(NEW YORK) -- Eva Long was a funny, bright and goofy child who became a talented singer, piano player and songwriter in her teen years, according to her mom, Caroline Long.
She was also someone who battled depression, an increasingly common mental health struggle among teenagers, but one that Long said Eva worked hard to keep a secret.
"She was so worried about people finding out," said Long, adding that the shame kept Eva from wanting to see a therapist. "She didn’t want anyone to know. She wanted to keep it so secretive."
The changes in Eva's mental health started in eighth grade, according to Long, who said she thought at the time that Eva was experiencing typical teenage angst.
"In eighth grade she had a phone and the social media thing was starting ... all the posing that the girls do, and the pictures. All that stuff, that was the beginning of it," said Long, who lives in Colorado. "Going into her freshman and sophomore years, she was just kind of struggling to figure out who her friends were."
"She would come home, exhausted, and she would say, 'You know, it's so hard for me, because I feel like I have to pretend,'" Long said.
For years, the rates of mental health struggles among teens have been on the rise in the United States. By 2019, the number of children between the ages of 3 to 17 with a diagnosed mental or behavioral health condition rose to over eight million, according to Department of Health and Human Services (HHS) data.
Long said she took advice from other mothers whose daughters were also struggling with mental health and sought professional help for Eva, who refused.
Then, in the spring of 2020, at the end of Eva's senior year of high school, the coronavirus pandemic struck, and Long said she watched her daughter revert even further.
"They stopped having school in person, so they all had to do online classes," said. "It was very isolating for all the kids, and for Eva, it was really, really devastating because she scrolled through social media that much more. There was just a huge disconnect from actually engaging with people."
Eva did not have a senior prom or a high school graduation, but earned her high school diploma and went on to study at a state university in Southern California, according to Long.
Though she faced difficulties -- including what Long says Eva described to her as two instances of sexually violent behavior from male peers -- by the end of last summer and the start of her sophomore year of college, Long said she saw Eva in a good place mentally and physically.
It made it all the more devastating to Long when, on Sept. 17, 2021, she received a phone call that Eva had died by suicide while away at college.
"I was just in shock. I said, ‘This can’t be real. This can’t be true," said Long, who was traveling overseas at the time. "That cry of a mother when they’ve lost their child is a pretty wicked one, and I couldn’t stop it."
It was the same grief-stricken cry Honey Beuf said she experienced two years earlier when she received a phone call on Jan. 8, 2019, that her then-19-year-old daughter, Liv, had been taken to the hospital while away at college in Colorado.
Liv later died, a death that was caused by suicide, according to Beuf.
"What you go through as a parent is you feel everything so viscerally and on a cellular level, it’s so incredibly awful. I sometimes have such a hard time putting it into words," said Beuf. "You can’t even process it, let alone the fact that she’s gone because she ended her own life."
Liv was diagnosed as a child with a nonverbal learning disorder that doctors said made her prone to depression and anxiety. Beuf said Liv started seeing a therapist early on.
In middle school, after episodes of bullying that Beuf said worsened her mental health, Liv went on medication, according to her mom.
Though her mental health was always at the forefront, Liv did well in high school, becoming a cheerleader and vocalist, and the "funniest person you've ever met," according to Beuf. She went on to college and told her family the day before she died that she wanted to become a mental health therapist.
Liv was also member of the LGBTQ+ community, according to Beuf, one of the populations of young people identified as most at-risk for suicide, according to the Centers for Disease Control and Prevention (CDC).
Though Liv was open with her parents and siblings about her mental health struggles, she hid it from her peers at college, which Beuf said she believes was a "huge contributing factor" to her death.
And it was only after Liv died that Beuf said she and other family members learned the extent of her struggles, which she said also included binge drinking.
"After she passed away we found all her journals and we saw the journaling of like eating, weight loss logs, different groups on Facebook for people to get information on how to continue their eating disorders," said Beuf, who said she knew Liv has struggled with an eating disorder but thought she was in recovery. "When we got hold of her phone, looking at her social media posts, the number of photographs she would put up and then take down."
"For one post, there would be like 50 photographs in her camera roll," continued Beuf. "I had no idea that she was that intensely into trying to perfect the image that she was putting out there."
A growing mental health crisis
In the years since their daughters' deaths, both Beuf and Long said they have watched as the mental health crisis among teens, particularly teen girls, has only grown.
"You think they’re doing fine because they’re very quiet about it and they don’t share," Long said.
"I think maybe they don’t even know what they’re going through," she said of teens who struggle. "And parents have so much shame. What I hear is, ‘I knew my son or daughter so well, how could I have not seen this?’ It's the worst grief."
