Why teens’ mental health may be more strained than you think heading into the holidays

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While many people might think of the end of the year as a time to wind down one’s workload and take a break, a Toronto psychiatrist says young people may actually be carrying more stress than usual heading into the holiday season.

“A lot of depression, a lot of anxiety, or general struggles with school as well – I would say that’s what we see, most commonly,” Dr. Kevin Gabel told CP24.com in a recent interview.

Gabel is a psychiatrist who runs the Day Hospital program for children and youth at North York General Hospital (NYGH). The program provides academic, mental health and coping skills to high school-age youth who are having trouble attending school because of anxiety or other mental health challenges.

Although parents might think of the start of the school year as the most stressful time of the year for kids, Gabel says he’s noticed that November is in fact one of the busiest months for youth seeking mental health services.

“I think just a lot of it is related to more pressures with school,” Gabel says. “Sometimes the seasonal effect as well. It gets a little bit colder and darker with the winter months coming. There can be a little bit more stress around that too.”

He points out that while the start of the academic year may offer students a chance to ease into school after the quieter summer months, by October and November, classes are in full swing.

Eating disorders, social difficulties and problems exacerbated by ADHD are some of the other issues the hospital sees ramping up in addition to mood and anxiety problems.

A survey released by the Centre for Addictions and Mental Health (CAMH) in August found a “worrying” overall decline in mental health among Ontario students in grades 7 to 12. It found that 37 per cent experienced elevated stress levels, while 51 per cent reported a moderate-to-serious level of psychological distress. That last figure has doubled over the past decade, the report’s authors pointed out.

The survey, which collected data from more than 10,000 students across the province, found that 33 per cent of students felt they needed mental health support from a professional during the past year, but did not seek it.

“The most common reasons cited for not seeking help are thinking they could manage it themselves, being afraid of what others would think about them, and being ‘too busy,’” the report said.

How to tell if your teen’s mood is concerning

Gabel says that while stigma around seeking mental health services has been decreasing, some young people might still be ambivalent about seeking help.

“So we certainly always encourage parents to have open communication with their teenagers and just sort of being there and listening and trying to understand what they’re experiencing,” Gabel says.

However he acknowledges that sometimes figuring out what a teen is feeling can be challenging.

Feeling down or anxious for days, or even weeks, could be a sign that something more is going on beyond regular stress, Gabel says.

“And then also when it really starts to interfere with their functioning. And the big areas we look for in teenagers, are sort of changes at home, at school, with peers,” he says.

Avoidance, becoming more withdrawn at home or not seeing friends as much are also signs to watch for.

“So really looking at the persistence, like something that’s lasting, and also how much it’s interfering with their functioning, or grades really dropping. So any big changes we really look for,” Gabel says.

On a positive note, many of the teens who do come in are enthusiastic about talking through some of the problems they’re dealing with, Gabel says.

“All of our therapists on our teams who do the assessment really try to come at things sort of being open, non judgmental – just trying to sort of meet a teen where they’re at, and trying to understand what they’re experiencing.”

Program caters to those struggling to attend school

Gabel says the day program at North York General is “unique” in that it offers services specifically for kids who are struggling with their mental health and having trouble attending school.

“With our program, they come in, they get therapy, they get school, sort of typically around an eight-week program,” he says. “We try to help them transition either back to their current school or sometimes to maybe a different school or different program.”

While the causes of teens’ mental health problems vary, Gabel says at least some of the patients he sees are struggling to re-adjust to life after pandemic lockdowns.

The number of mental health visits to NYGH’s Emergency Department doubled from 40 in September 2019 to over 80 in September 2024.

“I think for a period of time, for different reasons, you didn’t have to go to school. There was sort of that option to stay home,” Gabel says. “And I think for some of those kids, even though it’s a few years later now, it’s still sometimes a struggle getting back. The more you avoid something, or aren’t engaging in something, it can be a little bit harder to get back to it.”

The holidays can also present challenges for teens who are struggling

“For teenagers, that’s coming into exams, the term is ending, so there’s some stress around that, certainly,” Gabel says. “Or if they’re struggling with family conflict that can be exacerbated around the holidays.

“Sometimes socially there’s even more opportunity to connect with friends and peers over the holidays, but sometimes if a kid is struggling with that, that can be highlighted a little bit. So yeah, I think all of those are challenges.”

How to seek help

An assessment at NYGH is covered by OHIP and most of the youth mental health services are covered in some way, Gabel says. The hospital’s services are listed on its website.

Those needing help or referrals to other mental health services can also contact Kids Help Phone or Help Ahead, a centralized phone line to access child, youth and family mental health and well-being resources in Toronto.

Those in crisis and in immediate need of assistance should call 911.

People can also dial or text 988 to be connected with the national suicide crisis helpline.