I’m looking for advice for my own son who is 19 and in his first year in college. He has been on anti-anxiety medication for 18 months and earlier this year he had a type of breakdown (was suicidal, experienced hallucinations) and the GP put him on medication for depression and anxiety.

Over the last two years, he has been seeing a counsellor on and off, which has helped somewhat. He recently said he didn’t think this was enough and thought he needed something more specialist (and he has been more down in himself). There’s a range of issues going on with him – gender issues, friends/relationships/etc, excessive drinking. He has stopped drinking since going on the meds, but this has led to him not going out as much, as his friends are always drinking when they go out.

I think he may need more of a specialist for depression. Do you think he needs to go to see a psychiatrist? I would be grateful for whatever advice you have.

Answer

Many young people experience significant mental health problems in the transition years from school to college. This is a time of great change and great stress, as young people have to forge their own identity, discover what they want to do with their lives, and work out what friends and relationships fit best with them. It is not surprising that many experience anxiety and depression and may even go through a significant ‘breakdown’ like your son.

While a medical or psychiatric response is very important, simply prescribing medication is not usually sufficient to resolve these challenges in the long term. In his well-researched book, Lost Connections, Johan Hari explores the many causes of depression, such as loneliness, lack of purpose, trauma, and proposes many solutions and actions that can help. Also, in his book Coming through depression, the Irish psychologist Tony Bates describes a holistic way to resolve depression and to come through with increased meaning and purpose.

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It is good that your son is talking to you about his depression and upset, as it would be worse if he was “bottling” his feelings up which would increase his isolation. In terms of making progress, there is not usually a “one size fits all” and it is case of supporting your son to engage in a personal journey to find the right supports and to make the right life choices that best suit his needs. When working with young people who have been through a mental health crisis, I often encourage them to see the crisis as a “turning point” and as providing an opportunity to deepen their self-understanding and to discover the life they want to lead.

One of the advantages of attending college is the usual availability of accessible inhouse multidisciplinary mental health and learning support services (including psychiatry and counselling) that your son could explore to see what might help him. Some of the services might be self-led by other trained students and some can be delivered in groups which may suit your son.

In my experience, many young people who have been through a mental crisis become helpers themselves and this can be of benefit to them also. In addition, colleges usually have many active student-led societies and groups that may either help your son directly such as an LGBTQ+ society which might support him explore his gender issues (if he is ready to do this) or a student meditation group which might help him manage depressive thinking or a mountain climb with the hiking club might allow him to forget his problems, etc.

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Of course, your son may prefer to pursue support outside of college and this is an option. For example, Belongto.org have extensive supports for gender-questioning young people. It is good that your son already has had a good experience of counselling and he could go back to his existing counsellor for support and/or pursue the supports listed above in parallel. Alternatively he may wish to pursue a fresh start with a new professional service.

In your question, you briefly mentioned some of the issues that might be underpinning your son’s mental health challenges notably gender issues (discussed above), friends/relationships and alcohol. It strikes me as significant that he is in a friendship group that is dependent on drinking to stay connected. This could be a sign that he is masking his true need for relationships/friendships that are built around shared passions and deeper connections. He could explore meeting his existing friends in alcohol-free contexts and this might be easier in small groups or one to one. In parallel, he could also reach out and make new friendships.

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Through its societies and groups, college can provide a vast range of opportunities to try out new passions, interests and identities whether this is playing boardgames, engaging in social activism or trying out scuba diving or drama.

Such opportunities can help him make deeper connections with like-minded people and maybe to discover that truly makes him happy.

John Sharry is clinical director of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books including Positive Parenting and Parenting Teenagers. See solutiontalk.ie