February 1^st is known around the world as Time to Talk Day. This is a national day that encourages individuals to have an open dialogue about their mental health and to be supportive of others.

In this DocTalk article, Magellan Healthcare’s Medical Director Dr. Chris Squillaro shares why the act of talking about mental health is so important, the common misconceptions about mental health, and advice on how to approach the conversation for all age groups.

Q: In your opinion, why is it important to talk openly about mental health?

Dr. Chris Squillaro: Open conversation is important to communicate our feelings and emotions.  Without the ability to share the things that we are feeling inside, they can become confusing, which can feel out-of-control and lead to worsening emotions and possibly behavior.  Conversing about mental health also normalizes the subject matter.  The more frequently mental health is openly discussed the more accustomed we become to discuss it within our relationships and as a society.  Lastly, talking about it helps us to realize that we are not alone.  Since mental health and substance use is so prevalent in our culture, every one of us likely has a connection to someone struggling with one or the other.

Conversely, not openly discussing mental health has no benefit.  History has already shown that this only leads to stigma and worsens the potential problems associated with unaddressed mental health conditions.  If we’re not openly discussing it, we’re also not openly seeking solutions when needed.

Q: In 2024, what do you think is the biggest misconception about mental health?

Dr. Squillaro: That mental health issues are resolving as fast as our concerns about COVID.  Even though we are moving away from the day-to-day threat of COVID to us and our loved ones, mental health and the mental health system are far from recovered.  We are seeing consequences both in terms of children and adolescents who lost social connection at critical junctures in their development and are struggling to catch up from the delay.  This not only impacts them but also their family unit and their community.  The increase in alcohol and drug use that occurred during the height of the pandemic was not resolved.  Many of the people who developed addictions are just now starting to seek help and there are many who have not realized that there is a problem.

At the same time there is a greater need as the delivery of mental health services shifted.  Services moved from primarily face-to-face to virtual.  With this came a shift in the workforce.  Many mental health workers sought virtual positions and left critical services that required face-to-face interaction.  This left vacancies that have not been filled.  Every service in every level of care is experiencing staffing shortages.  The misconception is that as society normalizes, the mental health system has normalized and can accommodate the demand.  However, we are not seeing that same level of normalization at a time when it is needed.

Q: How do you think we can create a more supportive and understanding community when it comes to mental health?

Dr. Squillaro: It starts in the home.  Each generation has gotten better at this.  The best way to influence change is to teach our young.  More knowledgeable and understanding parents teach their children acceptance.  These children then begin to make a difference as they interact in the community and in school.  As the members of the generation mature, they create a more compassionate and embracing community.  When children grow up with these concepts that are taught and modeled in the home, their thinking and behavior is more solidified and less likely to be influenced by many of the external influences that continue to be intolerant.  I doubt anyone feels that society will eliminate extreme points of view that preach intolerance.  But the hope is that these extremes get smaller with the majority being a community that is accepting and supportive.

Q: What role can friends, family, or colleagues play in supporting mental well-being, and how can they contribute positively to someone who may have mental health struggles?

Dr. Squillaro: In terms of having tougher conversations and feeling safe to communicate about mental health and mental health struggles, family and friends are critical. They contribute to each other’s lives by caring and having the best of intentions, even when saying things that aren’t always easy to hear or when someone isn’t necessarily ready for help.  Many times, family and friends will be the first to identify when something is wrong and should be the first to speak up.  The most positive thing you can do for someone is to let them know what you’re seeing and that you are a person they can come to for help.  They may not be ready in that moment and they may need additional encouragement, but being there is the hardest and best thing to do.

On the other end, as things begin to improve, they will also likely see it first.  They can encourage and provide that perspective to continue instilling hope.  They can walk the recovery journey with their loved ones and make the connection even stronger.

Q: What advice would you give to someone hesitant to talk about their mental health issues?

Dr. Squillaro: An analogy I use to make this point is that emotions are like water.  Eventually, there is nothing that can hold it back and when it breaks through, it is one of the most transformative and potentially destructive forces on the planet.  Hesitating to talk about mental health doesn’t mean it’s not there.  We’re only able to hold it back for so long before the pressure becomes so great that we no longer control how it comes out and what it destroys.  Talking about mental health is like choosing to release the pressure and having a more constructive say as to how those emotions come out.

Q: Can you share 3-4 ways to begin an open dialogue with someone about your need for support?

• Identify the issue – you don’t need to know exactly what is wrong, only that your emotions are affecting your functioning.
• Identify someone who has historically made you feel safe.
• Take a risk – anxiety is about feeling conflicted. Choosing to move forward despite that feeling is how you begin to change take control of it.
• Gather information – after you’ve taken one risk, a second, third or more becomes easier. In that process, collect what people tell you and find your own path forward.

