Your questions for teen mental health expert Dr. Stan Kutcher

Greetings, great to be here and looking forward to our chats today.

Most children will not develop bipolar disorder if a parent has bipolar. Things to be aware of are: short periods (usually 2 - 3 days or so) of some of the minor symptoms of mania (such as excessive excitability/irritability; sleep difficulties; rapid speech and impulsivity) that are out of the usual or ordinary. Most young people who develop bipolar disorder experience a depressive episode first, so watching for the usual signs of depression is a good idea. Ask your family doctor to help monitor along with you and your child and have your child find out about bipolar disorder so that they can be part of their own self-monitoring.

There has been much made of this issue in the media lately. Frankly, we really do not have very good research on this issue. It seems that in some young people who have an existing mental disorder (such as depression) or who are at higher risk for suicide (for example: had a previous attempt or have a family history of suicide) bullying may be a trigger for suicide or self-harm. One thing that we do not know is this - do sensationalized media stories about bullying and suicide increase the risk for suicide or self-harm in young people who are being bullied? There are a number of things that we know may help reduce suicide rates, such as improving the ability of primary care health providers identify and treat young people who have depression and who have increased risk for suicide.

In my opinion, this needs to begin before post-secondary schooling and really needs to be based in good mental health literacy. This means that young people need to know about mental health and mental disorders, how to identify possible mental disorders and where to get the right kind of help if they have concerns. There are a number of mental health literacy type approaches that can be applied in post-secondary education. One example is the Transitions materials that can be downloaded from: www.teenmentalhealth.org. Training to help student advisers and others who interact with students may also be helpful.

This is a difficult question to answer because it depends on where the studies have been done. One issue that is still not so clear is the relationship between poverty and mental illness. Our best information based understanding is that there is a relationship but that poverty does not cause mental illness. Certainly people who live in low income neighborhoods may have greater difficulty in access to mental health care or other similar factors.

There are a number of factors to consider. Various factors increase the risk for suicide. These include: a family history of suicide; depression in the child (low mood, hopelessness, lack of pleasure, loss of interest in usual activities), a previous suicide attempt. We are also learning that young people who have close friends that have died by suicide or who have tried to die by suicide may be at greater risk.

Good question. There are many myths about youth suicide. Some of these are: teen hormones cause suicide; being a teenager causes suicide; everyday stress of teen life causes suicide. These are not true. What we know is that most teen suicide is related to the presence of a mental disorder - often depression - that has not been diagnosed or effectively treated. One of the factors that seems to be at play in teen suicide is that different to adults (who will often ruminate for a long time about suicide plans), teens may act more impulsively and quickly once they develop a suicide plan.

Difficult question but an important one. Teen years are characterized by greater emotionality - including moodiness. And sometimes the differentiation between usual moodiness and a serious problem such as depression can be difficult. We look for other signs besides moodiness: such as; lack of interest, decreasing grades at school, isolation from friends and family members, etc. If you have a concern about a particular teen then i suggest you share that concern with them and try to have someone who has had training in assessing the mental state of teens (for example: family doctor, school counselor, psychologist, etc) meet with him/her to discuss concerns.

I wish we had a good and simple answer to these very important questions. There is a lack of child and youth mental health care across Canada and it can be particularly problematic in rural areas and in some first nation's communities to access care that is needed. The factors related to suicide may also vary across different communities. One thing that we are trying to do is to integrate mental health literacy (as i described it earlier) into grade 9 and grade 10 school curriculum so that people do not see mental health and mental disorders as something "out there" but develop a good understanding of the issues. But the bottom line is that we need to have good child and youth mental health care available when young people need it. The solutions to these problems are fundamentally political. They depend on how provinces and territories fund, develop and deliver mental health care to young people and families. Improving this takes advocacy - i suggest you check out the "Institute for Families" for some directions on how this may be achieved in your community.

Many thanks for your insights today, Dr. Kutcher. Unfortunately we're out of time for today, but we have received a few questions from teachers who are seeking guidance on how to address the issue of suicide with their students.

I know you've worked on a curriculum for schools - what's a good resource for teachers who would like more information on that curriculum?

Fantastic, thanks again Dr. Kutcher. All the best in your work, and for those seeking to read more about parenting and teen health, The Globe's reporting on those issues can be found here.