Original artwork by Ella Johnson for Voices of YouthThis story was written by Conner McBryde as part of the Kalamazoo Voices of Youth Program. The art work of the hug is by Voices of Youth participant Ella Johnson. The Voices of Youth program is a collaboration between Southwest Michigan Second Wave and KYD Network.

On a sunny Thursday afternoon at 4 p.m. Elizabeth Collins, 13, walks into her bedroom, sits at her desk, and logs into a Zoom meeting session with her therapist.

Im on neutral grounds about therapy when Im in my room talking to someone who listens to me, says Collins, who struggles with anxiety, ADHD, and grief associated with the death of a grandmother with whom she was very close.

Her bedroom is a judgment-free zone, she says, and the mental health therapy she receives there helps her.

Therapy itself can be very helpful, says Collins. Its nice to talk about anything and everything, ranging from things I was excited for, to how I felt or issues I was having. After going to therapy, I was glad I went.

Professionals say they are working to make access to mental health services for young people better but some teens say its not always easy to find and get started. They also say there is still an age-old stigma attached to receiving treatment and that is felt by today's youth.

Elizabeth Collins has found that therapy has helped her.I mostly see the stigma spread on the Internet, with many people saying things such as mental health problems are just the new trend and arent real, says Collins. Or Ill see someone claim someone else who isnt OK mentally be it depression or anxiety be insane or a danger to society.

She says thats stupid, for one, because it shouldnt be there.

There shouldn't be a stigma about receiving help, she says, With the stigma attached to every aspect of mental health, it can be incredibly harmful to those affected by it. It can inhibit peoples ability to reach out for help due to fear of the stigma.

Georgia Hutton, a 15-year-old Kalamazoo resident who has struggled with anxiety since her parents divorced several years ago, says she thinks theres a lot less stigma attached to seeking therapy than there was when she started a few years ago. She says she's talked to people who told her they went to mental health services and they were ashamed of it.

I was really scared to do it at first because this was like four or five years ago. And it was really stigmatized at the time. But ever since then its become a lot less.

She says she thinks that now its less about how people are treated when it comes to the stigma and more about how people treat the idea of therapy.

It's not commonly talked about so if you talk about it people treat you differently, Hutton says. If anything, the stigma is about talking about therapy more so than therapy itself or going to it.

Georgia Hutton says she thinks there is less stigma attached to seeking therapy than there has been in the past.Christopher Aguinaga, principal of Loy Norrix High School, says, I dont think the stigma has changed. I think teenagers by default want to fit in so the attitude (towards stigma) has changed.

When it comes to negative stigmas, Gretchen Grappone, a licensed clinical social worker and consultant with Atlas Research in Washington, D.C., has identified seven main types that are barriers to people trying to access mental health treatment.

Grappone has said she is happy in her work but has struggled for many years with depression. In a Spring 2017 article for the National Alliance on Mental Illness, she wrote, Besides my symptoms of depression, I faced an additional barrier to school, employment and inclusion in general: unhelpful attitudes from well-intentioned health professionals. In other words, stigmas.

The stigmas she identified involving professionals and others are:

Public stigma This happens when the public endorses negative stereotypes and prejudices resulting in discrimination against people with mental health conditions.

Self-stigmaThis happens when a person with mental illness or substance-use disorder internalizes public stigma.

Perceived stigma The belief that others have negative beliefs about people with mental illness.

Label avoidance This occurs when a person chooses not to seek mental health treatment to avoid being assigned a stigmatized label. It is considered one of the most harmful forms of stigma.

Stigma by association This occurs when the effects of stigma are extended to someone linked to a person with mental health difficulties. It is also known as courtesy stigma or associative stigma.

Structural stigma Institutional policies or other social structures that result in decreased opportunities for people with mental illnesses are considered structural stigma.

Health practitioner stigma This takes place any time a health professional allows stereotypes and prejudices about mental illness to negatively affect a patients care.

Stigma, prejudice, and discrimination against people with mental illness can be subtle or it can be obviousbut no matter the magnitude, it can lead to harm, Borenstein writes. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help.

He says public, self, and structural stigmas have a very negative impact on teens self-esteem and social life, and they can create barriers in places like schools.

Emotional disorders can profoundly affect areas like schoolwork and school attendance, according to the World Health Organization. Social withdrawal can exacerbate isolation and loneliness.

Despite the negative perception that therapy may have among some people, there has still been an increase in the number of young people who seek out treatment, whether that be through medication, counseling, or other means.

Data from a study of national trends in mental health care for teens (ages 12-17) showed that from 2005 to 2006 and from 2017 to 2018 there was an increase in the use of outpatient mental health services by 9.2 percent for each of those periods. The study was done by Ramin Mojtabai, of the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, and Mark Olfson, of the Department of Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University.

My first experience with therapy was pretty good, Collins says. I remember being told that my mother had signed me up for therapy only hours before I had to log in (to Zoom) for the appointment. I was slightly apprehensive at first, being as I didnt know quite what to expect. My therapist was very kind, she was patient and always made sure I was comfortable in the situation.

Hutton says she has been in therapy since seventh grade and Ive had three therapists, so its taken a lot of trial and error for me. But its really just like, changed my life because its just been completely helpful.

She says that when her mother suggested therapy to her, she didnt want to do it. But then she had a sort of breakdown.

I have anxiety and depression, clinically diagnosed, Hutton says, and it was really bad before I was able to get help.

So she ultimately asked for help.

