How to talk to your teenager about mental health

“I think I have anxiety.”

The sentence comes in the car, somewhere between school and training, while you are both looking ahead at the road. Your fifteen-year-old says it in passing, almost as if she were telling you she had forgotten her PE kit. The parent at the wheel feels something tighten in the chest, and in half a second five answers flash through their head: “Where did you get that from?”, “You saw that on TikTok”, “We all got nervous at your age”, “We’re going to the doctor straight away” and “What did I do wrong?”. They say none of them. Or they say the first one that comes — and their daughter puts her headphones on.

Conversations with a teenager about mental health almost never happen when you plan them. They happen in the car, by the dishwasher, at eleven at night in the bathroom doorway. And it almost always feels as if everything depends on your first response. That is not quite true. But the first response does tell a teenager something important: whether it is safe to bring what they are carrying to you.

This piece is for parents. It is not about how to recognise depression or anxiety — I wrote about that in Teenage depression: telling it apart from ordinary mood swings. It is about how to talk about mental health at all: before things get bad, when they come to you with a self-diagnosis from the internet, when they mention a friend, and when you have to ask the question you dread.

Why this conversation is harder than it should be

Adolescence is the period when mental health problems often begin. A large American epidemiological study led by Ronald Kessler and colleagues found that half of all mental disorders a person will experience in their lifetime begin by the age of 14, and three quarters by the mid-twenties. That does not mean every bad week is the start of a disorder. It does mean that the years when your child is pulling away from you the most are also the years when they could most use your attention.

Why don’t young people talk about it? The Australian researchers Amelia Gulliver, Kathleen Griffiths and Helen Christensen reviewed studies on what stops young people from seeking help. The most common reasons were shame and fear of what others would think, difficulty recognising their own symptoms, and a strong wish to cope on their own. What helped, on the other hand, was above all one thing: a relationship with an adult they trust, and the experience of having been listened to before.

That is the heart of it. A teenager won’t come to you in distress because you once explained that they can always come. They will come if they have experienced a hundred times that smaller things did not cause a flood with you. Research by Margaret Kerr and Håkan Stattin showed that parents know most about their teenagers’ lives not because of supervision or questioning, but because teenagers tell them. And they tell the people with whom telling pays off.

Not one big conversation, but a hundred small ones

Many parents wait for the right moment for “a serious talk about mental health”. That moment rarely comes, and when it does, it often feels like an interrogation to a teenager. Far more is done by small, everyday conversations in which how you feel can be talked about as normally as the weather.

• Talk about feelings when there is no crisis. “I’ve been irritable all day — I think I’m worried about that meeting.” This shows that adults have an inner life too, and that it can be put into words.
• Comment on stories that aren’t about them. A series, a news item, a song. “Why do you think that character is so closed off?” Talking about a third person is safer, and often opens the door to talking about themselves.
• Use the words without drama. Anxiety, sadness, emptiness, anger — if they hear these as ordinary words at home, they will find it easier to use them about themselves.
• Don’t demand an immediate answer. Teenagers often answer a question two days later, when nobody is expecting it any more.

Some background on mental health in the teenage years is also in the knowledge base under adolescence.

Where and when: side by side, not face to face

It is no accident that teenagers open up in the car. When you sit next to each other and look ahead, there is no continuous eye contact, no sense of being studied, and there is a clear end — when you arrive, the conversation can stop. The same goes for walking the dog, cooking, putting together furniture or cycling.

A face-to-face conversation at the table, opened with your “We need to talk”, tells a teenager that something is wrong and that they are the thing that is wrong. In most of them, defences go up at that very moment. A side-by-side conversation leaves them room to withdraw, and that is exactly why they often stay.

Timing matters too. The teenage rhythm is shifted; sleepiness comes later than it does for adults. Teenagers are often most talkative late in the evening, when their parents are already tired. If you can, stay up ten more minutes. Those doorway conversations are often the most honest ones.

When they arrive with a self-diagnosis from the internet

“I’ve got ADHD.” “I think I’m depressed.” “There was a video about anxiety on TikTok and that’s totally me.” Many parents roll their eyes at sentences like these. Social media really is full of simplified symptom lists in which almost anyone can recognise themselves. But if you dismiss the self-diagnosis in one sentence, you also dismiss what lies beneath it: your teenager has just told you that something isn’t easy for them, and that they have found a word to say it with.

