Amanda Arellano felt a heavy weight weigh on her chest. It was May 2021 and the teenager was struggling to breathe.
Maria Arellano rushed her 17-year-old daughter to the pulmonologist. Amanda suffers from cerebral palsy, autism, epilepsy, asthma and a heart murmur. With COVID on the prowl, they couldn’t be too careful.
It wasn’t an asthma attack, the doctor told them. It was anxiety.
Sitting in a Jack in the Box near their home in Boyle Heights last month, Maria’s eyes filled with tears as she searched for the words to describe watching her normally gregarious daughter struggle.
“It makes you feel very helpless,” she said.
Many California parents are familiar with this feeling. Two years into the pandemic, our children are suffering. Rates of anxiety and depression have risen so rapidly that several national leaders, including the US Surgeon General, have issued urgent public health advisories. School-based therapists report long waiting lists and an increase in fighting and behavioral issues. Emergency room doctors say they are overwhelmed by the number of children arriving after trying to harm themselves.
On top of all this, the state faces a shortage of mental health care providers.
State officials know they have a serious problem and are committed to solving it. Along with county public health departments, school districts and other agencies that serve children, the state faces a complicated challenge: Gov. Gavin Newsom’s administration plans to build an all-new system to address these problems in the years to come. But the pressure is mounting to help kids like Amanda — now.
Dr. Mark Ghaly, a pediatrician who serves as secretary of state for health and human services, told CalMatters he feels “concerned but hopeful” about the state’s ability to respond to growing needs, although he is also “very aware that even the shortest, short-term interventions are not as immediate as I think we would like.
Last year, Newsom’s administration allocated $4.4 billion in one-time funds to create a statewide child and youth behavioral health initiative. The proposed sweeping transformation of the children’s mental health system will be funded with a sum that many describe as “unprecedented.” Most of the money has yet to be distributed, but efforts to develop a vision and work with stakeholders are underway.
Tony Thurmond, the state’s superintendent of public instruction, recently told CalMatters that he’s visited 45 schools since July. Staff tell him they don’t have the resources to help struggling students.
“We know this is job #1, to help our students deal with the trauma they have experienced and are experiencing during the coronavirus pandemic,” he said. “That must be our priority.”
Children’s advocates are excited about the state’s engagement on the issue, but also worry that help is coming soon enough.
A crisis was brewing before the pandemic; COVID has brought it to a boil.
Lishaun Francis, director of behavioral health for the advocacy group Children Now, appreciates the state’s long-term planning, but she wants to act now.
“I think what people are looking for is an emergency response,” she said. “That was never the plan for the state of California.”
On March 7, his organization joined a coalition of children’s rights advocates and health care providers in sending a letter to Governor Gavin Newsom, calling on him to officially declare the status of children’s mental health and teenagers in California a public health emergency. The challenges facing young people in the state, they said, are “severe and widespread”.
‘It’s getting worse’
The suffering of young people is widespread, as a January report on the state of student well-being reveals. Based on surveys of 1,200 California middle and high school students between April 2020 and March 2021, 63% of students reported having had an emotional breakdown; 43% said they had had a panic or anxiety attack; and 19% described suicidal thoughts, according to the report published by American Civil Liberties Union California Action, California State University, Long Beach and the California Association of School Counselors.
“We know from the numbers that the situation is getting worse,” said Amir Whitaker, senior policy adviser for the ACLU Southern California, which is the lead author of the report. “We’re not done yet.”
Whitaker leads the Youth Liberty Squad, a statewide group of high school students who advocate for better school-based mental health care. Many have experienced their own anxieties and traumas over the past two years. As life moves closer to normal, they discover details of their lives have changed in disturbing ways.
Los Angeles senior Lizbeth Zambrano-Sanchez notices the painful silence in math class after her teacher asks a question that could have sparked a conversation.
Sonia Banker, a high school senior from San Francisco, describes a new awkwardness in social interactions: “There’s this feeling that when you’re talking with someone, it’s harder.”
Labor shortages mean long waits for care
The trauma of the pandemic – grief, fear, loneliness and boredom – has added to concerns about food and housing insecurity, gun violence, climate change, political polarization, racism, transphobia, deportation and now war in Ukraine.
One in 330 California children have lost a parent or caregiver to the pandemic, according to a December report by COVID Collaborative.
Counselors working in schools say more and more students are taking action. Some children have trouble getting out of bed.
Josh Leonard, executive director of the East Bay Agency for Children, which provides mental health services to children, calls it “a natural, predictable response to stress and anxiety in the moment”.
“Children are in deep trouble,” he said.
But large systems aren’t nimble enough to respond to the building’s urgency, he said. As waiting lists grow, workers at overwhelmed schools and mental health agencies like his don’t always reach out proactively to children and families, he said. Why bring children into the system when no one is available to serve them?
Hope on the horizon?
Fans recognize the tension of this moment. They salute the leadership of the Newsom administration and its willingness to invest the state budget surplus in solutions. But they also say the state is playing catch-up, having failed for years to meet spiraling needs.
For many of these advocates – and for the families and children they serve – state promises are only worth the changes they see on the ground.
Alex Briscoe, director of the California Children’s Trust, an initiative to reform the state’s children’s mental health system, calls the state’s current leaders “extraordinary” and their investment “unprecedented.” But he also notes that California has “one of the worst records in the country” when it comes to child mental health.
A 2018 Commonwealth Fund report places the state 48th out of 50 in terms of the percentage of children ages 3 to 17 who received needed mental health care. A 2020 progress report released by Children Now just before the first shutdown gave the state a D grade for children’s behavioral health, noting that mental illness was the top reason children here were hospitalized. The 2022 report gave the state a D-plus.
“I don’t mean to suggest that nothing happens, but it’s not yet clear what that will mean,” Briscoe said.
Ghaly and other members of the administration say they are working hard to develop a strategy. They aim to create an integrated system that focuses on prevention and equity and brings together public, commercial and private systems that are often siloed and highly fragmented – “something with lots of entry points, lots of doors entrance,” he said.
“The truth is, we don’t really have a cohesive behavioral health system for children,” Ghaly said. “I see a lot of opportunities to put something together.”
The administration is still mostly in the first phase of a three-phase plan it plans to roll out over five years. Heads of state bring stakeholders together, set goals and identify overall issues. Over the next few years, they plan to translate this into major initiatives, including a virtual mental health platform that would be accessible to all young people. They also envision a public awareness campaign to combat stigma, a school-based treatment model that will be available regardless of insurance status, and training a larger and more diverse workforce.
Ghaly is aware of the urgency and says some initiatives are already underway. The state has rolled out CalHOPE, an online platform that offers mental health support. It has formed a partnership with the Child Mind Institute to provide educational materials on mental health. It allocated new funds to support partnerships between schools and counties. As part of a statewide effort to transform Medi-Cal, the health insurance program for low-income Californians, state officials recently announced that children and youth n do not need a diagnosis to access specialized mental health services.
“Is it enough? Is it reaching as many children as we would like? No,” Ghaly said. “But he’s definitely trying to move the needle quickly.”
Behavioral health coverage is supported by a grant from the California Health Care Foundation.