Susan (not her real name) is an eighth grader, full of life, energetic, outgoing and joyful. She can light up an entire room with her presence.

Yet underneath this joyous facade lies a teenager battling a crippling illness. In the spring of 2007, Susan lay down on the floor of her school nurse’s office and curled into a fetal position, unable to move. She was rushed to the emergency room and evaluated by a psychiatrist who diagnosed her with obsessive-compulsive disorder (OCD), an illness characterized by “recurrent intense obsessions” and “persistent thoughts, impulses or images that are unwanted and cause marked anxiety.”

As many as one in 200 children and adolescents have OCD; and according to the American Academy of Child Adolescent Psychiatry, between seven and 12 million American youth suffer from mental, behavioral or developmental disorders at any given time. Besides OCD, such disorders include depression, attention deficit hyperactivity disorder (ADHD) and bipolar disorder. Such illnesses can disrupt a student’s thinking, feelings, moods and ability to relate to others and function on a daily basis.

What’s more, according to the PBS “Frontline” documentary, “The Medicated Child,” which aired in January, during the past 10 years there has been a steep rise in the diagnosis and treatment of all childhood mental health illnesses. Given this increase, it’s inevitable that youth workers will encounter students facing these illnesses, something youth workers often are under-trained and ill-equipped to handle.

I know I was when I learned of Susan’s illness. Despite this, I’ve realized youth workers have great potential to impact students facing these illnesses. To do this, we must learn about these diseases, the treatments and the controversy surrounding them.

What’s the Problem?
Much of this controversy involves the diagnosis and treatment of mental health illnesses in children and youth. For example, though bipolar disorder traditionally has been recognized only in adults, since 1996 there has been a 4,000 percent increase in the number of kids diagnosed. According to “Frontline,” this increase is the result of a study by Dr. Joseph Biederman of Massachusetts General Hospital, who theorizes 23 percent of children diagnosed with ADHD also met the criteria for bipolar disorder.

According to Dr. Biederman, rapid mood swings, tantrums and explosive irritability are all symptoms of childhood bipolar disorder. Yet in his interview with “Frontline,” Dr. David Shaffer, Chief of Child Psychiatry at Columbia University, said, “Irritability also occurs in 26 other disorders.” If irritability is a symptom in that many illnesses, how then can childhood bipolar disorder and other mental health illnesses be diagnosed definitively in children and youth?

This controversy is made even worse because there are no definitive tests for diagnosing psychiatric illnesses. As a result, it can take months or even years to untangle a child’s symptoms.

In Susan’s case, her symptoms included obsessive counting, phobias and extreme anxiety. Though she exhibited these symptoms as early as first grade, it was not until after she finished seventh grade that she was diagnosed with OCD. This diagnosis took into account her symptoms, the fact her family history includes OCD, and a psychiatric evaluation.

For Susan, this diagnosis brought with it some relief, as it helped explain many of her behaviors and answer some of her questions including, “Why am I abnormal?” This diagnosis also offered Susan hope from the treatment and medication that was prescribed.

Unfortunately, the first three medications prescribed to Susan failed to alleviate her symptoms and produced severe side effects, including nausea and dizziness. This led doctors to prescribe a fourth medication to Susan—Prozac—which seems to be helping her. “Prozac clears my head,” Susan said. “Now, I can control my actions. I also get better grades because I’m not counting the ceiling tiles anymore.”

As Susan’s case demonstrates, correctly medicating kids with mental health illnesses is complicated. Often, it involves trying several drugs to see which reduces the illness’ symptoms the most while causing the least amount of side effects. Because prescription drugs can take weeks to begin working, this also can be a lengthy ordeal.

What’s the Treatment?
Though prescription medications certainly can help students, prescribing them is controversial. “When we’re dealing with developing brains and minds, medications have a whole different impact than they do in adults; and we don’t understand that impact very well,” said Dr. Marianne Wambolot, Chief of Psychiatry at Denver Children’s Hospital, in her interview with “Frontline.”

More long-term studies are needed to understand better how these medications affect children’s brains. “Too high a percentage of the time we don’t know what we’re doing. We need to study it in kids and get the dosing right and know whether it works in them,” said Dr. Dianne Murphy of the Food and Drug Administration (FDA) in her interview with “Frontline.”

What little research has been done has shown that many drugs that work in adults do not work well, or at all, in kids; and you cannot apply adult data to medications in kids.

Despite this controversy, Susan believes, “If it’s helpful, don’t take kids off their medications. Don’t stop healing kids. Monitor them. If you prescribe meds, you should also prescribe therapies”—advice Susan has taken to heart herself.

