Extended parent's guide to depression

How to help your son or daughter

 

This section of the website aims to help you recognise and understand depression and to get appropriate help for your son or daughter. It is based on the questions that parents ask us at CWMT and our experience over the last 15 years. It is not, however, a definitive guide and if you are ever concerned about a young person you should seek expert help.


Depression is a common problem. Around 1 in 10 young people will experience depression, stress or anxiety by the time they reach 18. But they can be helped. If it is diagnosed and addressed early, depression is less likely to recur in later life.


It can sometimes be difficult to distinguish normal adolescent behaviour from depression and it is not always easy to get the right sort of help. But there are a number of things that parents can do. This guide aims to help you feel more confident, more informed and better equipped to help your son or daughter.

Recognising depression - the warning signs

These warning signs are recognised by mental health professionals as being the common signs and symptoms of depression. However they can manifest themselves in particular ways in young people.

Look out for the following changes in behaviour:

  • Irregular sleep Less or more sleep, time clock upside down (e.g. waking very early or sleeping all day and up at night), not refreshed after sleep.

  • Decreased energy with sad, anxious or low mood Particularly with respect to activities and situations that they normally enjoy.

  • Appetite or weight change Under or over eating and comfort eating.

  • Changes in resilience Feeling easily ‘picked upon’, more irritable than usual or less able to ‘bounce back’ from small setbacks.

  • Changes in performance Sudden changes in academic or school work, such as wanting to drop out of courses, or missing deadlines or avoiding work.

  • Thoughts of death or suicide Becoming fixated with sad events and loss, ruminating over sad songs and tragic storylines.

  • Withdrawal Becoming isolated or avoiding normal social situations and networks, including family, friends and peers.

  • Difficulty making decisions An unusual degree of fretting and stewing about everyday events.

  • Feelings of worthlessness A new or unusual lack of confidence, or a sense of feeling ‘stuck’ and unable to make progress.

  • Guilt and hopelessness Self-absorbed and self-blaming for things, even when not within their control.

  • Risky behaviour Unusual risky or impulsive actions, including alcohol, drug use and self-harm.

  • Unexplained physical symptoms Young people who are depressed can also often have and complain about aches, pains and continuous fatigue

To read more about how depression can appear in young people see the Young Minds website


A single life event (eg. bereavement, parental divorce, change of normal routine, a severely disappointing experience such as exam failure or a relationship breakdown) may trigger a depressive reaction. Even if you as a parent have resolved such an event, it may continue to worry your child.

Noticing just one or two of these signs over a short space of time is not necessarily a cause for concern. Usually though, if you notice that your son or daughter exhibits five or more of these signs for over two weeks or more or if any one seems particularly severe, it may be more serious.

These signs may build up slowly, over a number of months or years but with a gradual impact on your son or daughter’s functioning.

Note down your concerns and see whether a pattern is building up over a few weeks or months. Keeping a written log with dates can help you track the severity of the problem. A written record can also help if you are seeing a doctor or therapist and it may help you to feel more in control of a worrying situation.

Remember, if you have any real concerns at any time seek expert advice.

Time for a chat - talking to your son or daughter

If you are worried you will want to talk to your son or daughter about your concerns. But asking them how they feel can be very difficult and may need some planning ahead to help it go well.

  • Think about what you want to say and keep it simple.

  • Choose statements that are facts and not judgements (eg “I have noticed you have not been yourself recently”).

  • Try to ask “open questions” which allow them to say how they are feeling rather than give a yes/no response (eg “What’s on your mind?”).

  • You may want to write down the things that are concerning you before you speak.

  • Try to keep any anxiety you may feel to yourself.

  • Be calm and supportive and allow plenty of time.

  • Show your child that you are there for them and that you care.

  • Choose your time carefully, when everyone is calm.

 

To read more hints and tips about difficult conversations see the Samaritans website

 

Suicidal thoughts

 

You may be worried that your son or daughter is thinking of harming themselves or is feeling suicidal. It is better to ask about this than ignore it.

  • Ask clearly and gently: “Are you thinking of killing yourself?”

  • If the answer is yes, ask: “Do you have a plan, such as how or where?"

  • If they have a plan the risk level is higher. Ask: “what has stopped you acting so far?”

  • It is important for them and you to understand what keeps them safe.

  • If you think your son or daughter is at risk of suicide, you should seek medical help immediately, from a GP or A&E.

  • Out of hours help is also available from Social Services or Mental health CRISIS teams. (These teams are made up of psychiatric nurses, social workers and support workers who provide emergency support and short-term help out of office hours).

  • To find local help call 111.

  • Asking young people about suicide is not the same as suggesting it to them. You will not be putting the idea in their head but simply gauging the seriousness of the situation.

  • Letting them know that you care and how to get help is better than not asking at all.

 

The charity Papyrus has useful information about talking about suicide on its website, and a “HOPEline” (0800 068 4141) which anyone can call

 

Self harm

You may also be worried about self harm. Self harm (such as cutting) can often be a coping mechanism. It is not necessarily associated with depression. Do not assume that self harm is the same as suicidal intention. But even so it can be alarming.

