Last month, California’s Health & Human Services Agency (CalHHS) released the Youth at the Center Report, which highlights what children, youth, families, and community members wish to see in a reimagined behavioral health system. The initiative commissioned 29 organizations to hold about 50 meetings in 2022, which allowed over 600 youth, families, and community members to share their insights and experiences.
Trauma due to the COVID-19 pandemic and the resulting mental health impacts were consistent themes across the meetings, and conversations brought up challenges of the current system of care. Overall, participants expressed disillusionment, mistrust, and sometimes anger at the behavioral healthcare system and how it failed them. Participants also frequently felt skeptical and hopeless about the possibility of real systemic change. The 12 proposed calls to action fall under three categories: shift thinking, reimagine services, and transform systems.
Throughout the conversations, youth expressed how stigma is more concerning in intergenerational settings, and said they experienced stigma from family members who had not had the opportunity to discuss and address mental health concerns of their own. Parents also noted a lack of information, resources, and support, which in turn limited their own understanding of behavioral health. According to the report, when family members received support for their own challenges and received education and resources about mental health, stigma was reduced, and youth were encouraged to access resources by their elders.
“Young people called for a culture shift that actively promoted mental health by normalizing rest, restorative practices, healing, therapy, peer support, cultural practices, and community care—not only for a young person who was struggling, but for everyone—as the way to not just end stigma but to change the social norms that drive stigma in the first place,” stated the report.
The report notes that culture allows individuals to heal from traumatic experiences and frequently prevents the experiences in the first place. Culture creates a sense of shared identity and can assist youth with feeling like they belong, which can’t be achieved through typical behavioral health treatment alone.
“The connection between the land and healing was named in particular by Native American/Indigenous communities; specifically, that there cannot be full healing and well-being if Native youth are separated from their land.”
Cultural gatherings allow youth to build safe and meaningful connections with peers and elders, and cultural healing practices were noted to have assisted youth with connecting to this holistic view of health.
Another call to action in the report includes youth and communities wanting self-determination, rather than “empowerment,” by moving to collaborative decision-making at the community level and creating access to resources to implement community-identified solutions. The report states that youth and families are tired of being asked what they need only to receive funding support for outside solutions instead of for community-led efforts.
Rethinking treatment is another call to action that places the community at the forefront. The report states there is a strong desire for the expansion of non-medical services, and youth favored a peer-to-peer model and mentoring model. Parents found it helpful to obtain behavioral health information from natural support systems, such as family members.
The report mentioned how youth and families had nowhere to go for mental health support unless it was an emergency.
“They described feeling the need for support, or being worried about their child, and then trying to find services proactively only to be told that they didn’t qualify for services because the issue ‘wasn’t bad enough,’” stated the report.
When parents did find care, it was often too expensive and had long wait times. Youth are aware of cost-free crisis lines, but they believed the lines were only for people experiencing thoughts of suicide. The report expressed how care is needed to meet families where they are, at whatever level of distress, and in an accessible format.
Youth and families also called for physical spaces that are safe, beautiful, and full of connection and joy for young people. The spaces must be accessible and include community centers, schools, and parks—which must be open late, on weekends, and on school holidays. Youth repeatedly brought up how the connection to undeveloped nature and green spaces has a direct impact on their mental health, and cited socio-economic barriers as a division between their peers who regularly access physical spaces and those who do not.
“[I’d have access to] nature on a dock, by myself, swinging my feet,” a child from the report said. “Us inner-city kids don’t have access to nature. To be grounded walking around on our ancestral lands.”
The report states that physical spaces should be filled with mentors, peer-to-peer relationships, and opportunities for youth to express themselves through storytelling, dancing, writing, playing music, planting a garden, building relationships, gaining skills, and simply existing in that moment.
Youth also expressed concerns about how sharing their own mental health challenges, such as thoughts of suicide, would negatively affect or add stress for their parents or caregivers. Youth also showed an unwillingness to access professional services, specifically in school settings, because they noticed counselors were struggling and they did not want to add to their burdens. The report’s call-to-action includes supporting families and parents for the stressors of everyday life, while assisting them with healing from their own experiences.
Youth and families reported the exhaustion of navigating the complicated and disconnected systems of behavioral healthcare.
“When I went to get help for her, I called her phone number who gave me four more phone numbers,” a parent said. “I call the first phone number. They gave me two more phone numbers. It’s absolute cat and mouse. And then when you do get through, you get through to someone’s voicemail.”
Youth and families experienced referral loops where they called one number and were given other numbers to call. Families and youth want more points where they can receive support in the early stages of mental distress.
Californian youth and families want the state to build a diverse and representative behavioral health workforce, according to the report. Consequences of providers who did not understand or relate to the youth they served included providing ineffective care and causing distress.
“One LGBTQ+ student stated that their provider was offering solutions that were not a good fit for who they were as a person, while another recalled a mental health provider trying to ‘pray away the gay from me,’” stated the report.
Having a representative workforce would create a sense of safety and alleviate the emotional labor of constantly having to explain themselves. Youth and families hope to bring in more mental health workers that have firsthand understandings of racism, trauma, oppression, and mental health challenges.
Youth and families also want to decriminalize behavioral health and disentangle it from policing, prisons, and carceral systems. They believe that systems must cease locking up and punishing youth during a time when they need the most support. It’s suggested that the state invests in positive school climates, restorative and transformative justice, and sending mental health professionals into the field in response to an individual experiencing mental health distress, rather than calling the police.
Youth also expressed the inability to feel hope about the possibility of reaching change or to engage with services and programs without unacknowledged harm being recognized or repaired. The report states that the first step to rebuilding trust and rekindling hope is for leaders to listen, acknowledge impacts, and take responsibility.
Racism, white supremacy, settler colonialism, poverty, and other forms of systemic oppression and violence aren’t only barriers to treatment, but also root causes of mental health and substance use challenges. The final call-to-action consists of addressing the ways in which the system perpetuates inequalities.