Susan has undergone four months of intensive group therapy, as well as family counseling and one-on-one therapy. This therapy has taught Susan how to manage her stress, anger and anxiety, as well as how to do exposures, activities intentionally designed to trigger her OCD in order to reshape her thinking.

For example, the day I interviewed Susan, her hands were intentionally covered with paint, a situation that normally would cause her to wash them repeatedly. Instead, Susan forced herself to leave the paint on her hands in order to expose her behavior and learn how to deal with it effectively.

Therapy and exposures are teaching Susan how to function in her daily life and manage her disease. “I use all the coping skills I learned in therapy every single day,” Susan said.

What’s the Youth Pastor’s Role?
Just as Susan has had to learn how to manage her disease, as her youth pastor, I, too, have had to learn about this disease and how I can best support Susan and her family as they face it. Here are some of the things I’ve learned.

First, in order to support students with mental health illnesses, as well as their families, youth workers must understand these illnesses are real diseases, with real symptoms and real treatments. As Susan’s father, Dan, said, “We make these illnesses worse when we, as a church, say they’re not real.”

Because of the stigmas and shame often associated with mental health illnesses, many people who suffer from them feel alone. As a result, one of the biggest things youth workers can do for students and families who are struggling with mental health illnesses is to help them find community. Connect parents and students with others who are struggling with the same issues. Then give them a safe place to discuss the disease honestly and how it’s affecting various facets of their lives, including their faith.

“I was in such a hell before,” Susan said. “I don’t know why a loving God would let me go through this. Even though I’m strong enough to work through this, I would NOT choose this for myself. I can’t see a purpose in this.”

Never trivialize such feelings from students or their families. Instead, help students understand it’s OK for them to experience any emotion, even doubt and anger; and they can ask you and God anything, even questions like, “Why did God create me like this?” and “Why me? This isn’t fair!”

To help students further process their emotions, encourage them to keep a journal. Promise them you never will read it without their permission, but you’ll be happy to read anything they want to share with you. Such an invitation may spark conversations that otherwise may not have occurred.

Even before you know a student has one of these illnesses, take time to get to know local counselors and therapists. Develop relationships with them so that when the time comes, you confidently can refer families in need. Learn about these illnesses by attending classes at local hospitals or behavioral health centers. Pass on what you learn to other volunteers and students in order to teach them about mental health illnesses and how to care for those who face them.

Be an encourager to parents. “Let me know you’re not in our game but are there for me and that I can call you if I need to,” Dan said.

Also, go out of your way to encourage students suffering from these illnesses. Catch these kids doing something good and praise them appropriately.

Be aware of the symptoms of mental health illnesses and understand how to deal with them. In particular, when it comes to dealing with the mood swings that so often accompany these illnesses, remain calm and give kids space. Constantly reassure the student that she’s OK. “Keep me grounded,” Susan said. “Let me know I’m safe.”

Give students with mental health illnesses clear boundaries. Give them responsibilities and help them understand the consequences of their behavior—even if it’s a symptom of their illness. Doing so will help students take ownership of their illness without allowing it to become their crutch.

At the same time, be willing to make reasonable accommodations for students with mental health illnesses. “Constantly tell us, ‘It’s no problem,'” Susan said. “Otherwise we feel like we can’t go to you.”

Work with parents to determine realistically what a student can and cannot handle, especially regarding retreats and mission trips. During any trip, manage a student’s medications for them and know who to call in a crisis.

Above all, help students understand the truth to which Susan has clung – that her situation is not hopeless. Even though Susan cannot cure this disease, she can manage it; and she can learn to live with it and flourish.

“OCD is really common, and it’s really treatable,” Susan said. “OCD is an illness caused by chemicals in your brain. You cannot cure it, but you can manage it … Giving up didn’t work, so I tried working at it. If you get help, it will get better. I’m armed and ready to work at this. I don’t have an inspiring story, and it’s not traumatic. It’s just my life. This is my battle, and I’ll battle it.”

Through the grace of God, my hope is we, as the body of Christ, can learn how more effectively to stand with and support Susan and others like her in their battles with mental health illnesses.

Suggested Resources:
“Frontline”: http://www.pbs.org/wgbh/pages/frontline/medicatedchild/

American Academy of Child and Adolescent Psychiatry: http://www.aacap.org/

National Alliance on Mental Illness: http://www.nami.org/

National Institute of Mental Health: http://www.nimh.nih.gov/

Bipolar Disorder: http://www.healthline.com/health/bipolar-disorder