Guest Opinion: Understanding youth mental health and building a strong community


The outpouring of discussion around stress, school, mental illness and the welfare of our teens has been tremendous these past few months. These discussions are critical for change and it is clear that change is happening. Comments have spanned the gamut of potential contributors to suicidal ideation, including mental illness, stress, social isolation and pressures, homework and school factors, sleep debt, family issues and societal expectations.

The Palo Alto Weekly's Jan. 30 editorial stated: "Suicidal ideation, they say, is not the product of too much homework, test anxiety, too little sleep or worry about college admissions, in spite of the stress they may cause." As an adolescent psychiatrist, it was my intention to address this piece since "they" referred to "mental health professionals." It seems unlikely that most health professionals would agree that stress (internal or from the environment) or sleep abnormalities do not play a role in contributing to mental illness or suicide.

Then, I came across a truly brave and vulnerable account of one student's experience and that teen said it all! The story is a reminder of the strengths in our midst, some of the contributors to great distress, and subsequent hope and health moving forward.

The teenager shared how stress in the family, school and social life eventually led to serious suicidal thoughts. Environmental stressors can absolutely contribute to mental disorder and are one of the first things medical professionals look for when trying to understand how to best help someone struggling with disease.

Stress causes the brain to release chemicals that drive a person to fight or flee the perceived problem. This can be life saving in the short term. The hormones can help a person perform well at certain things, such as getting through the SAT on time. These stress hormones make a person hyper-alert, ready for action, feeling less need for sleep or food, and more resistant to infections. But if the stressors are chronic or overemphasized as a danger in one's mind, the person's health deteriorates. Chronic stress affects many parts of the body, contributing to diseases, increased infection and mental illness. For the teen in this story, chronic stress kept them focused on fleeing the perceived threat. This fleeing was, for awhile, equated in their mind with dying to escape.

The teen noted that stress affected sleep and attitude. Sleep abnormalities are intricately connected with stress and mood. Stress hormones can make it difficult to fall asleep even when one is quite tired. The combination of high stress hormones and sleep deprivation can impair rational thinking and cause depressed or irritable moods.

Our brains can become hyper-focused and narrow-minded in the choices for dealing with stress -- or react impulsively without being able to analyze the consequences of the action. Teens are more susceptible to this as their brains are not fully developed in the executive functioning areas, the frontal lobes. This means they are less able to stop and think, prioritize solutions and plan before acting. It also means they can have more intense emotions, react more quickly and jump to conclusions more readily than adults. That can be useful or dangerous.

With lowered sleep, the frontal lobe functions even less well, impacting mood. In fact, two recent studies of thousands of teens showed those who slept seven hours or less a night and did not meet criteria for depression still had a two-fold increased risk of suicide compared to teens with normal sleep habits. Another study published this past month is the first of its kind to show smartphone usage causes increased disruption in teens' sleep and repeats what others have found: that electronic devices can be connected to sleep difficulties, which in turn were related to depressive symptoms.

For people with anxiety, depression and many other psychiatric conditions, sleep abnormalities are a common thread in the cluster of symptoms used to define disease. Like hypertension, which warns of the risk of heart disease and stroke, sleep problems can warn of the risk of mental disorders. Further, if hypertension or sleep problems go untreated, the health of the person is at risk.

Part of our teen's story referenced another student whose family courageously stepped out of their grief to share that their son was living with depression and despite help had been unable to conquer it, taking his own life. Severe cases of clinical depression are rare before puberty, but there is a drastic increase in the disease so that nearly 20 percent of the population has experienced a depressive episode when turning 18 years old. The co-morbidity of depression and sleep disorders in adolescence is very high, with 73 percent of depressed teens suffering from a sleep disorder. In fact, a large meta-analysis in 2014 "concluded that sleep disturbance rather acts as a precursor to the development of depression."

