Illustration by Jon Krause

With the nation in the throes of a teen mental health crisis, our region is stepping up its response with an expanded array of treatment options.

Lynn’s safe place is a woodsy trail in a Chester County park near her home. It was there that she had a crucial discussion with her daughter’s therapist. “It’s my hard conversation spot,” she says. Elizabeth has been a challenging child. Now a sophomore in high school, she was a student at Malvern’s Fusion Academy, which specializes in supportive individualized learning, offering unique daily scheduling. Administrators promised a soft landing upon her return to public school. “In my mind, no landing’s soft enough,” her mom says.

This past March, Elizabeth completed an intensive outpatient program with Embark Behavioral Health, a treatment center in Berwyn. After multiple levels of intervention, she began turning her troubled teen life around. “Elizabeth is still so fragile,” says her mom. “She wanted to transition back to public school, but there would have to be some nonnegotiables—seeing a tutor, a school mental health clinician and a weekly private therapist.”

Teen depression is among the nation’s most pressing post-pandemic problems. In a recent Centers for Disease Control and Prevention study, more than four in 10 high schoolers reported feeling “persistent feelings of sadness or hopelessness.” The suicide rate for ages 10–24, stable from 2000 to 2007, jumped nearly 60 percent in 2018—and that was before COVID-19.

U.S. Surgeon General Vivek Murthy has declared a teen mental health crisis in our country, ramping up funding to meet the need. Last year’s $45 billion-plus Pennsylvania budget set aside $100 million for school-based mental health services in its almost $8 billion state education allocation. Before the school year started, the Biden administration announced nearly $85 million in federal and grant-funded help, all of it earmarked for youth mental health awareness, training and treatment.

More than 50 million Americans are affected by mental illness. One in five adults and one in six youth experience a mental health condition each year. Even more concerning are treatment rates. Less than half of those adults and only 50% of their younger counterparts receive care. The crisis was big enough to capture award-winning documentarian Ken Burns’ attention. Hiding in Plain Sight: Youth Mental Illness, his two-part series, debuted this past June.

The pandemic made it worse for active teenagers by limiting real-time learning and social contact. Yet it was also a perfect recipe for anxious and depressed kids, forcing disengagement. “A lot of adolescents only engage in school because of their relationships with friends, teachers, coaches and mentors,” says Laurence Steinberg, a renowned expert on adolescence and the Laura H. Carnell professor of psychology and neuroscience at Temple University. “School provides the glue—the structure—to hold kids’ lives together.”

“Some [school districts] are more responsive than others, but they’re going to keep it in-house. Let’s face it—if it’s made public that five kids died there last year, are you going to want to live there?”
—Embark Behavioral Health’s Regan Sarmento

Many see social media as at least partly to blame for the crisis. Steinberg, however, says research is inconclusive. No doubt young people are adversely affected, he notes, but studies have shown that a higher proportion of them say social media makes them feel better rather than worse. “Exaggeration about the role of social media causes an epidemic in itself,” says Steinberg. “I’ve been studying adolescent development for 45 years, and I don’t see it in the evidence.”

Many experts agree that modern helicopter parenting isn’t helping adolescents learn to cope with stress, hardship and failure. That leaves adults wondering when to intercede and when to promote independence. “There’s certainly no shortage of issues to feel depressed about today,” says Steinberg. “We tend to think young people are oblivious. Not at all.”

Elizabeth was just 2 when her parents discovered she had severe ADHD. On the playground, she’d climb the swing set instead of taking a seat. “It was her M.O.,” her mother says. “She was a crazy monkey, a freakin’ Tasmanian devil—God love her.”

By fourth grade, inner frustration escalated to verbal and physical aggression—and medication. Elizabeth was diagnosed as a special learner, and the family pulled her from the local parochial school. She was assigned her first individualized education program, or IEP. By sixth grade, she’d also been medically diagnosed with Crohn’s disease. By seventh grade, it was clear that she wasn’t maturing like her friends, making it consistently difficult to meet societal expectations. Elizabeth felt like a failure. That generated more anxiety, self-loathing and a deepening depression.

