Despite increased focus on mental health, myths and misunderstanding still common

(This story was updated to meet our standards.)

Over time, Gabriella Thomas has noticed a trend: Resources to help college students like her navigate the stressors of school are cropping up everywhere.

"They're not something you really have to go seek out," said Thomas, the president of Marquette University's mental health-focused Active Minds club.

That's a sign of needed progress, she said.

However, in the wake of increasing national attention on mental health, the average person's understanding of the topic is still relatively weak. For decades, research has shown most people lack the background knowledge needed to spot signs of common mental illnesses or name treatments that are known to help.

In itself, the umbrella term "mental health" is a close cousin to physical health — something that fluctuates over time and requires care and attention to manage. And just as sometimes people get physically sick, whether temporarily or in the long term, they can also sometimes develop a mental illness.

Not only do stereotypes and misconceptions fester without better "mental health literacy," advocates and researchers warn, but fewer people ultimately reduce symptoms through treatment.

“I think a lot of the time, people don’t seek help because they genuinely just don’t know where to start,” Thomas said. “That’s definitely the hardest part. Then you start to go (to get help), and you figure out what works best for you, and it’s like a domino effect.”

Awareness of mental health is increasing — but more is needed

In many ways, mental health today is hard to miss.

In 2021, the U.S. Surgeon General released a 53-page advisory outlining action steps at the national level to address troubling data on the state of youth mental health. In 2022, a national poll found that 90% of people believed the country was in a "mental health crisis."

It's no different in Wisconsin. In 2023, the state's Office of Children's Mental Health called the issue "extremely concerning" in its annual report. In 2024, Gov. Tony Evers pledged to respond with a "whole-of-government approach."

Despite that increased attention, an estimated 2 of 3 young people in the U.S. who need treatment for mental health issues don't get it. And advocates have been pushing for reduced stigma against people living with mental illnesses for decades, not just since COVID-19.

One solution, advocates and researchers say, is going beyond increased public awareness to increased public understanding.

Rachel Tambling, a professor who studies mental health literacy at the University of Connecticut, said many messages about mental health are over-generalized or lack specificity.

Most people would think it's ridiculous to see a sign saying "your physical body is important," she said. But it's common to see messages like that about mental health, especially since the pandemic.

"It just shows you where we are with the concept of mental health literacy," Tambling said. "We aren't really even (at the point of) educating people. We're literally saying, 'Hey, it's important.'"

More: Most students find returning to school stressful. Here's a quick primer for parents.

Many people can't recognize common signs of depression, anxiety

For many people, the first step to getting help is simply acknowledging it's needed. But without the ability to recognize symptoms, it can be tough to even reach that first step.

Symptoms of "mental health issues" can be many — and more complicated than just stress and anxiety, or hopelessness and sadness. Someone with generalized anxiety disorder might struggle to concentrate, make decisions or fall asleep. They might notice nausea or trouble disgesting food, muscle pain, twitching, excess sweating or lightheadedness.

In a 2010 study, fewer than half of undergraduate college students enrolled in psychology courses could correctly identify generalized anxiety disorder or panic disorder. Years later, a study of over 1,000 high school students came a similar conclusion about depression.

Efforts to increase physical health literacy have made major strides, Tambling said. More people are able to recognize terms like blood sugar and insulin, or pinpoint signs of a stroke or heart attack.

But the public's understanding about mental illness is often based on stereotypes, she said.

For example, someone might assume depression is noticeable only if someone cries frequently and stays in bed. But that's a narrow view of the illness, missing its many other potential symptoms.

"We don't realize as a culture that most people who struggle with mental illness are going to work, are going to the grocery store … are cracking jokes, are at your birthday party," Tambling said.

Thomas, 21, said she's proud of her generation: It's becoming far more common to talk about symptoms of mental health, largely due to social media.

But with more of an ability to call attention to the issue, it's also easier to misuse common language.

“I’m sure people with ADHD don’t appreciate when somebody throws out, ‘Oh, that was so ADHD of me,’” she said. “These terms are becoming more common because people are getting more informed — which is great — but some people are now using it too loosely, in a way.”

Once you recognize symptoms, then what?

Intertwined with a lack of ability to recognize symptoms, studies have shown, is a lack of understanding about how to address them.

The 2015 study on high schoolers' mental health literacy unpacked that question, asking study participants to list the resources to manage depression. The answers: friends, family and "counselors," the study found.

But figuring out who is a "counselor," a therapist or mental health-focused doctor can be confusing. Within the long list of professionals who work in the field, there's variation in who can assess symptoms, make a diagnosis, hold a therapy session or prescribe medicine.

The majority of people who get medical help for their mental health start with a general practice doctor, not a specialist. And the list of quicker options, like walk-in mental health clinics or in-school staff trained to direct students to help, is growing.