This is scary stuff when a person feels alone, with a bad attitude, stressed and sleep deprived. Even worse when people do not have others to help them see the big picture. Their mind is not working properly and thinks in ways that are abnormal. Perceptions are off and not necessarily legitimate.

Fortunately, this Palo Alto teen texted their concern to friends. Fortunately, compassionate friends responded and realized they are a part of a community. They called the school. Mental health services involved the family and engaged professionals to work with the teen. The teen no longer felt alone, which is a common contributor to suicidal feelings, and got needed help from their community. Further, the teen now realizes it is hard therapeutic work to understand the triggers leading to suicidal thoughts as well as to maintain healthier ways of thinking.

So how do we improve our community and the lives of teens around us? Try simple steps such as sleep hygiene, turning off electronic devices at night, getting eight hours of sleep (nine if you are a teen), counting how much time you or your child does work without electronic distractions, getting help when these things don't work, and understanding common diseases such as depression. By learning and applying these things to our own lives we are an example to others.

We can also look beyond mental illness to address what the Palo Alto Weekly suggested, "the happiness and well-being of all students in a hyper-competitive culture." Consider mindfulness or exercise as ways to decrease stress and improve clarity. Consider a change in course or workload or an emphatic shift from success in performance to relationships and connections. Consider collaborating with others to identify what areas need attention and improvement, then work towards those goals together as a collective community.

And when we feel we have given what we can to our hyper-competitive community, let us not forget the words of our teens, "We're all in this together." When we have learned and changed in our community, we can continue the work by stepping beyond ourselves to find that teen sleeping in the shopping cart. Remember, her story was also part of what saved our student's life. Let's focus on compassion and collective change, and when we have healed, spread our wings further.

Maria Daehler, M.D., is a PAUSD parent, adolescent psychiatrist and smartphone owner.

Related content:

Guest Opinion: Living proof that we are all in this together

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4 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Feb 20, 2015 at 1:58 pm

Dear Palo Alto Onliners,

Ms. Daehler's piece takes a compassionate view of the dilemmas faced by our kids, and makes a strong case for good old-fashioned sleep—"sleep, that knits up the raveled sleeve of care," as Shakespeare wrote.

Ms. Daehler's piece offers some good "home remedies," having to do with "sleep hygiene," but is at its strongest when she points to the benefits of "relationships and connections" and of collaborating with others to find solutions that would benefit one and all.

Such solutions are offered by "Save the 2,008," a community initiative to bring a healthier, happier life to Gunn High.

The initiative would shrink classes to a friendler size—a foolproof way to create surer ties between teachers and students, relationships that can be lifelines.

The initiative would give teenagers what they've never had: a way to communicate with teachers about homework loads (another relationship-building tie), and thus not have to burn the midnight oil.

The initiative would forbid student cellphone use during school. "Turning off electronic devices at night," as Ms. Daehler proposes, would surely come easier if we've weaned our kids from texting and Instagram and Snapchat dependence during the day.

"Save the 2,008" would do away, once and for all, with the rampant cheating that keeps kids tossing and turning with anxiety about competition and anxiety and keeping or betraying one's friendships.

If you're in sympathy with Ms. Daehler's view of what kids need—and I know I am—please visit the "Save the 2,008" website to learn how you can add your voice to a mounting community chorus for kids' well-being.

Marc Vincenti
Gunn English Dept. (1995-2010)
Co-founder, "Save the 2,008"

7 people like this
Posted by IAQ in PAUSD
a resident of Another Palo Alto neighborhood
on Feb 20, 2015 at 6:26 pm

Another recent study involving over 1700 10-year-old children showed suggests that indoor mold or dampness negatively influences sleep in children (not only children with allergies, either).

Other major study has shown a dose-dependent correlation between indoor mold and depression. Solid evidence also shows increased risk of asthma, allergic rhinitis (also linked to sleep problems), atopic dermatitis, and common colds, in damp indoor environments.