 

To read more about self harm see the Royal College of Psychiatrists website

 

Gaining a fuller picture

 

After talking to your son or daughter, you may also want to talk to their teacher, school nurse or another trusted adult.

It is best to tell your son or daughter that you are planning to do this and include them in the conversation so they do not feel excluded.

You may also want to ask a teacher or similar to keep a note of concerns with dates to add to your own records.

What to do and when to act

 

After talking to your son or daughter, if you have any concerns you should seek advice.

And if you are worried about any risk of suicide, or your son or daughter’s mood is so low that they are unable to function normally, do not hesitate to visit a doctor.

But try not to be rushed into finding instant answers. Sometimes it’s best to try and find a way to resolve things together. You can seek advice from a number of sources, such as the helplines or websites shown here.

There are also reliable online self-help sites that may be useful to you both. They can answer your questions and suggest practical strategies.

A good example of a clinically based website is Students Against Depression. As well as information about depression, it includes workbooks to help young people to take action and stories by others about what has helped.


Professional help, such as a school nurse or university counsellor, are also places to go for advice. Some may be qualified therapists.

A school nurse or psychologist can also make a mental health assessment and are sometimes able to refer people for expert help.

However, your GP is the main place to raise your concerns. Only they can diagnose the problem and offer a wide range of medical therapies, support and advice.

 

Going to your GP

 

It can be very difficult to raise these concerns with your GP or another professional.

You, or your son or daughter, may be worried that they will be “labelled”, or be concerned about the type of treatment or medication that may be offered or even whether they might be admitted to hospital.

But in the vast majority of cases the outlook is good and seeking help, which is usually given locally in a community setting, sooner rather than later is best.

Not all GPs are as experienced as others in looking after young people with depression.

Ask if there is a GP in your practice who specialises in mental health or ask friends if they have any experience of local GPs in this regard.

If possible book a double appointment to allow plenty of time and explain to the receptionist why you need this. Accompany your son or daughter.

You may wish to be seen together but be prepared to be asked to leave so the GP can talk to your son or daughter alone.

The GP will want to know what is happening and why you are worried. If you have noted down your concerns it will be easier to relate some pattern of events and the number, severity and frequency of the warning signs. You may want to take a letter from a teacher or similar, with their observations.

 

The Doc Ready app is designed to help young people get the most out of an appointment.


What will the GP want to know?

  • Any triggers to the depression.

  • How long it has been going on and how severe it seems.

  • Whether there are any self-harm or suicidal thoughts.

  • How is home, school, social life; any bullying or abuse?

  • Any changes in self-care, eating, sleeping, exercise, drug or alcohol usage.

  • Is there a family history of depression?

  • Are there any new risky behaviours or impulsive acts?

 

They may ask your son or daughter to complete a questionnaire to assess the severity of the problem. Or they may suggest a more detailed assessment by a mental health specialist (such as a young people’s mental health nurse).

The GP should explain this to you. It is within your rights to ask for a more detailed mental health assessment from a psychologist or a psychiatrist on behalf of your child (or a young person over 18 years can ask for this themselves).

 

Confidentiality

There are protocols of confidentiality in regard to your son or daughter and their GP if they are under 18. The practice will have a confidentiality policy you may ask to see. Or see the following links :

 

Doc Ready: Confidentiality, and Doc Ready: Know your rights

Your son or daughter may want to know that their privacy will be maintained. You as a parent may be supportive role, rather than the key player. Supporting your child in accessing a GP is a positive move.

You may also want to ask the school about the confidentiality protocols and policies and about what and how information is held and shared about pupils.

Therapies and treatment: what should the GP recommend?

 

The NICE guidelines tell you what treatments to expect.


Whatever the severity of the depression, your GP should give you and your son or daughter information to help you understand what is going on and how to help yourselves. He may give some written information, eg CWMT’s 'Fancy a Chat' booklet

 

If the depression is mild, your GP may recommend 'watchful waiting' (ie monitoring the situation) and arrange a two week follow-up appointment to see how things progress

If there is no improvement in two to four weeks, or if your GP thinks the depression is moderate or severe, the next step will be a referral to a psychological service for 'talking therapy'. Evidence-based talking therapies that are recommended by NICE include Cognitive Behavioural Therapy, Interpersonal Therapy or Family Therapy

 

CBT

 

One of the most effective and frequently used treatments is Cognitive Behavioural Therapy (CBT).

It has been proven to help treat a wide range of emotional and psychological health conditions in adults, young people and children.

CBT looks at how we think about a situation and how this affects the way feel and act. In turn our feelings and actions affect how we think. The therapist and young person work together to examine and test out unhelpful thinking patterns and behaviours.

 

There are a number of options for accessing therapy:

  • If your son or daughter is under 16, they will be referred to the local CAMHS (Child and Adolescent Mental Health Services). These are NHS run teams of doctors, nurses, therapists and psychologists who are experts in working with young people. The exact arrangements vary across the country, but practitioners from CAHMS can see young people in a variety of community settings, including GP surgeries, schools, clinics and at home. This links explains more about CAMHS

 

  • If your son or daughter is over 18, they will usually be referred to adult services, perhaps to a local “Improving Access to Psychological Therapies” (IAPT) service. IAPT services provide evidence-based talking therapies (mainly CBT) for a wide range of mental health problems.