Beuf described herself as "stunned on a daily basis" by the growing mental health crisis she sees across the country and through families that reach out to her after the loss of a child to suicide.
"One mom just reached out to me who lost her 11-year-old," she said. "The statistics are horrifying."
Among girls ages 12 to 17, there was a 51% rise in suspected suicide attempts from Feb. 21 to March 20, 2021, compared to the same time period in 2019, according to data released last year by the CDC.
Last year, amid the pandemic, youth mental health was declared a "national emergency" by a coalition representing over 77,000 physicians and over 200 children's hospitals.
U.S. surgeon general Dr. Vivek H. Murthy issued a 53-page advisory warning of a growing mental health crisis among young people, writing, "The challenges today’s generation of young people face are unprecedented and uniquely hard to navigate."
While the pandemic put a spotlight on kids' mental health, experts say, it has been a long-boiling crisis. Between 2009 and 2019, for example, the number of high school students in the U.S. who reported feeling sad or hopeless increased by 10 percentage points, to nearly 37%. The number of students having seriously considered attempting suicide increased in that same time period from nearly 14% to 19%, according to CDC data.
"We were already kind of in a place of a very serious and significant mental health and suicide crisis, even before the pandemic began," said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention (AFSP). "And during the pandemic, there have been some further data points that relate to girls in particular."
According to Moutier, suicide rates for youth have been on the rise in the U.S. for the past 15 years. As of today, suicide is the third leading cause of death for kids ages 10 to 19, and the second for young adults ages 20 to 34, the AFSP said, noting that suicide disproportionately impacts Black children and kids who identify as LGBTQ+.
Suicide deaths are much more prevalent among men, while suicide attempts are much higher among women.
Long said she believes her daughter Eva's death was done on impulse, saying, "I think she didn’t want to die but she just wanted the pain to end."
Moutier said that while girls still remain less at risk for death by suicide, the past two years of the pandemic have seemed to impact girls in different, worrisome ways when it comes to their mental health.
In April, a CDC survey found that nearly half of high school girls in the U.S. said their mental health was not good most of the time or always during the pandemic, almost double the percentage of boys who reported the same.
"The pandemic meant less in-person time with their peer group and in healthy activities with their peers, such as academics, athletics, other kinds of positive social engagement, and more might have shifted towards screen time and social media time," said Moutier. "We wonder if that's one of the reasons that girls' distress level was kind of pressed upon, perhaps even more so than boys as a group."
Dr. Nicole Cammack, a licensed clinical psychologist and president of Black Mental Wellness, a Washington, D.C.-based practice, said she believes girls suffered more of a loss of coping tools during the pandemic. She said girls, particularly Black girls who face greater mental health stigmas, often have a harder time asking for help.
"I have a lot of young girls who come to therapy, and it's a struggle to even get to the place of feeling empowered to say, 'These are the emotions or the feelings or the struggles or challenges that I'm having,'" she said. "Even being able to put that into words could feel very different."
A difficult search to find help
Hannah, a 14-year-old from San Diego, California, was finishing sixth grade in 2020 when the pandemic began and her classes shifted online.
Hannah, who asked that her last name not be used to protect her privacy, said she became a "hermit" in her room, turning to her phone as a social outlet.
"I think that definitely was negative," she said. "I had my phone and we did a lot of FaceTiming and texts, so I wasn’t completely cut off from my friends, but it was definitely different from face-to-face contact and seeing each other and socializing every day."
Hannah's mom, Brooke, who also asked that her last name not be used, described her daughter's phone habits during the pandemic as "endless scrolling" on social media. In time, she said she noticed personality changes in her daughter, including after Hannah returned to school in-person.
"Any social interactions seemed to be really taxing, and I was watching her not just get shy and show signs of anxiety or stress, but extreme fatigue, especially when she went back to school," said Brooke. "She would just come home from school and hit the bed and fall asleep for hours and hours and hours."
Fatigue is an early sign of depression and anxiety, along with other changes in behavior like withdrawing from activities and friends, eating more or less, sadness or irritability, avoidance and performing worse in school, according to the Child Mind Institute, a nonprofit organization focused on kids' mental health.
Brooke said she decided to have a direct conversation with Hannah about her mental health after she said three friends who are moms had teenage daughters who attempted suicide within the span of a few months.
At the advice of those friends, Brooke asked Hannah directly if she had thought about killing herself, to which Hannah replied she had multiple times.
Long said it is a question she wishes she had asked Eva.
"If I could go back, that's what I would do over," said Long. "I think all parents should ask their children, 'Have you ever contemplated suicide? Have you ever attempted suicide?' You have to keep at it with your children, keep asking those questions, keep that conversation open."