Q: Are there unique ways to approach a discussion about mental health with an adult versus a child (under 18) or a young adult?

Dr. Squillaro: Pay attention to the language you use.  Whether it’s a child, adolescent, or an adult, they must be able to understand what you’re saying.  Logically, children will need more simple language and concepts.  It’s okay with adolescents to take a more informal approach to how you communicate.  You’re trying to connect with someone who is at a stage where they may not want to rely on authority figures or feel that they know better.  Adults can have a wide range of capabilities.  Trying to match the language they use will put it in terms they can understand.

Be aware of their developmental stage.  Each age group is at a different stage of brain development.  Children will need to be told the answer and will need help developing the solutions.  They are much more open to direction from authority figures.  Adolescents are more impulsive and tend to believe they can easily overcome the issues.  They may also be more comfortable receiving recommendations from peers, so look to engage people within their age group to help reach them.  Adults have more lived experience, and their decision-making is more progressed.  Predicting the consequences in areas of importance to them helps to prepare them engage in help.  No matter what age group, sometimes people need time to process information.

As a person trying to support someone with a mental health issue, patience and consistent messaging are key.  Very few people react immediately.  Continue to support them through their process and reinforce a message of help and hope that will eventually be heard when they are ready.

Q: What tools or resources would you recommend on this topic?

Dr. Squillaro: This may sound simplistic, but doing an online search can bring you to both national organizations and local resources that may be of benefit.  It offers choices about which sites, information, or resources speak to you.  Specifically, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a resource on this: How to Talk About Mental Health | SAMHSA.  Another great organization to seek support is the National Alliance on Mental Illness (NAMI) Resources | NAMI: National Alliance on Mental Illness.  NAMI also has local chapters and can provide support to families as well.

Your insurance provider will also have resources available on their website and may be able to aid in facilitating referrals or tools to help you understand what you’re feeling or start a conversation with someone who needs help.  Along the same lines, the county you live in has mental health resources and is well-versed in the network of providers who can provide the services needed.

Resources

How to Talk About Mental Health from the Substance Abuse and Mental Health Services Administration

Resources from the National Alliance on Mental Illness

Tips for parents and professionals

To be sure, Covid-19 changed a lot of things. One of which was doubling the average amount of screen time for American adolescents[1].

• Pre Pandemic: 3.8 hour per day
• Current: 7.70 hours per day

It is important that parents, teachers, counselors, and others who live and work with children and youth become familiar with the ever-changing digital landscape to provide timely guidance and support. The following information and downloadable tip sheet will give you a good foundation to get started.

Influence and Information

To understand the degree of influence of digital media on children, we must first understand the speed and scope of peer-to-peer information sharing in the digital age. Due to use of algorithms built to share information on a global scale instantly, it is often difficult to immediately curb the spread of misinformation and propaganda on the platforms. Algorithms are digital code built to recognize engaging content and then deliver that content to audiences to generate higher views. The algorithm does not distinguish positive or negative types of viral content. As content can be seen by adolescents and parents or professionals in the same general time frame, this provides the ability to prepare an appropriate response.

What it means to “Go Viral”

When a piece of content becomes widely shared, is referenced in other content, and begins to influence the social structure of its intended audience, the content is considered to have “gone viral.”

To give you an idea of how quickly content can reach worldwide audiences, here are the viral rates for Tiktok:

• > 500 views in the first .25/hr
• > 10k views in the first 4/hr
• > 250k views in the first 24/hr
• > 1 million views in the 48/hr

Empowering Viral Content[2]

Not all viral content is bad. Some viral content empowers adolescents to be the change they wish to see in the world. It’s important to understand that viral content can be positive and widely influential. Positive examples of viral content include:

• Student-led peaceful protests—In the spring of this year, high school students from Boston, Chicago, and other cities across the Northeast organized peaceful walkouts to protest the unsafe in person learning conditions amidst rising regional Covid cases. These students passionately demonstrated for the safety of their teachers and classmates to demand access to virtual learning. This was an excellent example of our youth being the young leaders of tomorrow.
• Neighborhood cleanups—Throughout 2020 lockdowns, a viral trend showcased individuals standing in front of an area with litter and trash visible. Dancing along with a selected audio, the creator would stitch a transition using choreography to a new scene where the area had been cleaned and the garbage bagged. These videos slowly became more dramatic over the summer as creators became more competitive, however the end goal was always environmental cleanup.
• “Show Your Talent” Challenge—The “Show Your Talent” challenge of 2021 featured an original creator issuing a challenge to others to “Show Your Talent”. This video garnered significant positive feedback and resulted in people of all ages showing talents.