 

  • If there is a long wait for accessing local services, your GP should keep in touch in the interim and monitor the situation. If this does not happen as a matter of course, do get back in touch with your GP and make regular appointments to see him/her so that they can monitor the situation.

 

  • You may choose to find your own private therapist. Make sure that they are registered and accredited by a professional body. Do also check that they are used to working with children and young people. Sometimes private health insurance will pay for therapy. For a therapist specialising in CBT, check that they are accredited by the British Association for Behavioural and Cognitive Therapies (BABCP). To find an accredited CBT therapist in your area go to the BABCP website

  • Your son or daughter may be able to visit a school or university counsellor.

  • Local voluntary groups also sometimes offer counselling. However, do make sure that they are registered and accredited by a professional body, (such as the Health Professions Council (HPC), United Kingdom Council Psychotherapy (UKCP) or British Association for Counselling and Psychotherapy (BACP), as well as experienced in working with children and young people.)

 

Whichever route you choose to go down, it is important that your son or daughter is happy with the therapist – be prepared to see more than one person to make sure you find the right 'fit' for your child’s situation.

 

Medication

 

Your GP is unlikely to suggest medication initially if the depression is mild. If it continues or worsens she/he may review this decision.

 

Psychological help may be enough on its own to treat the depression but sometimes medication will be prescribed alongside therapy if depression is severe.

 

What to do if you unhappy about what is offered

 

If you are not happy about what your GP suggests you should ask again for help in line with the NICE guidelines, or ask to see another doctor to seek their advice.

There are a number of different ways you can complain about Mental Health Services available if you are not happy with treatments offered. See the Young Minds website for advice.

Or contact your local Healthwatch.

What YOU can do to help

You can help by keeping family routines as normal as possible.

"I just wanted friends and family to treat me normally,” is familiar feedback from young people.

Showing them that you care by ordinary acts and not just focusing on your concerns is important. It will keep you in contact with how they are feeling and help them not to feel isolated.

Let them feel “we” can sort this out and not “I” am alone in this.

For examples of how parents can help see this Time To Change blog


Linking your son or daughter into self-help information that they can read and use at their own pace will allow them some privacy.

 

It may be difficult to know if they are accessing or taking up your suggestions. Once you have spoken to them, you could send things to read or self-help links by a text or an email rather than keep trying to talk if tensions are high.

Self-help links include ElefriendsTeenage Health FreakYouth SpaceEpic Friends and Students Against Depression.

 

You may also want to consider your own mental health needs whilst supporting your child. Making positive changes to lifestyle and routine can be useful to the whole family.

The Royal College of Psychiatrists has helpful information for the whole family.

Young Minds also has a helpline for parents themselves: 0800 802 5544

 

If your son or daughter is at university there may be student run groups that offer peer support as well as university counselling services.

 

If they have started work they may be able to access a confidential support scheme, these are often called Employee Assistance Programmes.


Keeping other people in the loop can be important for your son or daughter to help them feel supported and on the right track.

If they are at school, their form tutor, or personal tutor, will be used to dealing with mental health and family issues. Talk to your son or daughter about who needs to know what and exactly what is going to be said to whom.


Other siblings and close friends may also need to know what is happening. Try to normalise the situation by accepting it, and supporting your child.

This section of the Rethink site is for siblings of someone who is depressed

 

What if your child refuses help?

 

Your son or daughter may not respond to you, talk to you or use any of the information you suggest. They may also refuse to seek help or to see a GP.

You can see a GP for help and advice for yourself, even if your son or daughter will not.

A doctor or a therapist may be able to give you suggestions or material for your son or daughter to use in private or ideas of things you could say to persuade them to seek help.

School is another important starting place: pastoral staff will be used to dealing with parental enquiries.

Contacting a person who is already involved with your son and daughter and expressing your concerns can allow them to follow it up on your behalf and offer you some support.

If you son or daughter is worried about attending an appointment suggest someone who they may like to go with. This could be a friend or other family member.

Make them aware of self-help and reading material. And always ask what they think will help – they may have ideas that you are unaware of.

Provide practical support to lighten the load overall and reduce feelings of stress and anxiety. Being consistent and not ignoring or criticising them may encourage them to take action.

Other useful web links

This link will help you find your university counselling service service

This link will help you find student run self help groups in University and College settings

This link provides a comprehensive range of information, advice, and guidance about young people and mental health

End note

We are grateful to the organisations that have provided access to their information to help create this parent’s guide.

 

The information has been reviewed by:

  • Mary Bennett, Clinical Psychologist

  • Professor Roz Shafran and Pamela Myles of Bespoke Mental Health Consultancy Services LLP

  • Dr Monika Parkinson, Charlie Waller Institute

 

Author: Jackie Williams, M.A. MBACP (Accred)

 

Endorsements

This guide is endorsed by the following organisations:

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Young Minds Logo
Papyrus logo
Student Minds logo

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