Thomas said it's easy to stop looking for help after self-diagnosing a mental health issue using resources online — and delay getting help from a professional.

"They're not realizing that, 'Hey, there's a way to get access to support that will make you not feel this way," she said.

What does a specialist doctor look for in making a diagnosis?

It's normal for people to be worried or sad, said Dr. Margaret Altschaefl, a licensed psychologist at Children's Wisconsin. Feelings like those are the body's way of signaling it's time to make a change.

“Once it starts to really functionally impact us, where we’re not able to do things, or not take care of ourselves, that’s when it becomes more of an illness or a disorder," said Altschaefl, who works with children and adolescents in Milwaukee.

For example, worries could become so intense they cause someone to lie awake for hours each night. Someone could fear failure so much that they become hyper-focused on studying, stop spending time with loved ones, avoid school, feel sick or become quick to anger.

When Altschaefl meets a new patient, she looks for clues in four categories associated with mental health: thoughts, emotions, "body feelings" and behaviors.

Mental health issues can cause repeated, negative thoughts that won't go away, Altschaefl said. Those thoughts can take many forms: fear of being made fun of at school, worrying something bad is about to happen, or not liking yourself, for example.

Especially for younger kids, feelings in the body like stomachaches, headaches and exhaustion can act as signals of mental health issues. Behavior might change, too: A child could have more tantrums or avoid situations like school, trying new things or interacting with other kids.

Altschaefl tries to figure out whether a patient's symptoms generally happen in specific places — at home, at school, with friends — or follow them everywhere. She also wants to know how long the symptoms have been happening and how much they impede the patient from living a normal life.

Regardless of the diagnosis, Altschaefl said, symptoms can be managed. Put another way, if someone's foot hurts, the pain still exists whether they have a diagnosis to explain why.

It's why she helps make a care plan for each patient, outlining specific steps they can take to reduce symptoms.

“Those aren’t restricted based on your diagnosis,” she said.

As self-reported mental health issues rise, talking about mental health is becoming increasingly common

Thomas said in her parents' generation, talking about emotions was relatively taboo. Going to therapy was seen as a last-case scenario, only for people with debilitating mental illnesses, she said.

"I think that's something that my generation is doing a great job with," Thomas said. "There's a lot of people who are younger who are realizing, 'Hey, I just want to work on myself ... so I can be happier, so I can feel better about myself.'"

One study on youth mental health, in particular, has made its way into government reports, politicians' statements, news stories and researchers' analyses.

The first year that federal Youth Risk Behavior Survey asked about symptoms of mental health issues, other than suicidal ideation, was 1999.

High school students were asked whether in the past 12 months they ever felt "so sad or hopeless almost every day for two weeks or more in a row" that they "stopped doing some usual activities."

That first year in 1999, 28% of high school students said yes. By 2021, the figure had risen to 42%. In Wisconsin, the picture is slightly better, going from 28% in 1999 to 34% in 2021.

The survey eventually added the term "mental health" to its questionnaire — for the first time — in 2021.

Students were asked whether in the past 30 days their mental health was "not good," using "stress, anxiety and depression" as a definition.

Nearly one in three students, or 29%, said their mental health was poor most of the time or always.

Altschaefl, the psychologist, said she's noticed increase in the number of teenagers and their guardians who arrive at the doctor's office with an idea about what their diagnosis could be.

"The knowledge, awareness and comfortability of talking about it with health professionals, and with kids and parents, has increased," Altschaefl said. "That's probably what's leading to some of the increase in people seeking services."

It's OK to seek help

Basic mental health education ultimately sends a broader message, advocates say, that it's a medical issue with proven treatments.

In other words, mental illness is not a choice.

But that's been the fallacy for decades, Tambling said.

"It's all tied to resources. If we don't value mental health, and we don't have mental health literacy, we don't know what's going on. Then we're not valuing and investing in resources for kids, for adults, for people," Tambling said.

There are myriad stereotypes associated with mental illness, studies have shown. It doesn't make people dangerous, criminal or incompetent — but fears about being associated with stereotypes like these can prevent people from seeking help.

People of color, especially Black, Latino and Indigenous people, as well as LGBTQ+ people, are less likely to receive mental health care. Factors like poverty, substance abuse and incarceration are also tied to a lack of access, according to 2020 research.

For Thomas, one key way to expand access to services is to continue spreading the message that it's OK to ask for help.

“'Normal' looks different for each individual,” she said.

Cleo Krejci covers education and workforce development as a Report For America corps member based at the Milwaukee Journal Sentinel. Contact her at [email protected] or follow her on Twitter @_CleoKrejci. For more information about Report for America, visit jsonline.com/rfa.

This article originally appeared on Milwaukee Journal Sentinel: How do doctors define 'mental health issues' among K-12 kids?