The main two triggers for her in middle school were having a dip in her grades. Hutton has been an all-A student. Those made me freak out. And then also when I was in middle school, that was when my parents got their divorce. So that, along with my grades was a huge source of anxiety for me

She said therapy helped clear her mind. It allowed her to talk fully about her experiences with someone who had an unbiased perspective about the situation. And to just have someone to help me break it down and understand what Im going through, how I feel? Like that really, really helped. And it essentially saved my life at a certain point.

While therapy is helpful to some, that is not the case for everyone. Like Toxic Hayes, 16, in Kalamazoo, who saw a therapist off and on since he was 15. He has struggled to deal with a very religious family that has not accepted him as he works to discover his sexual identity. He created the first name for himself as he works to discover himself.

I was really just hoping for it to help me cope with things, he said. But he has had limited success. I know it's all just about finding a good therapist that you trust. But even after seeing three different therapists, none of them had worked.

Of finding a therapist who works for a person and their situation, Hutton says, Its like a guess and check math problem.

Toxic Hayes is working to discover himself.For some, access to proper care is difficult because it may be too expensive and their family doesnt have insurance to cover it.

Without insurance, most people may have to pay for therapy out-of-pocket, according to information provided by the Michigan Counseling Centers. That can be anywhere from $30 to $250 per one-hour session.

Another reason therapy might not work for some are the personal boundaries that people have. Being able to discuss their emotions and issues is no big deal for some people. For others, it can make them feel uncomfortable or weirded out.

I just thought it was weird to talk to a stranger about personal issues, Hayes said.

Some people are prevented from getting the help they need, one therapist says because they dont know where to turn.

Teens often dont know where to turn or how to get connected to therapy, says Tim Henson, director of clinical services for children at Community Healing Centers of Kalamazoo. Some teens that are already feeling alone and disconnected may also struggle to reach out on their own.

Teens may find help at school. The Kalamazoo Public Schools have many ways to access a therapist or some form of mental help. With their student services provides information about a wide range of services such as LGTBQ+ support, career counseling and mental health services (social workers, psychologists, and counselors). Professionals also say information can be found at physicians' offices, local health care clinics, or mental health agencies.

Schools can play a big part in helping young people find their way to needed mental health services. Some possibilities may be introduced through health or psychology classes. Teachers and counselors who are trained in the subject may provide guidance.

Rita Raichoudhuri, superintendent of Kalamazoo Public Schools, is also making an effort when it comes to mental health services in school. In the fall of 2019, teachers started to get more training to help students cope with mental health issues. The training is intended to help teachers improve their skills so they can help young people in a way that integrates that information with students' subjects.

Overall, school-based services demonstrated a small-to-medium effect in decreasing mental health problems, write researchers Sanchez, Cornacchio, Poznanski, Golik, Chou, and Comer.

While it has started to improve in recent years, students have their own opinions on what could be done to better improve schools' response to mental health concerns.

Tim Henson, director of clinical services for children at the Community Healing Centers of Kalamazoo.I feel like I would have school counselors and teachers have resources and pamphlets for students to take and like, do research with, Hutton says. And there should be required mental health education in classes other than health classes.

Henson says, The biggest misconception is that mental health struggles among young people are rare.

Research has shown that one in every five young people will experience a mental health condition, he says. And, he says teens most common struggles are: adjusting to life experiences, depression, and anxiety.

The recent COVID-19 pandemic and the big move to online schooling that accompanied it has had a big impact on many students mental health, school officials have said. The transition from school in real life to virtual learning has been a disruption that has affected some students grades. And some students concentration wavered during online classes.

My grades were doing good, but then online school hit, Hutton said.

Collins asked, How am I expected to pay attention to school at 7 in the morning when there are so many other things that can distract me?

Therapy can be difficult for young people to access, Henson says, Part of that is due to the fear that parents will find out what a young person talks about. However, therapists should always include young people in discussions about what parents will know about sessions. If a youth cannot get a parents permission, there is a law in the state of Michigan that a youth aged 14 or older may request and receive mental health services and a mental health professional may provide mental health services on an outpatient basis without the consent of a parent or guardian. However, it is limited to no more than 12 sessions or four months per request for services.

Collins says, Therapy is valuable to those who benefit from it. It can be incredibly useful to confront what you're feeling and to have someone there with strategies to help you work through it.

Says Hutton, I think the stigma (towards mental health) is very strange as mental healthcare is just that, healthcare. And it (the healthcare) is extremely valuable and important.

Hayes says, I think it (the stigma) should be talked about more, and then people who have mental illness should be listened to. I think therapy is worth it for some people but it's not for everyone and people should find what works best for them.

Conner McBride, 16, is a Junior at Loy Norrix High School. Her mother is a physical therapist at Bronson Hospital and her father is a chemical engineer at Pfizer. She has a younger sister. Her interests include reading, music, baking and cooking, photography, hiking, and traveling. Sleep makes her the happiest and spoilers for a book she is reading make her the saddest. Her career interest is Executive Chef.

EllaJohnson is a Senior at Portage Central High School. Her passions are art, her many animals, and her online business (selling her art and vintageclothing). She plans to attend collegeat North Central Michigan College, majoring in small business. In her free time, she paints and cares for the un-homed population in Kalamazoo. Her plan for the future includes owning a small business using her profits for philanthropy.

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Voices of Youth: Kalamazoo teens discuss the realities of mental illness and its stigma - Concentrate