Introduction
Almost every parent I’ve sat with after a crisis has said some version of the same sentence. “I had no idea.”
They’re not careless parents. They’re attentive, loving people who ate supper with their child every night of the thing they didn’t know was happening. That’s the difficult truth about teenagers and mental health: by the time a young person says “I think I need help”, they’ve usually been thinking it for a very long time.
World Mental Health Day falls on 10 October, and most of the campaigning around it will encourage people to speak up. Worth saying plainly, then: teenagers already know they can speak up. Something is stopping them. This post is about what that something is, and how to make yourself the adult they eventually come to.
The Size of the Silence
Start with the scale of it. A review of 90 studies on adolescent help-seeking found that roughly three-quarters of adolescents with mental health problems never make contact with services at all. Not that they get poor treatment. That they never arrive.
Locally, the picture is harder to see clearly, because South African data on young people is patchy. SADAG’s widely quoted figures put around 9% of teenage deaths as suicide, with as many as one in four teenagers having attempted at some point. Those numbers are estimates, and probably undercounts, since stigma and inconsistent reporting keep much of this out of the record.
What I see in my room lines up with the research. Teenagers rarely arrive at the start of the difficulty. They arrive months, sometimes years, before anybody finds out how long it has actually been going on. Almost every one of them can name the point at which they first thought about telling someone, and the reason they didn’t.
Why They Don’t Ask
When researchers ask young people directly, the same handful of reasons come back. They match, almost word for word, what teenagers tell me.
It will get out
Stigma is the biggest single barrier in the research, and for teenagers it isn’t abstract. It’s specific and social: being the one with issues, the one people are careful around, the topic of a group chat. In a school where everyone knows everyone (and where half the parents know each other from junior school), being seen going to the counsellor’s office at break can feel like a public announcement.
Mental health stigma in teens rarely looks like the version adults picture. Nobody says anything cruel out loud. It’s quieter than that: a slight change in how people treat you, a reputation that arrives before you do, a thing your friends know about you that you didn’t choose to share.
They’re protecting you
This one surprises parents every time. Teenagers watch you closely. They know about the retrenchment, the medical bills, the marriage that’s gone cold, the sibling who takes up all the oxygen. Many decide, quite deliberately, that you’ve got enough on your plate. If they’ve gone quiet with you, it isn’t always distance. Sometimes it’s mercy, and it’s costing them.
They’re supposed to cope
A strong preference for handling it themselves is one of the most consistent findings in the research. Teenagers are in the business of becoming independent, and asking for help feels like a step backwards. For boys especially, there’s the older script underneath it: sort yourself out, don’t make a fuss, be fine.
They don’t have the words
Teenagers today have plenty of mental health vocabulary from social media, but the labels don’t always help them recognise what’s happening in their own body. Many describe being tired, irritable and blank rather than sad. Some are carrying something they can’t yet say at all, because the words for it don’t exist yet at fifteen.
They don’t think it will help
Often there’s a history here. They told someone once, at eleven or twelve, and it was waved away. “You’ve got nothing to be depressed about.” “Everyone feels like that.” One dismissal can close a door for years.
They’re frightened of what you’ll do
This is the one I hear most often, and it’s the most practical. They think you’ll panic. They think you’ll take the phone, ring the school, tell the family, cry, or sit them down for a Serious Conversation every night for a month. Teenagers weigh the cost of telling against the cost of carrying it, and quite often the carrying wins.
What Closes the Door
Adults rarely mean to shut this down. A few common responses do it anyway:
- minimising: “you’ve got nothing to worry about”, “wait until you have a mortgage”
- comparing: “in my day we just got on with it”
- blaming the obvious: “it’s that phone”, “you’d feel better if you exercised”
- over-reacting: tears, panic, an immediate flurry of phone calls
- passing it on: telling extended family, or the family WhatsApp group
- turning it into leverage in an argument later
The last one costs the most. A teenager who hears their own confession quoted back at them during a row about chores has learnt something permanent about what is safe to say in that house.
Notice what’s missing from that list: not wanting to get better. I have yet to meet the teenager who enjoys feeling like this. The silence is almost always about consequences, not about wanting to stay stuck.
What Makes a Teenager More Likely to Ask
The same research is clear about what helps. Teenagers are far more likely to seek help if they have a trusting relationship with at least one adult, if they know what mental health support actually involves, and if they’ve seen it go well for somebody else.
That’s an encouraging list, because none of it requires a crisis. All of it can be built in advance.