Destructive Viral Content[3]

Viral content can also be destructive and damaging, influencing individuals to engage in behaviors that result in the loss of life, property, or safety. Examples include:

• “Silhouette” Challenge—The “Silhouette” challenge involves individuals dancing provocatively, often using a filter to showcase a millisecond long video of the individual either nude or barely clothed, viewed through a lens such a “Heat Filter”. This portrays a lewd image under the guise of it being safe due to the filter. However, these videos can be downloaded and the filter removed through the use of apps, allowing that content to be recirculated showing the real, unfiltered video.
• “Morning-after-pill” Challenge—The “Morning-after-pill” Challenge resulted from adolescents opening the plastic device used for a pregnancy test. Inside this plastic device is a silica tablet, meant to absorb moisture and maintain the validity of the test. Adolescents mistakenly thought this tablet was a free Plan B pill and ingested the tablet. This misinformation spread quickly, resulting in such a negative impact that manufacturers of the pregnancy tests released public statements educating the public about the silica tablets.
• “Devious Lick” Challenge—The “Devious Lick” Challenge started as individuals being dared to lick disgusting surfaces, such as the bottom of a sneaker, a toilet seat, or the bathroom door handle. However, this trend quickly escalated to damage of property, with multiple schools reporting damage. Damage included sinks being torn from walls, toilets broken, mirrors broken, and soap dispensers stolen.
• “Who Want Smoke” Challenge—The “Who Want Smoke” challenge hit our local schools the hardest. In November of 2021, a viral trend began using a specific audio on TikTok referencing gun violence. The image provided is taken from the viral video showing Clarksville students coming around a corner pretending to be holding a firearm aimed at the camera. Over 50 students were suspended for participating in this trend.

These types of viral content provide misinformation which can be harmful or dangerous.

Benefits to Consider

It is critical to practice the language of the digital age on a daily basis. Linguistics is evolving at an unprecedented rate. This may create opportunities to connect with children and adolescents that were not previously available. Other benefits include:

For the Professional:

• Becoming more familiar with ever-changing digital landscape
• Understanding the evolving linguistics of the digital age child
• Faster and stronger rapport building

For the Child/Adolescent:

• Providing opportunity for discussion on current trends and topics
• Creating an environment for authentic growth and self-reflection
• Establishing a sense of trust and safety

Due to using this best practice, Magellan Federal counselors at Fort Campbell were aware of the “Who Want Smoke” trend prior to its arrival to local schools. This allowed the opportunity to have preemptive support for adolescents. Through this support, adolescents were able to have authentic conversations about the trend, its meaning, and how it could impact them.

Sites to Search

To stay on top of digital trends, we recommend actively searching the following media channels:

• Local news source
• Facebook
• Other social media platforms
• Tiktok
• Reddit
• Twitter
• Instagram

Pro Tip: Ask the adolescents where they spend their time online. Populations will differ by region and age group. It never hurts to ask!

Article originally published on MFed Inform. Visit to download free tip sheet.

[1]   Nagata JM, Cortez CA, Cattle CJ, et al. Screen Time Use Among US Adolescents During the COVID-19 Pandemic: Findings From the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatr. 2022;176(1):94–96. doi:10.1001/jamapediatrics.2021.4334

[2]   Alfonseca, Kiara. Jan 14 2022. Students walk out over COVID-19 in-person learning conditions in schools. https://abcnews.go.com/US/students-walk-covid-19-person-learning-conditions-schools/story?id=82265171

[3]   Quinlan, Keely. Nov 23, 2021. Over 50 students suspended for viral TikTok video at West Creek High in Clarksville. https://clarksvillenow.com/local/over-50-students-suspended-for-viral-tiktok-video-at-west-creek-high-in-clarksville/

It was hard enough for kids without social media. Many of our older readers will remember… We compared ourselves to others, but it happened mostly in-person at school or events, or when we consumed one-way media like TV or magazines. While it could be hurtful, we still got a break at home, while riding in a car, or for much of the rest of the day, as we didn’t have smartphones. We became the subject of gossip, but we had the benefit of an imperfect “grapevine” that took longer to spread information, and likely, we didn’t even always hear about it. And we played the popularity contest, but we could never be sure just who were the winners and losers.

We’ll dive into these issues in this post and you can learn more by watching a recording of our webinar, “Addressing the impacts of social media on kids,” here.

