A Parent and Nurse Practitioner Opens Up About Mental Health

Christine Waggoner speaks about the importance of listening and keeping friends close.

[Disclaimer: This article includes discussions of sensitive mental health topics, including suicide.]

In 1949, Mental Health Awareness Month was established in May “to increase awareness of the importance of mental health and wellness in Americans’ lives and to celebrate recovery from mental illness.” Every year, this month acts as an opportunity to speak about the importance of mental health, break stigmas and better our understanding of this crucial topic. The American Association of Nurse Practitioners^® (AANP) is committed to advancing mental health care by supporting nurse practitioners (NPs) through continuing education, legislative advocacy and community partnerships. As frontline providers across every setting, NPs are uniquely positioned to lead integrated, compassionate and preventative approaches to mental wellness.

In commemoration of Mental Health Awareness Month, AANP spoke with Christine Rankin Waggoner, DNP, FNP, PMHNP, an NP based in Mississippi. Four years ago, her son, Malcolm McArthur, took his own life. After this tragedy, Waggoner became determined to celebrate Malcolm’s life through the creation of the Malcolm McArthur Memorial Scholarship, and she is open and candid about her loss and the importance of mental health for everyone — family members, patients and practitioners — and about how to best reach adolescents who may be struggling.

A Family and National Crisis

The National Institute of Mental Health reports that, in 2021, an estimated five million adolescents “in the United States had at least one major depressive episode. This number represented 20.1% of the U.S. population aged 12 to 17.” Adolescents are dealing with an array of stresses that are different than what previous generations have encountered. The combination of social media, mass violence and political polarization sitting alongside the already-frenetic pace of young adulthood means that many families struggle to find the time to slow down and just talk. “This society has become go, go, go,” relates Waggoner. “We're going to dance, we're going to baseball, we're going to soccer, and then it's nine o'clock, you're sitting down with some microwave chicken tenders thrown on a paper plate…to do it all over again the next day.” Her biggest takeaway, she says, is “you’ve got to engage your children. We’ve got to slow down some.”

When it comes to adolescents experiencing depression, Waggoner says that “we’re watching for changes in behavior, social withdrawals, different patterns. Of course, it’s hard with teenagers because they’re changing and they’re moody and they’re hormonal anyway.” However, she puts special emphasis on quality time and just listening. “It’s time to have dinner with your family. It’s time to know what your kids are doing, get off the devices, get off social media, know what’s going on.”

One way an NP can screen for suicide risk in adolescent patients is by using the Ask Suicide Screening Questions (ASQ) tool. An article for the Journal of the American Association of Nurse Practitioners (JAANP) found that, in one study conducted at two adolescent-focused health clinics, “Most clinicians reported that using the tool was feasible within their practice (66%) and 100% endorsed its acceptability (i.e., reporting that they were comfortable screening for suicide and that the ASQ was easy to use).”

After noting negative patterns, a caregiver has a chance to open a conversation about what may be wrong. Being open and vulnerable is a step to help young people relate and feel comfortable sharing: “I think as NPs, we have to ask those hard questions. And sometimes it’s uncomfortable, but once you ask and make yourself comfortable saying, ‘I felt down the other day, how are you doing?’, it’ll make somebody start talking.”

When her son began showing severe depressive symptoms, Waggoner and her husband worked to find any kind of lasting or helpful treatment and spoke with him constantly about what he was experiencing. “With Malcolm, he was depressed for so long and we walked that walk with him every day,” she says. “I mean, the things we did — you just don’t give up on your kids.” Even an effort to have Malcolm committed to a mental institution was unsuccessful. “We were working with the psychiatrist pretty tightly… they were trying to get him on something that has an anti-suicidal effect. But that didn't happen.”

Support Systems

Now, Waggoner is asking young people to open up through a scholarship her family created in Malcolm’s honor. The scholarship, named after Malcolm, is awarded to two seniors from Malcolm’s high school every spring. “Malcolm was a very quiet and reserved young man, but he was very loyal and committed to his friends,” states the scholarship description. “Malcolm had a wide variety of types of friends — to be Malcolm’s friend was truly an honor to all.” The scholarship asks applicants to consider the prompt — “What does it take to be a good friend?” — and write an essay about what friendship means to them. “Every year we get more and more applicants,” says Waggoner. “You would be surprised how the most popular kids, the prettiest kids, the smartest kids, all struggle with friendships.”

When it comes to her own mental health, Waggoner also values the importance of having friends and sees a mental health professional. “I’ve got great, great, great friends,” she says. “I go to therapy. I think that everybody should go to therapy, even when you feel great, to keep you on a good path.” When it comes to staying on that good path, she says, “I would love to tell you that I sit here and eat salads and exercise,” but “when my white flag goes up, I’m calling the therapist, because sometimes life is a lot. And even with Malcolm, everybody thinks, ‘Oh, you’re doing so good.’ You know what — I cry on the way to work three mornings a week, and I get it out and it’s okay. And I talk about him. I don’t care if people want to hear about him or not, or if it makes people uncomfortable talking about him. I say his name. For me, the biggest thing is you’ve got to surround yourself with people that care about you, people that are truly interested in you and are compassionately wanting to know how you are doing and checking in with you.”

More Mental Health Resources

Any person who is experiencing a mental health issue can call the Substance Abuse and Mental Health Services Administration hotline at 1-800-662-4357 for free, confidential assistance at any time of the day or night.

A recent podcast episode of NP Pulse: The Voice of the Nurse Practitioner® is also dedicated to the subject of adolescent health, and “emphasizes the importance of upstream prevention, holistic care, reducing stigma, and integrating mental health support into primary care.”