For Brooke, while she said the conversation with Hannah was difficult, what surprised her more was how difficult it became trying to find help for Hannah. After taking her to a behavioral health urgent care center in San Diego, Brooke said she spent three weeks and countless hours on the phone trying to get Hannah in to see a mental health expert.
"I started calling and emailing dozens of different clinics and providers and didn’t get any responses or got responses saying they were completely full or had a seven month wait-list," she recalled. "Nothing was improving and I felt extremely frustrated and helpless and then you start to worry if I really can’t find help, how do I make sure things aren’t getting to an acute state?"
The lack of mental health providers to treat young people is a nationwide issue due to the unfortunately high demand, according to Dr. Hina Taib, a pediatrician and adolescent specialist at the Atria Institute in New York City.
"There truly is a bottleneck with not enough services to meet the demand," she said. "Some of the most common questions I get are how do I find a therapist, or I can’t find a therapist and how do I convince my teen to see a therapist."
Long said she experienced the shortage firsthand when her daughter Eva came to her the summer before her death, asking to see a therapist.
"It was the first time she said she wanted to see a therapist but I called probably 60 therapists and all of them were full," Long recalled. "There are not enough therapists out there to deal with the amount of depression going on today."
Moiya Toliver, now 20, said she had no mental health resources available to her when she began to withdraw from life as the pandemic hit in her senior year of high school.
Switching to online school, she said, left her with no way to socialize with her peers, and without the ability to go to school ever day, she was stuck in what she called a "toxic" situation at home with her family.
"I sunk into a more depressive state," she said. "And I really didn’t have time to ground myself and try to figure out how to regain myself mentally. I just had to basically push through."
Toliver said no one she knew in her small hometown in Texas, including at her school, talked about mental health.
It was only when she began attending Howard University in Washington, D.C., that Toliver said she heard people openly discussing mental health, which allowed her to take steps to heal, including seeing a therapist.
Experts say that due to the high demand for mental health services among teens, there have been new efforts to respond.
"Pediatricians like myself and adolescent medicine specialists have been up-training themselves in therapeutic skills to be able to provide families with first steps into getting better mental health spaces," said Taib, adding for parents, "Mental health is health and your pediatrician is an appropriate point of contact, even a first point of contact, for a concern that you may have with your child."
The pandemic also spurred the use of telehealth, which has made it easier to access mental health help, especially for young people, both Taib and Moutier said.
Brooke said she was finally able to find a therapist for her daughter through Brightline, a virtual behavioral health company that, among other things, offers interactive mental health content and care tools for teenagers.
Hannah is now preparing to enter high school in the fall, she says feeling much stronger mentally thanks to the coping skills she learned and the freedom she feels to share her mental health struggles.
"I think that because the pandemic brought a mental health crisis, schools and the world began to recognize it more," she said. " That is when we began to talk about it more and more at school, and that’s when my friends, we started to talk about it more."
Mom and daughter work to end a mental health crisis
For Honey Beuf and her daughter Tess Kunik, one of her two surviving children, their grief over the loss of Liv was compounded by the growing mental health crisis among teens they saw playing out across the country.
"It makes me angry that we are not doing enough to support young people," said Tess, who was eight years older than Liv and considered her sister her best friend. "It makes me angry and then I kind of float in and out of re-traumatization and in my own grief."
After Liv's death, Beuf moved to Pennsylvania to be closer to Kunik. Together, the mother and daughter started a nonprofit organization, The Liv Project, which is focused on creating tools and resources to help kids and families talk about mental health and end the stigma.
In addition to presenting workshops on mental health in schools across the country, Kunik and Beuf worked with mental health professionals to develop a game, called The Game That Goes There, which provides prompts for people to have what Kunik describes as "fearless conversations about mental health."
"One of the responses that always stands out is one of the kids said, 'I like this game because it gives kids a chance to talk without adults thinking they have to fix this,'" said Kunik. "A lot of the people I talk with say, 'Adults want to jump in and fix us. We just want them to listen to us.'"
Added Beuf, "We've heard over and over again, 'The grownups come into school and they put up this big PowerPoint presentation and then they're done.' We need to be having these open dialogues [on mental health] all the time, every day."
Beuf said she believes it will take everyone -- parents, teens, schools, government, medical professionals, nonprofits and more -- fully listening to kids to turn the tide of the youth mental health crisis.
She said she wants to encourage parents especially to have "difficult" but open conversations with their teenage kids about their mental health.
"One of the biggest lessons that I've learned through this whole process that I wish I had known is that when your child is struggling, it's really important to just sit down with them, and say, 'I am here for you. I love you, and no matter what you say, nothing can scare me,'" said Beuf. "Just sit with your child and let them talk. They just want to be heard."
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada) and The Trevor Project at 866-488-7386.
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