Kids’ self-image and social media

Social media makes it easy—and even entertaining—to endlessly scroll through the latest and greatest images of our friends, celebrities, and perfect strangers. We get to see the best of everyone all the time. If any one of our friends isn’t posting their best on any given day, we’re seeing someone else who is posting their best. This can put undue pressure on our kids to attain perfection, as they are developing their self-image and self-esteem.

For kids, and us all, there is tremendous value in limiting the time we spend on social media and understanding that what we see there isn’t usually the full picture. Social media can provide a great sense of connection with others, along with many other positive impacts, but life outside of it can be refreshing and cleansing when we focus on all that we have and want to do.

Social media and cyberbullying

It’s a lot easier to be mean to someone when you’re not doing it to their face. With social media, not only is it easy for a bully to target another child from behind the protection of their screen, but they can do so publicly for classmates and the world to see and weigh in with opinions, or even just a “like,” on the matter. This ruthlessness can be humiliating and overwhelming for the victim, and lead to serious mental health concerns.

As our kids’ gossip and squabbles naturally pervade and have the potential to be broadcasted instantaneously on social media for all to see, let’s talk to them about leaving the negativity off of social media and focusing on positive messages that will ultimately reflect better on us all. If your child is a victim of cyberbullying, find resources at https://www.stopbullying.gov/cyberbullying/prevention and learn more in our webinar on May 11.

Our kids’ popularity, quantified

Our kids’ popularity is now quantified and displayed on social media. They have a number of followers, and every time they post, it’s assigned a number of likes and comments. Is this environment creating additional pressure for our kids to be liked and drive up their social stats at the risk of harming their mental health in the process?

While we can’t make a direct correlation with kids’ use of social media, we know the prevalence of depression among adolescents aged 12–17 has steadily increased–and more than doubled–from 8% in 2010 to 17% in 2020, and that certain demographic groups have been disproportionately affected, including girls, of which the prevalence of depression has increased from 11.9% in 2010 (4.4% among boys) to 25.2% in 2020 (9.2% among boys).[1]

We know our kids are much more than the number of likes they receive on a social media post. It’s important that we talk to our kids about what is really important and build up their self-worth through meaningful activities that stimulate their learning and interests, and help others.

On May 11 Magellan Healthcare hosted a webinar, “Addressing the effects of social media on kids,” for Mental Health Month with former Magellan child psychiatrists, Dr. Keith Brown and Dr. LaShondra Washington, and Senior Director Children’s Healthcare Barbara Dunn, and Creator of Magellan Youth Leaders Inspiring Future Empowerment Greg Dicharry. Watch a recording of the webinar at https://www.magellanhealthcare.com/event/addressing-the-effects-of-social-media-on-kids/.

[1] SAMHSA 2020 National Survey of Drug Use and Health, Youth Mental Health Trend Tables

The COVID-19 pandemic has had a profound affect on everyone, particularly children with emotional health concerns. Many support structures in place prior to the pandemic to help children thrive have disappeared or been changed significantly, resulting in increased pressure on caretakers and overwhelming stress for children. New and innovative solutions are needed to meet these challenges. Magellan Healthcare’s Emotional Health for Kids by Mightier is a clinically proven video game solution that helps children build emotion regulation skills through play and caregivers build emotionally healthy homes.

Developed at Boston Children’s Hospital and Harvard Medical School, Mightier helps children ages 6 to 14 who are struggling with emotional health concerns, such as irritability, aggression, and anger, as well as children diagnosed with oppositional defiant disorder, attention deficit-hyperactivity disorder, autism spectrum disorder (ASD) and general anxiety disorder.

Mightier’s impact on children’s emotional health

In a pilot program, Magellan provided members access to the Mightier program for a period of twelve weeks during the COVID-19 pandemic. Families were recruited and randomized into a group that received Mightier in addition to applied behavior analysis (ABA), or a group that received only ABA as a control.

• Children engaged with Mightier at a high rate. On average, Mightier families played for 30.4 minutes above the 30 minutes per week recommended to see clinical change.
• Clinical symptoms improved. Eighty percent of children with ASD who used Mightier showed an improvement on primary symptoms, compared to only 50% in the control group.
• Children showed twice as much decrease in aggressive behaviors. Adding Mightier to ABA resulted in a reduction in aggressive behavior in children with autism by twice as much compared to ABA alone.
• Families reported a less stressful and more supportive environment. Families using Mightier showed 50% improvement in family stress, 114% improvement in parent confidence, and 114% improvement in access to resources relative to control.

Visit  Magellanhealthcare.com/kids-emotions-mightier/ to learn more about the pilot and how Mightier helps children build self-regulation skills and supports caregivers in building emotionally healthy homes.