Relevant dampness can be anything from water tracked in by kids in campuses that chronically flood, condensation from air systems dripping onto ceiling tiles, or chronic condensation at the surface of cool, uninsulated concrete slab foundations in warm rooms in which hundreds of children respirate or track in moisture from outside, regardless of the outdoor humidity level. All of these conditions exist on our campuses, especially the middle schools.

Our district does not have especially good asthma rates, they seem to increase in middle and high school (rather than go down as one expects in adolescents), though the district has done a poor job tracking asthma and inhaler usage and failed even to report the data with the California Healthy Kids Survey.

Allergy produces adrenaline, which also hurts sleep.

Adopting and properly implementing an Indoor Air Quality management plan is a positive, recommended step we can take to eliminate the above issues as yet another contributor to the problem. Improving indoor air quality has also been shown through considerable research to demonstrably improve student performance in school. When we take steps like this, it improves our ability to to help kids as discussed in this wonderful article.

The Palo Alto PTA has adopted a resolution recommending we improve IAQ (indoor air quality), and our bond Measure A promised "improving indoor air quality" in all bond work. Here is the wonderful resolution adopted by our PTA Council, based on an equally wonderful state PTA resolution adopted in 2007:

"Indoor Air Quality (IAQ) in PAUSD Schools Palo Alto PTA Council Resolution Passed at January 21, 2015 PTAC General Meeting

WHEREAS, Indoor Air Quality (IAQ) problems may affect the health of student and staff and contribute to poor academic performance, absenteeism and learning difficulties; and

WHEREAS, There are multiple solutions for improving and maintaining good IAQ, and resources are available to implement solutions in school construction, renovation, and maintenance; now therefore be it RESOLVED, that the Palo Alto Council of PTAs supports the PAUSD School Board and School District in implementing policies and practices that promote healthy IAQ, including but not limited to the use of IAQ management plans, proper maintenance techniques such as adherence to heating, ventilation and air conditioning system standards, protocols to reduce pesticide use, and the use of low‐toxic classroom materials and cleaning supplies; and including regular communication with the community on IAQ policies and implementation. "


To support the adoption of an IAQ management plan for the district, which if properly implemented would improve indoor air quality and would research shows demonstrably helps student performance, health, absenteeism, asthma, and the above environmental issues, go to:
Web Link

Community members who have already signed their support (online or paper):
Gail Price (City Council and former School Board)
Amado Padilla (former School Board)
Enid Pearson (former Vice Mayor, signed on by phone)
also signed:
Karen Holman
Tom DuBois
Eric Filseth
Lydia Kou
Cory Wolbach
Janet Dafoe
Wynn Hauser
Fred Balin
Tim Gray
Bob Moss
Simon Firth
Cheryl Lilienstein

It's good to hear sensible input about all the many contributors to the problem and what we can do about them. Here is an easy one, long overdue.

Posted by Name hidden
a resident of another community

on Feb 20, 2015 at 7:07 pm

Due to repeated violations of our Terms of Use, comments from this poster are automatically removed. Why?

1 person likes this
Posted by Mom
a resident of Palo Alto High School
on Feb 20, 2015 at 11:48 pm

I can tell you right now that prohibiting cellphone use during school won't work, will bring upon more stress and enforcement would be impossible - teachers and admins won't want the backlash. Cellphones are used in learning for some classes and Paly students would use them at T&C. We can't even get PAPD to enforce off-leash laws; there is no way a school can prohibit 2000 cell phones. The idea might work for a small, private school where parents want their children inside a bubble. Instead, students will be using them after school, giving up studying time. For some, this is their only source of socializing (sad but true) because they have to go home and study or build their resume after school. Sure, it's an addiction for some, but Big Brother is not invited; it's a family issue.

17 people like this
Posted by Mom
a resident of Palo Alto High School
on Feb 20, 2015 at 11:53 pm

Per the author's recommended 9 hours of sleep for teenagers, please write to PAUSD BoE and tell them the workload is too much, the school start time is too early. M-A starts at 8:45 and 9:30.