It helps to take the word as an attempt at description, not as a diagnosis the two of you now have to debate. Neither confirm it nor contest it. Ask what it means to them:

• “What in that video feels most like you?”
• “When did you last feel that?”
• “What does it look like from the inside — what happens in your body, in your head?”

The answers will tell you much more than the label. Maybe it is nerves before being tested in class, which are understandable and manageable. Maybe it is something that has lasted for months and is getting in the way of her sleep, eating and friendships — then it is time for a professional assessment. A diagnosis should be made by a doctor or specialist, not by you and not by a video. Your job is to hear how your child is doing and to judge whether they need more than you can give them at home. A short explanation of what anxiety is and how it differs from ordinary worry is in the knowledge base under anxiety.

What to say and what not to

There are no magic sentences. There are, however, responses that open a conversation and ones that close it. In their book on talking with teenagers, Adele Faber and Elaine Mazlish set out a simple principle that I see again and again in practice: a teenager whose feelings are acknowledged is far more willing to listen than a teenager who is being told why they shouldn’t feel what they feel.

Here is how it might sound (a composite, not a real person):

“I don’t know what’s wrong with me. I’m tired all the time, and I’m not even doing anything.”
“Tired even though you’re not doing anything. That sounds rotten.”
“Yeah. And then I feel lazy on top of it.”
“As if you’re tired and to blame for it too.”
“Yeah… And school isn’t going well either.”
“Do you want to tell me how it’s not going? Or shall I just sit here for a bit?”

In this conversation the parent doesn’t advise, doesn’t reassure and doesn’t ask “why”. They reflect back what they heard and offer a choice. That is exactly why their son tells them the next piece. Responses like these don’t mean you agree with everything or that you will never set a limit. They mean you listen first and act afterwards.

Sentences that often close the door:

• “But you’ve got no reason to feel like that.” Distress doesn’t need a reason an adult would accept as big enough.
• “You’re on your phone too much.” That may be true, but in that moment the teenager hears that it is their own fault.
• “We’ve already talked about this.” Repetition is common with distress, because the distress hasn’t gone.
• “Don’t say that in front of your grandmother.” The teenager learns that their inner life is something shameful.

If one of these slips out — and one will — you can repair it. “Yesterday I said you had no reason. That wasn’t fair. I still want to know how you’re doing.” A repair is sometimes worth more than a perfect first response.

The question parents fear most

If you notice that your teenager has shut down, talks about hopelessness, is saying goodbye, giving things away, or has wounds they are hiding, you will wonder whether they are thinking of harming themselves. Many parents don’t ask, because they are afraid that asking will plant the idea.

Research does not support this fear. A review by Teresa Dazzi and colleagues brought together studies in which people, adolescents included, were asked directly about suicidal thoughts. Asking did not increase such thoughts; for some, it even reduced them, because they could finally tell someone. So ask clearly and calmly:

“Sometimes when people feel really bad, they think they don’t want to be alive any more. Have you ever thought anything like that?”

If they say yes, don’t panic and don’t promise to keep it to yourself. Thank them for telling you, stay with them and find help the same day. If they have a plan or are in immediate danger, call 112 or take them to A&E. In Slovenia, for a conversation, there is the Klic v duševni stiski helpline on 01 520 99 00 (daily from 7 pm to 7 am) and the Samaritan helpline on 116 123 (24 hours a day), and for children and young people the TOM helpline on 116 111. I have written more about how to respond to hidden wounds in Self-harm: what it really means and how to respond, and there is a short explanation under self-harm in the knowledge base. Suicidal thoughts from the perspective of the person who has them are the subject of When you think it would be better if you weren’t here.

When they talk about a friend

“A girl in my class cuts herself.” “My friend says he can’t see the point.” Teenagers often open a subject for the first time through someone else. Sometimes they really are talking about a friend. Sometimes they are checking how you will react before they tell you about themselves. Both need to be taken seriously.

If they are talking about a friend, first ask how it is for them. Being the confidant of someone in distress is a heavy burden for a fifteen-year-old. They have often promised their friend not to tell anyone, and now they are carrying a secret that is too heavy for them. Help them distinguish two kinds of secrets: the ones it is right to keep, and the ones that have to be told to an adult because safety is at stake. Tell them that they are not betraying their friend, but protecting them.

