The pandemic’s impact on youth mental health is compounding California’s preexisting youth mental health crisis, and behavioral health services for young people in the state are struggling to meet the extremely high demand.
In a webinar hosted by the Little Hoover Commission on Monday, representatives from Children Now and the California Alliance of Child & Family Services (CACFS) responded to the Little Hoover Commission’s recommendations for state leadership to strengthen youth behavioral health services. These recommendations were originally published in the commission’s report on COVID-19’s impact on youth mental health released in August 2021.
The commission cites considerable data to support their claim that California youth remain in a behavioral health crisis. According to the California State Auditor, the annual number of suicides of youth aged 12 to 19 increased by 15% statewide between 2009 and 2018. Incidents of youth committing acts of self-harm increased by 50% during the same time period.
Additionally, the California Healthy Kids Survey found that the percentage of seventh graders reporting chronic sadness increased from 25% between 2011 and 2013 to 30% between 2017 and 2019. 11th graders reporting chronic sadness increased from 33% to 37% during this period.
The pandemic’s toll on youth mental health is also clear in the data — mental illness is now the leading cause of hospitalization among children, and California ranked 48th in the nation in 2020 for providing necessary mental health services to children. The commission’s report mentions that the UCSF Benioff Children’s Hospital in Oakland saw a 77% increase in children seeking emergency mental health services between May and December 2020, compared to the same period in 2019.
Sean Varner, vice chairman of the Little Hoover Commission, attributed this significant increase of youth in distress to the long-lasting feelings of loneliness that came as a result of the pandemic.
“Many young people experienced social isolation and disconnection, which I think they were already suffering from somewhat with regard to social media and the lack of human interaction when people are on their devices, but this just showed that additional measures in social distancing, remote learning, [separation] from their family and friends, are further exacerbating the issue.”
Varner also noted that youth in communities of color and low-income communities disproportionately bore the brunt of the pandemic’s mental health impacts.
“COVID’s Impact on California” subcommittee member David Beier said the commission had identified several main barriers to addressing children’s mental health needs in the state, such as a decentralized and fragmented child mental health system, severe capacity and workforce shortages, and complicated and administratively burdensome funding mechanisms.
Beier said the commission’s first recommendation to coordinate California’s response to the pandemic’s impact on youth mental health was to establish a single point of overall leadership for children’s mental health and set common outcome goals.
“We have commissions, we have oversight bodies, we have division and delivery between counties and school districts and commercial health plans, but we need somebody at the top of the house who’s looking at this and coming up with metrics to measure how many children are being counseled, and what are their outcomes. We need to know what we’re paying for and what’s happening with respect to the health status of children through the funding provided by the state.”
Children Now’s Director of Behavioral Health Lishaun Francis emphasized the importance of identifying specific outcome goals that prioritize reducing racial disparities.
“We can’t just focus on increasing the number of children who get screened for depression for example, we have to increase the number of Black and brown children who are screened for depression. The good news is if we do this, we will also improve the outcomes for white children. Systems that are failing communities of color are actually failing all of us.”
The commission’s second recommendation was to build capacity for statewide approaches to children’s mental health. The organization believest the $4 billion Children and Youth Behavioral Health Initiative passed by the legislature was a fantastic place to start. Beier said coming up with actionable plans to enact with the funding would be especially challenging, however, due to the size of the state’s population.
Francis said consumer feedback for children’s mental health needs to be a priority consideration in the formation of work groups for this initiative. She said data collection and feedback has to be solicited early and often so that the work groups can reflect the needs of youth and their families.
“How will we know the system we’ve created is responding to the needs of children and families if we have no idea what it is they’re asking for?”
The commission’s third recommendation was to center schools as sites for supporting child mental wellness. Due to the myriad of funding going toward mental health services in schools, Francis said Children Now hopes that the state can provide technical assistance to help schools and districts wade through the confusion of multiple funding sources that might have multiple goals and activities attached.
Francis also mentioned she was particularly excited about the toxic stress aspect of the initiative’s $100 million investment in public education.
“We think it’s vital that every family understands how toxic stress shows up in the body both physically and mentally. It’s why we sponsored SB 428 this year, which will allow commercial insurance companies to cover trauma screenings … We’d really love to see the state go out of its way to make sure that they’re educating communities in a fashion that they can receive the information, whether it’s by language or other cultural competence, as we think about toxic stress.”
Expanding on the commission’s original recommendations, Christine Stoner-Mertz, CEO of CACF, said addressing issues with the behavioral health workforce in California was top of mind for her.
She noted that salaries for behavioral health staff at non-profits serving low-income communities are at least 30% lower than others serving in public systems. Additionally, she said regulatory and contractual issues that impact how quickly new staff can be brought on poses a major challenge to improving workforce conditions, and that California needs to engage in efforts to retain staff in this field. These could include providing grants to non-profit community-based providers, loan forgiveness, and tuition reimbursement.
She said engaging community colleges in the development of behavioral health apprenticeships would also be a key strategy to recruiting more individuals for this workforce.
“[This will help] students begin early in their educational career to learn about work in children’s mental health, and we’d like to see funding that supports this effort either through the behavioral health initiative or new funding in the 2022 budget … Not every mental health staff needs to have a masters degree. They do need to be well-trained and they need to be supervised, but there are models that currently exist that could be implemented across [school] districts in partnership with [community-based organizations].”