5 people like this
Posted by Interesting
a resident of College Terrace
on Feb 21, 2015 at 7:12 am

"M-A starts at 8:45 and 9:30"

Of course, M-A also has a zero period that begins at 7:50. And also has about an hour less instructional time each week.

8 people like this
Posted by Appropriate Respect
a resident of Fairmeadow
on Feb 21, 2015 at 12:38 pm

Thank you, *Dr.* Daehler, for writing this cogent and sensible piece. I hope more people will read it carefully and understand how we can be more mindful of our kids' needs.

10 people like this
Posted by Another Mom
a resident of another community
on Feb 21, 2015 at 1:19 pm

Re M-A's zero period: Most don't take zero period, even the more academic students. The ones who want to attend Ivy's do, but they accept sleep debt anyway. The late start time has saved us all. Let's be real, one hour less instruction per week is peanuts compared to the havoc sleep deprivation causes.

6 people like this
Posted by AndSometimesItsTheSchool
a resident of Old Palo Alto
on Feb 21, 2015 at 5:25 pm

Great article!

"Chronic stress affects many parts of the body, contributing to diseases, increased infection and mental illness"

Yes. The teachers at Jordan pressured and intimidated our son to the point of anxiety and depression.

Anyone who does not believe the school has a responsibility in some of these cases has their head in the sand (or elsewhere)

And Principal Barnes did nothing to address this.

He needs to go. Along with the teachers doing this [portion removed.]

6 people like this
Posted by It's Often the School
a resident of Jordan Middle School
on Feb 21, 2015 at 7:09 pm

We agree 110% with the above poster^. The same happened to our son, who has mild brain damage due to oxygen deprivation during a long and difficult labor/delivery. Principal Barnes appears to see the students as statistics, not flesh and blood. Many of the teachers think likewise.

No more PAUSD middle schools for,us!

2 people like this
Posted by Paly Mom
a resident of Palo Alto High School
on Feb 21, 2015 at 7:50 pm

Dr Daehler and other parents -
I was wondering why the issue of widespread use of drugs has been ignored?
With so many students using stimulants like caffeine, Adderall, Ritalin, and all the others, how can this not be part of the discussion?
Whether these students are taking a prescribed medication, or doubling up their doses for a kick (as my teen says), or getting it from other students,
the fact is that many students are now taking these drugs to keep up with everything, and it is not just a certain "druggie" type of student.
The honor students, AP students, athletes, and all races of kids ARE taking these drugs in order to keep up and stay up.

4 people like this
Posted by Mom
a resident of Palo Alto High School
on Feb 21, 2015 at 9:56 pm

Students are taking stimulants because they are trying to keep alert. Too much schoolwork perhaps? Athletes lose 3 hours per day to their sport after school.

To pre-high school parents: Drugs are not the majority of students so don't panic.

Like this comment
Posted by SleepyHead
a resident of Crescent Park
on Feb 21, 2015 at 11:39 pm

I have never heard that lack of sleep or stress could lead to hypertension?
Can anyone expound on that, cause and treatment?

4 people like this
Posted by Maria Daehler
a resident of Another Palo Alto neighborhood
on Feb 23, 2015 at 10:35 am

To those wondering about medications:
The editorial was limited in its scope so many factors could not be addressed. As a Child Psychiatrist, many folks in my profession find that stimulants are oversubscribed and have taken certain patients off of them. Sleep deficit, anxiety, depression, learning disorders, trauma, drug abuse .... to name a few other causes all can look similar to ADHD and kids are easily misdiagnosed and put on stimulants as a quick fix. However, those children who live with Attention Deficit Disorder can benefit greatly from the medications and large muli-center studies have shown that medication management is a first line treatment for ADD. If you have concerns about medications for your child it is a good idea to get a second opinion from a child psychiatrist.
Maria Daehler

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