How to Be the Adult They Come To
Talk about it before there’s a problem
The easiest conversations about mental health are the ones that aren’t about your child. A news story, a musician, a character in a series you’re both watching. “Poor kid. I’m glad he told someone.” You’ve just signalled where you stand, with no pressure on anyone.
Say plainly that you’d rather know
Teenagers need to hear it out loud: “If something is ever wrong, I want to know. Even if it’s awkward. Even if it’s about me.” Then say what will happen next, because that’s the part they’re calculating. “I won’t phone the school without telling you first.”
Keep your reaction smaller than your feelings
If they do tell you something frightening, your first job is to stay steady in the room. Take it seriously, thank them for telling you, and save the panic for later, when you’re out of sight. You can fall apart in the car. Not in front of them.
Ask directly, and then wait
“Are you okay?” gets “fine”. Try something harder to bat away. “You’ve seemed flat for a few weeks now. I’m not cross, I’m just asking: how are you actually doing?” Then leave the silence alone. Teenagers often answer on the second or third attempt, days later, usually late at night.
Give them a say in what happens
A teenager frogmarched into therapy tends to sit with their arms folded for fifty minutes. A teenager who gets to choose the person, the time, whether it’s online or in person, and what you’re told about it, arrives as a participant. Resilience is built long before the crisis, and so is the willingness to accept help.
Widen the circle
You are not the only possible adult, and that’s a relief, not a failure. An aunt, a coach, a youth leader, a teacher they like, a family friend. Make sure your teenager has at least one grown-up in their life who isn’t you.
What Therapy Actually Looks Like for a Teenager
A lot of the fear is simply about the unknown, so it helps to describe it plainly.
There’s no couch. In a first session I mostly want to know who they are, what they like, and what they’d want to be different. Nobody is diagnosed on day one. They don’t have to talk about the worst thing straight away, or at all, until they choose to.
Confidentiality is the question every teenager asks, usually in the first ten minutes. I explain it directly: what they tell me stays between us, with one exception, which is if I’m worried about their safety or someone else’s. Then their parents will be involved, and wherever possible we’ll do that together. Most teenagers find that reassuring. It’s the vagueness that frightens them, not the limits.
Parents are usually part of the work too, sometimes in a separate session, sometimes in the room. If the difficulty is sitting in the family rather than in the child, the whole family is part of it. And it’s worth parents knowing that anxiety and depression in young people are treatable, often in a matter of months rather than years.
If You’re the Teenager Reading This
You might have found this page yourself, at eleven at night, having typed something into your phone you wouldn’t say out loud.
Three things worth knowing. Asking for help isn’t weakness; it’s one of the more difficult things a person can do, at any age. You don’t need a reason good enough to qualify, and you don’t have to be at your worst before it counts. And you get to choose who you tell first: a parent, an aunt, a teacher, a coach, or a stranger on a helpline at midnight. Any of those is a real start.
If you don’t know how to begin, you can send it as a message instead of saying it. “I’ve been struggling a bit and I don’t really know how to talk about it.” That’s enough. The other person will take it from there.
When It Can’t Wait
If your child talks about not wanting to be alive, if you think they may be hurting themselves, or if something has happened that frightens you, don’t wait to see if it settles. Stay with them, and get support the same day.
SADAG runs a 24-hour suicide crisis line on 0800 567 567, and free telephonic counselling nationally on 0800 20 50 26 between 8am and 8pm daily. Your GP is a reasonable first stop for anything you’re unsure about, and any emergency unit will help.
Conclusion
Teenagers aren’t silent because they don’t need anyone. They’re silent because, somewhere along the line, they worked out what telling might cost. Change that arithmetic and they will talk, usually at an inconvenient hour, usually without warning.
World Mental Health Day is a good excuse for one conversation that isn’t about marks, screens or washing. That’s all it takes to start.
I offer support for teens, parents and families, in person in Claremont (close to Rondebosch, Newlands, Kenilworth and Wynberg) and online across South Africa.
Be the adult who is easy to tell.
About Me
I’m Paula Marais, a registered specialist wellness counsellor based in Claremont, Cape Town. I hold an Honours in Psychology (Unisa) and a Master’s in Creative Writing (UCT), and I’m registered with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP).
I offer individual and couples counselling, in person in Claremont and online across South Africa. Online sessions are equally as effective as in-person sessions.
There’s no pressure and no judgment. You can reach me at info@paulamaraistherapy.com or on WhatsApp at 072 633 7661.
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