SignsSigns a Teen Needs Mental Health Support. How to tell normal teen ups and downs from real warning signs, and what to do next.
A guide from The Blackburn Group. Last reviewed October 2026. This guide is general information, not medical or legal advice.
Moodiness or something more
Teens are supposed to be moody sometimes. What matters is how long a change lasts, how strong it is, and whether it gets in the way of daily life.
A bad day or a weekend alone in their room is often just part of growing up. A good rule of thumb: pay closer attention when a change lasts more than two weeks, shows up in more than one part of life, or seems out of character.
Changes worth noticing at home:
- Sadness, irritability or anger that does not lift
- Losing interest in things they used to love
- Big changes in sleep, like being up all night or sleeping all day
- Eating much more or much less, or new worry about weight and food
- Pulling away from family and friends, not just from you
- Worry or panic that stops them from doing normal things
Changes at school and with friends matter too. Watch for grades that drop fast, skipped classes, refusing to go to school, dropping a sport or club, or a sudden switch to a new friend group they will not talk about.
Signs of substance use
Many teens try alcohol or drugs, and it often goes along with stress, anxiety or depression. Take it seriously without panicking.
Some signs can point to substance use. None of them prove it on their own.
- The smell of alcohol, smoke or vape on breath or clothes
- Red eyes, slurred speech, or acting unusually sleepy or wired
- Missing money, pills or alcohol at home
- Vapes, lighters, small bags or unfamiliar pills in their things
- Breaking curfew or lying about where they were
Teens often use substances to cope with feelings they cannot name. So treat use as a sign to look deeper, not only as a rule to enforce. Lock up alcohol and medications in your home, including old prescriptions. If your teen may be drinking heavily or using pills like Xanax, know that stopping alcohol or benzodiazepines suddenly can be medically dangerous. Talk to a doctor.
Self-harm and suicide warning signs
These signs need action today, not later. If you are worried your teen may hurt themselves, call or text 988 to reach the 988 Suicide and Crisis Lifeline. In an emergency, call 911.
Warning signs include:
- Talking or posting about wanting to die, or about not being around
- Saying things like everyone would be better off without me
- Searching for ways to hurt themselves
- Giving away things they care about or saying goodbye
- Unexplained cuts, burns or bruises, or wearing long sleeves in hot weather
- A sudden calm after a long low period, with no clear reason
It is okay to ask your teen directly, in plain words, if they are thinking about suicide. Asking does not put the idea in their head. It tells them you can handle the answer.
If they say yes, stay calm, stay with them, and call or text 988 together. Make your home safer right away: lock up or remove firearms, medications and alcohol. If they are in immediate danger, call 911 or go to the nearest emergency room.
Starting the conversation
You do not need perfect words. You need a calm moment, a few honest sentences, and a lot of listening.
Pick a low-pressure time. Car rides, walks and late-night snacks often work better than a sit-down talk. Lead with what you have noticed and why you care, not with blame.
- Say what you see: I have noticed you seem really tired and quiet lately.
- Ask open questions: What has been the hardest part of your week?
- Listen more than you talk. Do not rush to fix it.
- Keep your own reaction steady. You can feel scared later, with another adult.
If they shut down, that is common. Let them know the door stays open and try again in a day or two. Some teens find it easier to text, or to talk with another trusted adult first.
Working with the school
The school can be a real partner. Counselors and teachers see your teen for hours each day.
Reach out to the school counselor first. Share what you are seeing at home and ask what they see at school.
If mental health is getting in the way of learning, ask about formal support. Public schools in the U.S. can offer a 504 plan or an IEP. These can include things like extra time, a quiet place to take tests, a reduced workload for a while, or a safe person to check in with. Put your request in writing.
Ask the school to tell you right away if they see signs of self-harm or suicide risk. Most schools have a plan for this.
The first evaluation and your options
A first evaluation is a conversation, not a test your teen can fail. It helps sort out what is going on and what kind of help fits.
You can start with your teen’s pediatrician or a licensed therapist, psychologist or psychiatrist. A first visit usually includes time with your teen alone and time with you. Expect questions about mood, sleep, school, friends, substance use, family history and safety. At the end, ask what they think is going on, what they recommend, and what to watch for at home. Our guide on what happens at a psychiatric evaluation walks through a first appointment.
Common options include:
- Therapy. Weekly sessions with a licensed therapist to build coping skills. Family sessions can help too.
- Psychiatric care. A psychiatrist can diagnose and, if needed, discuss medication. Medication decisions should always be made with a doctor.
- Neuropsychological testing. Useful when attention, learning or memory problems may be part of the picture. See what a neuropsychological evaluation is.
- A concierge outpatient program. More support than weekly therapy, built around school. Blackburn Clinical Services offers a teen Concierge Outpatient Program of 3 to 5 hours a week, so your teen can keep going to class.
- Mentoring for structure. A mentor is not a therapist, but can help with routines, school goals and motivation. Blackburn Mentoring works one-on-one with high school students, with parents kept in the loop.
If your teen is in danger or cannot stay safe at home, a higher level of care may be needed. Ask the clinician directly what level of care they recommend. For help choosing, see case management, mentoring or therapy.
Caring for yourself
Your teen needs you steady. That means your own stress needs somewhere to go too.
Guilt, fear and exhaustion are normal. They are not a sign that you failed.
- Talk to one or two people you trust, not your teen, about how you feel.
- Keep up the basics: sleep, food, movement and time away from the problem.
- Agree with your co-parent or partner on a shared plan, so your teen hears one message.
- Think about your own therapist or a parent support group.
Blackburn Recovery Services runs a free virtual family support group every two weeks that is open to any family. See also support for families.
Sources
Where to learn more from public health and official sources.
Next steps
If something feels off, trust that feeling and take one step this week.
Write down what you have noticed and when it started. Talk with your teen. Call the school counselor or your pediatrician. If you want help figuring out what fits your family, read Where to start, call (888) 305-5422 or email info@theblackburngroup.org.
If your teen may be in danger, do not wait. Call or text 988 to reach the 988 Suicide and Crisis Lifeline. In an emergency, call 911.
Related help in Los Angeles: Teen mental health help in Los Angeles. Or call (888) 305-5422.
Related guides
Questions
Will my teen be angry if I get help without asking them first?
They might be at first. Tell them what you are doing and why. Give them real choices where you can. Safety comes first, though. If you are worried about suicide, act even if they object.
How long should I wait to see if it passes?
If a change lasts more than about two weeks, or it is getting in the way of school, friends or sleep, it is reasonable to get an evaluation. If there are any signs of self-harm or suicide, do not wait at all.
Will a therapist tell me what my teen says?
Usually therapists keep most of what teens say private, because trust is what makes therapy work. They will tell you if your teen is at serious risk of harm. Ask about the privacy rules at the first visit so everyone knows what to expect.
What if my teen refuses to go?
Many teens resist at first. Try offering a single visit instead of ongoing therapy, or start with their pediatrician. A parent can also meet with a clinician alone to get guidance. Our guide on helping a loved one who will not accept help has more ideas.