Nineteen-year-old Trace Terrell is studying public health and writing at Johns Hopkins University, specifically how mental health advocates like himself can use narrative and poetic voice to contextualize public health in research and policy. “Lived experience is sometimes put to the side when it can be a powerful way to talk about health and how we care for our wellbeing.”
Terrell struggled with suicidal ideation, depression and disordered eating in middle and early high school. He lived in La Pine, an isolated community in Central Oregon. “From a young age, I felt alone — no one was having conversations about mental health.” Healthcare resources were also limited. “There was one clinic in town that everyone went to, and you wouldn’t want other people to know you’re actively struggling.”
He says feeling isolated was compounded by his queerness and gender. “Men’s mental health isn’t talked about much and we’re often told to be stoic and stubborn — so what are we supposed to do when we’re struggling?” His desire to help teens who felt like him motivated him to get involved with mental health advocacy as a high school freshman, working as a volunteer at YouthLine, a peer-to-peer support helpline at Lines for Life in Oregon.
Talking to people and helping them with their challenges taught Terrell how to navigate his own. It also showed him that he wasn’t alone. He says the exchange between a person reaching out to the line and a peer counselor — “two people expressing truth and vulnerability” — is life-changing. “There’s a vulnerability in storytelling and sharing the challenges you’re facing. Having your story resonate with a peer and reflected back to you is incredibly powerful.”
Talking about his thoughts of suicide, says Terrell, is what saved his life. From 6th grade until he was in 10th grade, he went to bed, wishing he’d wake up straight. “I’d tell myself, maybe if I were straight, I’d be normal, and any mental health concerns wouldn’t be there.” He thought no one could understand his feelings, which further isolated him. “Learning there were numerous others in my position helped — I wanted to be that person for someone else.”
His first few shifts on the helpline, each about three hours long, helped Terrell realize the challenges people were experiencing. “My struggles were a microcosm of these much larger public health issues that affect hundreds of thousands of young people across the country.” After a shift, he’d spend the hour-long car ride home thinking about the calls. “It was so powerful and awakening for me to have these conversations and realize I could use my skills and knowledge to help people.”
Two years ago, child and adolescent mental health was declared a national emergency. As communities and mental health experts scramble to address the emergency, Terrell says they must provide ample opportunities for young people to share their stories and have their efforts translate into change.
For the first time since President John F. Kennedy’s Community Mental Health Act of 1963, there’s widespread legislative momentum because of 988 — the nationwide number for mental health and suicide crisis — and the Covid pandemic. Talking about mental health was already happening before Covid, points out Terrell, but the public health emergency further normalized conversations and federal and state dollars provided funding for communities to address the adverse impacts of the pandemic.
As communities throughout the United States redesign, expand and implement their crisis systems and overall mental healthcare systems, Terrell says momentum can’t be lost legislatively and young people must be actively involved. “We need to lead the charge when it comes to legislation that impacts and shapes youth mental healthcare.”
Young people who want to be involved in mental health advocacy — working to normalize dialogue for themselves, their families and their communities — are often sidelined. Biases foster misconceptions that youth can’t meaningfully or substantively engage in advocacy. “Many of us are also not taken seriously by adults because they think the challenges we’re facing aren’t intense enough to give a lot of merit or credibility,” says Terrell. These falsities, he says, are a disservice to the work of young people across the nation who are leading mental health advocacy in their communities.
“They’re forming their own campaigns and initiatives and talking with their friends about mental health. Change really requires adults to reflect and acknowledge that mental health concerns are valid and can happen from an early age.”
Crisis intervention services for teens led by teens give youth a safe space; they also, notes Terrell, provide early exposure to the mental health professions. He shares that, anecdotally, he’s seen the impact — he and other former Youthline peers are pursuing careers in the field. He plans to work in mental health policy while others he worked with are training to become therapists. “These are opportunities to build out our mental health workforce during a time when there are shortages across the country,” he says.
Having youth work in mental health support services also has immediate benefits, not just for the person in crisis and volunteers but also the community at large. “When you learn skills on a teen crisis line, you’re able to take them off the shift as well,” says Terrell. “We learn active listening, resilience and strength-based mindsets, how to take care of yourself and respond to a friend in crisis.” Teen volunteers become impromptu peer support at school, with family and friends and in the community, helping weave a safety net of support.
The skills he learned, especially how to broach difficult conversations, helped him come out to his parents. “At Youthline, we emphasized that what happens after the call is just as important as what happens during it,” he says. That means having a safety plan if the person is at risk of suicide or ensuring they have a few self-care steps to take after a call. “That might be watching a movie or talking to a friend but also can include brainstorming how to bring up conversations with a loved one — where and when to have it.”
His training taught him the logistics of having hard conversations, such as when is the best time and with whom to share information. “It helped me to map out my support system and who were my go-to people,” he says. He first came out to his sister-in-law, who supported and helped him strategize how to tell the rest of his family. “I was doing that on calls, helping teens navigate conversations in a way that worked for them, keeping them safe and protected and ensuring their agency and autonomy.”
The skills he learned to talk about mental health weren’t accessible elsewhere, not at school or home. He’s not alone. “Far too many young people don’t have people in their lives that can help them through challenges,” he says. This reinforces his public health approach to mental health. “Mental health education and life skills need to be wherever young people are — school, home and social media.”
Terrell is on the Youth Advisory Council for MTVE and Active Minds’ new campaign A.S.K. “It’s teaching people the stop, drop, roll for mental health,” he says. The goal is to strengthen the youth community safety net by teaching young people to just A.S.K. — an acronym for acknowledge, support and keep-in-touch.
He believes that opening up opportunities for youth peer support would help young people learn mental health skills that will remain with them and help build a more aware and supportive community. “For me, the act of helping others helped me help me, but also, these skills, especially those focused on communication, are so translatable to other parts of a person’s life.”