How to start a conversation with youth patients about their mental health

Last September Doctors of BC’s Council on Health Promotion published a policy paper, Reaching Out: Supporting Youth Mental Health in British Columbia, that encouraged physicians to initiate conversations about mental health with their youth patients and to undertake continuing medical education related to youth mental health. Research indicates that only 25% of Canadian youth will seek support for their mental illness because of a lack of understanding about mental health, a lack of awareness of where to get help, and fear of judgment from friends, family, and professionals.[1] These findings suggest all the more reason for doctors to start routine discussions about their patients’ well-being during medical visits; however, when a patient is unwilling to divulge personal information, physicians may be challenged to start a conversation around a highly stigmatized subject. More often, studies find, it is not what doctors say, but rather how they communicate—the way they enter the room, maintain eye contact, and their general behavior—that affects whether their youth patient will feel comfortable revealing information and accepting treatment.[2] 

Developed by the General Practice Services Committee, the Practice Support Program’s Child and Youth Mental Health (CYMH) learning module provides verbal and nonverbal communication guidelines when initiating conversations with youth patients:
•    Create a supportive and safe space.
•    Demonstrate a compassionate and nonjudgmental attitude, but be real.
•    Demonstrate active listening: eye contact, and verbal (“Ah hum,” “Go on”) and nonverbal (head nod) clues to listening engagement.
•    Request clarification (“Help me understand,” “Could you explain what you were thinking about that?”).
•    Suggest emotional identification (“It seems as if you are feeling frustrated”).
•    Do not surmise what is happening for the young person too quickly; you are likely to be wrong.
•    If you do not know what they are talking about, ask.
•    If you do not know an answer to a question, admit it and tell them how you will find out.
•    Establish confidentiality and limits of confidentiality (self-harm, danger to others, etc.) and be very clear about your role as the physician.
•    Use open-ended questions (what, when, who, where, how) to learn more about your patient, his or her goals, and potential barriers.

These recommendations reflect similar studies that support physicians’ positive verbal and nonverbal behavior when assessing youth, such as warmer vocal tones, leaning toward the patient, openness, willingness to listen, composure, and some formality, all of which produce higher rates of patient satisfaction.[2]

Through its website (www.pspbc.ca), local regional support teams, and Divisions of Family Practice, the Practice Support Program provides CYMH resources, coaching, and support to help physicians identify a patient’s state of mental health. 

Physicians can also refer to www.openmindbc.ca for a list of resources that help youth patients and their families to access information and support services.

References

1. Doctors of BC. Reaching out: Supporting youth mental health in British Columbia. Vancouver, 2014.
2. Burgoon JK, Pfau M, Parrott R., et al. Relational communication, satisfaction, compliance in communication between physicians and patients. Commun Monogr 1987;54:307-324.