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When Your Adult Child Has a Mental Health Issue

How to offer support and connection in times of struggle

By Elizabeth Fishel and Jeffrey Arnett

Emerging adulthood is a high-risk life stage in many ways, and many internal obstacles can block a young person’s departure from home or undermine a successful, long-term separation afterwards.

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(MORE: When Terrible Things Happen to Our Adult Kids)

Seventy-five percent of adult mental health issues show up by age 24, including diverse disorders such as depression, anxiety, bipolar disorder, schizophrenia or other psychological problems. Adult children may also have to cope with ongoing learning disabilities, ADHD or other disabilities that make going to college or living independently more difficult. And there are all-too common problems such as alcohol or drug abuse and eating disorders.

Parents of young people with mental health disorders often need to stay more connected, for longer, than other parents do, because their grown-up kids need more help in order to make progress toward building an adult life. We’ll talk about several mental health issues and red-flag warnings in this post and address others in future posts.

Digging Out of Depression

The twenties decade is a time of high hopes, but it’s also a time of struggle for most young people. The result is this paradox: Overall, self-esteem and life satisfaction rises, but at the same time, rates of depression rise, too. Out on their own, most young people swim successfully and contentedly, but more sink than when they had mom’s and dad’s daily support to hold them up.

(MORE: Off to College: How to Step Back But Stay Connected)

The college transition can be a rocky one, and the first year or two of college is sometimes when depression first appears. Gloria Saito, a clinical psychologist who runs the counseling service at the University of California-Berkeley, sees students with a range of issues from homesickness and roommate problems to eating disorders and bipolar disorder.

Depression is one of the most common problems.

“We often see students who can’t focus, because they feel hopeless and they’re having suicidal thoughts,” she says.

Her first priority is to reduce their current distress. “We help them make a structured plan for how to relieve stress that day: eat a good meal, talk to a friend outside of the counseling center, come back in a couple days,” says Saito.

If major depression is diagnosed, often the approach is a combination of counseling and anti-depressant medications. Research has consistently found that this combination works better than either counseling or anti-depressants alone.

One issue that complicates parents’ involvement is that for students who are age 18 or older, college counseling services may not inform parents of the student’s counseling visit or the nature of the student’s problem. The only way this confidentiality can be breached is if the student signs a release form or if the student is believed to be suicidal. If students decline to sign the release, parents may not know that their college kids are having serious problems.

So it’s crucially important for parents to keep in touch — texting, phoning, emailing, Skyping — especially during that first year of college when risks are highest. If you notice a change in your grown child’s mood over the course of two weeks, especially sadness or a loss of pleasure or interest in activities, it would be wise to urge your college student to see a mental health professional for a full evaluation.

(MORE: Ways to Keep Phone Calls Going With Grown Kids)


Severe Mental Health Disorders

Among the most serious and challenging problems of the emerging adulthood years are the severe mental health disorders, especially bipolar disorder and schizophrenia. Bipolar disorder, also known as manic-depression, is part of a class of mental disorders called mood disorders. It involves swings of mood from a manic extreme to a depressed extreme. Sometimes, people go directly from one extreme to the other; sometimes, the extremes are separated by periods of relatively normal moods.

Schizophrenia is another severe mental disorder that affects thought processes, emotional responsiveness and social behavior. It may include hallucinations, disorganized thinking, emotional difficulties like sudden bursts of anger and hostility, and delusions, like a belief that someone is trying to poison your food or that the television is broadcasting your thoughts.

Both disorders have genetic origins and run strongly in biological families. The genetic triggers appear to be timed to go off in the late teens or the 20s for most people. Fortunately, there are a variety of effective drug treatments for bipolar disorder, but unfortunately, many of the medications have unpleasant side effects, such as weight gain, hair loss, acne and hand tremors. These side effects often lead people with bipolar disorder to stop taking the medications. The complete list of symptoms of major depression, bipolar disorder and schizophrenia as specified by the American Psychiatric Association can be found here.

Getting Help

Although parents’ influence diminishes once their children reach emerging adulthood, they can still provide essential help by offering emotional support and connecting their emerging adults to mental health services. An excellent clearinghouse for finding mental health resources is the National Alliance on Mental Illness (NAMI). NAMI’s website contains a wealth of information on a wide range of mental health disorders, including medication and treatments available for each disorder and contact information for programs and services pertaining to specific issues. In addition, parents can connect to local and state NAMI chapters, where they can make direct contact with other parents whose children have faced similar problems.

Therapists experienced with working with twentysomethings, like Jane Malkiewich, a clinical social worker in Massachusetts, caution parents to be prepared for changes of direction in emerging adults with mental health problems.

“I see a lot of flipping back and forth between dependence on parents and independence,” Malkiewich says. “They want their parents to be there when they need them, and leave them alone otherwise.”

The challenge of stepping back while staying connected and offering support is even more acute for parents of emerging adults with mental health problems than for other parents. It’s especially difficult to step back when you’ve seen your child struggle, stumble and fall so many times before. It’s also challenging to stay connected when doing so often brings pain and frustration.

The improvement over the twenties decade may be intermittent, and there may be steps backward as well as forward. Yet for nearly all, progress is possible with parents’ support and with access to mental health treatment.

Elizabeth Fishel is the author of five nonfiction books including Sisters and Getting To 30: A Parent’s Guide to the 20-Something Years (with Jeffrey Arnett).  She has contributed to numerous magazines including Vogue, Ms., New York, The Writer, and Oprah's O.  She has written for Next Avenue since 2014. Read More
Jeffrey Arnett is the co-author of Getting to 30: A Parent's Guide to the 20-Something Years. Arnett is a professor in the Department of Psychology at Clark University. Read More
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