Then decide together whom to tell — the friend’s parents, the school counselling service or the form teacher. And don’t forget to come back to the question that was left open: “And what about you? Do you ever feel like that?”

Your own mental health is part of the conversation

Teenagers don’t learn only from what you tell them. They learn from how you deal with your own hard days. If the rule at home is that distress isn’t talked about, that adults “cope”, and that seeing a psychologist is shameful, they will learn that too — even if you tell them a hundred times that they can come to you.

This doesn’t mean you have to tell your teenager everything that weighs on you. It means you can show them, in a way suited to them, that you have bad patches too and that you look after yourself through them: “This month has been hard for me, so I’m seeing the doctor”, or “I’m going for a walk to calm down before we talk.” In his book on the teenage brain, Daniel Siegel describes how an adolescent who is around an adult able to regulate their own emotional reactions gradually learns to do the same.

If the distress is yours and it is serious, though, look after yourself separately — not through your child. A teenager cannot be the confidant of a parent who is falling apart without paying for it themselves. I wrote about what children need when a parent is depressed in When a parent is depressed: what children need.

An exercise: ten minutes side by side

This exercise is for the parent, not the teenager. You can do it this week, whether or not you have noticed any distress.

1. Choose a side-by-side activity. A drive, a walk, cooking, clearing out the garage. Something you do together without looking at each other.
2. Open with an observation about yourself, not about them. “I’ve been pretty tired this week.” Don’t immediately ask how they are.
3. If they say something, repeat the gist in your own words. No advice, no “but”. Just: “So that made you angry.”
4. Count to five before you speak. Teenagers often carry on only in the silence that adults can’t bear.
5. End without a task. “Thanks for telling me.” Don’t add what they should do now. If something needs doing, come back to it another time, once you have thought it over.

If your teenager says nothing, the exercise hasn’t failed. It has shown them that with you there is a space without interrogation. That is an investment that pays off later.

When talking isn’t enough — and where to find help

Everything I have written here has limits, and it is only fair to name them.

Talking does not replace professional help. If the distress has lasted for weeks, if your teenager is withdrawing from friends, not sleeping, not eating, their grades are dropping or they talk about hopelessness, good communication at home is not enough. Then the first step is your family doctor or paediatrician, who can refer you on, and the school counselling service. Therapists who work with children and adolescents can also help. I have described how to judge when it is time for this step in When to take a teenager to a therapist: signs, routes and what if they refuse.

They don’t have to open up to you, specifically. Many teenagers would rather talk about their distress with an aunt, a coach, a teacher or a counsellor. That is not a failure on the parents’ part, but part of growing up. What matters is that they have someone. A teenager can also turn on their own, anonymously, to the TOM helpline on 116 111 in Slovenia, which is there for children and young people.

Sometimes the difficulty lies in relationships at home. If conversations always end in an argument or silence, if home is tense because of a divorce, an illness or conflict between the adults, then advice on how to talk is not enough. That is where family therapy can help, opening the conversation in a space that is neither yours nor theirs. I have described how this works in When a teenager goes quiet: how family therapy opens the conversation.

In an emergency, don’t wait for the right moment. Suicidal thoughts with a plan, self-harm with a serious wound, confusion or dangerous behaviour are reasons to call 112 straight away or go to A&E.

As a therapist in training under supervision in marriage and family therapy, I work with parents, couples and families. When a teenager is in distress, my role is to help parents understand what is happening in the family and where the conversation has got stuck — not to replace the doctor or the therapist who works with the young person themselves. I also work with English-speaking families in Ljubljana.

What to remember

• Half of all mental disorders begin by the age of 14 — conversations about mental health belong in adolescence, not only in a crisis.
• Teenagers tell the person with whom they have experienced a hundred times that smaller things didn’t cause a flood.
• Side-by-side conversations — in the car, on a walk, while cooking — are often more open than face-to-face ones.
• Take a self-diagnosis from the internet as an attempt at description: ask what it means to them, and leave the diagnosis to a professional.
• Asking about suicidal thoughts does not plant them. Ask clearly, stay with them, and find help the same day.