In middle school, Elizabeth saw three private therapists, which only reinforced her distrust of the process. “She’d say, ‘Nobody can help me—I can’t be helped—and this thing is never going away,’” Lynn recalls.

A fourth therapist wanted Elizabeth’s parents to raise her like they were raised—as good soldiers. “But she was a spitfire,” says Lynn. “She was always an eccentric, headstrong kid. She wouldn’t talk at in-person sessions. She’d turn her chair and back to her therapist, or she’d push back and launch f-bombs. They brought in therapy dogs.”

The family tried a mental health professional at school. “She’d tell me, ‘Elizabeth just sits there and stares at me,’” Lynn recalls. “She learned that if she didn’t say anything, these people go away.”

Theresa Agostinelli has preached resilience and faith for 20 years. A life coach, licensed clinical psychotherapist and motivational speaker, the Glen Mills resident is also the author of The GRID System: Creating More of What’s Good in Your Life, which offers her personal story and philosophy as a recipe for overcoming mental health challenges. Agostinelli works with everyone from first responders to real estate agents to salon owners. She’s also been more involved in schools. This past January, she paid a visit to Williamson College of the Trades in Media. “A lot of kids are suffering in silence,” she says. “Kids are extremely confused, anxious and vulnerable.”

But kids are also resilient, provided they’re surrounded by the right people and have access to the right tools. “Parents need to ask the hard questions,” says Agostinelli, who also teaches in Immaculata University’s psychology department. “Your kid might not answer right away, but eventually, he’ll soften.”

Unionville-based life coach Chip Miller concurs. “People live in their heads, so mental health becomes a function of what you’re believing,” he says.

Miller works with kids and adults, including teachers in the Unionville-Chadds Ford School District. His youngest client is 9 years old, “If you want to know when a kid starts living in his head, it’s at 9,” Miller says. “Kids live with the resentments of the life their parents create for them—one that’s often not fulfilling. Anyone who has trouble with their kids, I always ask, ‘Are you getting them tired every day?’ Until then, they’re part of the problem.”

Money doesn’t insulate anyone from stress, but the mental health stigma isn’t as shameful in affluent communities, where it’s no big deal to say your child sees a therapist. “Yet some of those same parents think taking 15 minutes out of the day to meditate won’t help their child get into Yale,” says Steinberg.

Not surprisingly, the Main Line region has a surplus of mental health resources, advocacy and intervention. One of about 600 affiliates of the National Alliance on Mental Illness, NAMI Main Line PA is a volunteer organization in Merion Station offering cost-free information and support to those with mental illness. Services include workshops and forums, weekly and monthly support groups, a newsletter, and advocacy alerts. Known for its eight-week Family-to-Family educational program, NAMI started nationally in 1979, thanks to the efforts of organizers on the Main Line. NAMI representatives agree that the pandemic has exacerbated the issues, and that the demand for services is enormous. Last year at a Havertown event, people waited in line to talk to NAMI reps, many of the inquiries centering on what they have available for adolescents and kids.

NAMI frequently hands out literature on Embark Behavorial Health, which offers services and support to youth ages 12–17. Partial hospitalization and an intensive outpatient programs are available. Embark is an out-of-network provider, so insurance isn’t typically an option. “Today, if Susie says she’s going to jump off a roof tonight, the insurance company says, ‘Let’s see if she actually does it,’” says Regan Sarmento, Embark’s director of professional relations for the Philadelphia metro area. “Without treatment, the end result could be the same—death. And the goal is for everyone to come back tomorrow.”

NAMI’s outreach has been more successful at colleges than at private and public schools. When contacted multiple times, administrators in Lower Merion, Radnor and Tredyffrin-Easttown school districts didn’t respond to requests for interviews—though the latter did host a March 2022 Zoom call for parents to discuss how the pandemic may have impacted their children’s mental health.

Sarmento applauds West Chester and Downingtown schools. Both districts employ teams of professionals charged with easing students back into the classroom after treatment. Downingtown calls them prevention specialists, and there are some 13 of them district-wide. “Some [school districts] are more responsive than others, but they’re going to keep it in-house,” says Sarmento, a parent of two who lives in Chester Springs. “Let’s face it—if it’s made public that five kids died there last year, are you going to want to live there?”

