a child who's coming home and they're going to their room in the evening, and then they don't come out of their room for the whole evening, maybe they're playing video games or something like that, check on 'em and see what's going on. They're talking to friends. But, you know, if they're sitting in there, they're sleeping, they're tearful, they're crying, that kind of a thing, and just isolating more. And it's different from their baseline. It's different from what they normally do. That's what you should be concerned about it
Frankye: And there are certain medications when you look at side effects that can cause depression. Right.
Dr. McQueen: Right.
Frankye: But the, the, the benefit is so important that it outweighs some of the side effects.
Dr. McQueen: Know, right? It can be. I mean, and, and you even see that on TV with some of the medications that they advertise that aren't even for, you know, mental health concerns. Right. Right. They tell you, you know, well if you're feeling more depressed or sad, like you wanna hurt yourself during the commercial, let your doctor know. Right. So happen with any medication. So if you do feel that when you take a medicine, let your doctor know so that it can be changed. And just because one, let's say it is a medication for depression, just because one medication causes that doesn't mean that the other ones will. You know, you and I could both take Lexapro and I feel like I'm more sad when I take Lexapro, stop the Lexapro, which mean a Prozac and then I feel fine. Right. That's usually a pretty rare side effect.
Frankye: Yeah. Very good. I can't think of anything else, but this was very educational for me and I'm a healthcare professional. So I really appreciate your time, your knowledge, and your expertise. Um, and thank you for your commitment and your team. All the great work that your team is doing over at Riverside Behavioral Health Hospital to support. Well, thank you. Our patients and the communities that we serve.
Frankye: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, riversideonline.com.