In her first go at public school, Elizabeth took five days to complete a test. She’d just sit and stare. After a 10th call from school during her eighth-grade year, a guidance counselor suggested Embark. By then, Elizabeth was cutting herself—something her mom says her daughter learned about in health class. “We decided Elizabeth needed more help than weekly therapy sessions,” Lynn says.

The family’s insurance provider wasn’t willing to pay for residential treatment, so Elizabeth went on a wait list for an intensive outpatient program at Embark. It took six weeks for a spot to open. By then, it was summer. Her intensive outpatient program was three hours a night and four days a week, with one weekly family night. Despite initial resistance, Elizabeth remained for 12 weeks.

When school resumed, things worsened, and the family successfully cosigned a legal waiver that allowed the district to pay for private schooling at Fusion for a year. But first, from mid-October through December 2021, Elizabeth enrolled in Embark’s residential program in the Poconos. With the center’s help and the 12-week intensive outpatient program on her chart, insurance covered the cost.

Once home again, Elizabeth started at Fusion and returned to 12 weeks of intensive outpatient sessions with the same Embark therapist. Her walls were coming down. “In the Poconos, Elizabeth made a name for herself,” her mom says. “At the graduation ceremony, they all stood in a circle and talked about what they learned from her. You could feel the energy, and Elizabeth could feel the love and encouragement. Maybe for the first time, she thought, ‘I did something. I was successful.’ One life coach hugged her for five minutes. Elizabeth cried, and I saw her smile that day. I hadn’t seen her do that for so long.”

Kayleigh Texter’s beautiful smile once hid everything sad in her life. Today, after years of teenage misery, she’s finally happy. “I grew up, and that smile became real,” she says. “I can see in the photos when that smile changed and became real.”

She first attempted suicide at age 12. Three years later, an overdose failed. “I was lucky to be alive, but I was in a period in my life where I felt like it wouldn’t get better,” says Texter.

An only child, she’d eventually have one residential stay in Illinois and benefit from three inpatient programs, five partial hospitalizations and too many outpatient programs to count. It was all part of her journey to overcome a genetic disposition, a dissociative episode, a sexual assault and other trauma. “For a lot of my teen years, I didn’t expect to be alive past 18, and the adults in my life didn’t think I’d make it either,” she says. “I know a lot of kids who didn’t make it. It’s hard to look back.”

Moving forward, Texter is enrolled in online early-childhood education classes at Walden University. She’s living on her own, has taught at an education center and is working as a private nanny. “Trauma’s not hard to explain—it’s like all the wires in the outlet get unplugged,” she says. “Therapy puts the wires back in the outlet, but you need to remain diligent because they’re always loose and can come out easily. Any form of therapy is a tool, but it has to come at the right point in life. I had the tools for years before I decided to use them.”

Elizabeth has also been succeeding. She’s had two jobs and is taking voice lessons and even singing on stage. “She sang to a theater full of people, and not a dry eye in the place,” says her mom. “She’s been confident and positive about herself, but we wouldn’t be where we are without getting her the help she needed.”

Lynn recently resigned her position in a neighboring Chester County school district, where she helped manage a special education program as a liaison. She’s now focusing on her family, while also sensing an additional calling to help other families trying to navigate mental illness. “If we had someone like me when it all started with Elizabeth, it wouldn’t have been as painful,” she says. “To me, it’s a form of abuse to not get your kid the help she needs.”

In the wake of her journey, the first word that comes to Texter’s mind is empathy. “There’s always someone who’s been through more,” she says. “I’ve tried finding pride in overcoming all I went through. In some ways, I guess I do inspire other people. I still feel emotions very hard—but that means I feel happiness very hard, too.”

May is Mental Health Awareness Month. To learn more, visit mhanational.org.

In some cases, only first names were used to ensure privacy.

Related: Mental Health Takes Priority on Main Line College Campuses