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By Mark Ghaly

Dr. Mark Ghaly is Secretary of the California Health and Human Services Agency.

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Linda Darling-Hammond, Special to CalMatters

Linda Darling-Hammond is president of the California State Board of Education.

Mental health is now the leading cause of hospitalization of children under 18 in California. This crisis facing youth and their families is staggering.

In addition to the effects of the COVID-19 pandemic, young people face existential threats like climate change, gun violence in schools as well as communities, civil rights crises, and an uncertain educational and economic future.

From 2009 to 2017, depression increased 69% among 16- and 17-year-olds. The suicide rate among 18- to 19-year-olds increased 56% from 2008 to 2017. An estimated 8% to 10% of children under age 5 experience clinically significant and impairing mental health problems.  

The stress and social isolation caused by the pandemic have intensified the already existing crisis, particularly for children and youth of color, low-income communities, LGBTQ+ youth and other vulnerable populations. 

Last week, the U.S. Surgeon General issued an advisory on the youth mental health crisis. It calls attention to the growing prevalence of mental health challenges nationally and offers multi-sector recommendations to address the challenges.

California is already taking action on many of the Surgeon General’s recommendations. Gov. Gavin Newsom and the state Legislature invested $4.4 billion in the 2021-22 state budget to establish a bold new initiative to transform the state’s children and youth behavioral health system. Through this initiative, California is building an innovative, prevention focused ecosystem where all children and youth ages 0 to 25 are routinely screened, supported and provided services for emerging and existing mental health needs.  

In addition, the budget included $3 billion for community schools that offer wraparound services and supports for young people, as well as outreach to families, creating a whole child approach to education. Many of the newly funded mental health services can happen right at or nearby the school site, making group and individual counseling and support immediately available. 

As a pediatrician and an educator, we know that a holistic approach is critical to improve the social and emotional well-being of our state’s children and youth. Schools – including early childhood learning sites, K-12 schools, and colleges and universities – can serve as essential points of access for prevention, early intervention and mental health treatment. 

Caring, nurturing relationships with an adult and feeling connected to school, community and family are key to a young person’s mental health and resilience. These social and emotional supports are not a distraction from academics; they are the pathway to safe schools and successful learning. 

Partnership between health and education to improve the social and emotional well-being of children and youth has long-term implications for California. Half of all lifetime cases of diagnosable mental illnesses begin by age 14, and 75% of all lifetime cases of diagnosable mental illness begin by age 25. Serving young people and doing it well pays off. 

Children who receive behavioral health care connected to their regular primary care have reduced behavioral issues and anxiety. Those who receive supports that help them rebound from trauma and develop successful coping strategies are more successful in education and in life. For example, lifetime earnings quintuple for people with serious mental illnesses when they receive more than a high school education. 

Despite the significant number of children and youth with behavioral health needs, many do not receive care. A 2018 report by the California Health Care Foundation finds that about two-thirds of adolescents with major depressive episodes in California do not get treatment. They suffer in the shadows.

California’s landmark investment in the Children and Youth Behavioral Health Initiative, in combination with other critical efforts at the federal, state and local level such as community schools, aims to build the infrastructure we need to deliver equitable and accessible mental health and substance use services. 

Under the initiative, California will develop a virtual portal to provide culturally- appropriate information, services and interactive tools via age-appropriate apps, games, resource connections and support services. Investments will increase school-linked prevention and early intervention, as well as facilities and programs to provide more intensive behavioral health services. 

The initiative will support use of evidence-based practices that improve outcomes for children and youth at high risk, with a focus on efforts tailored to highly impacted communities. The voice and experience of youth will be at the center of California’s efforts, which the U.S. Surgeon General’s advisory emphasizes is critical to address the needs of youth at greatest risk.

It is also vital that we address the issue of stigma. That’s why the initiative funds a public education campaign to reduce stigma and encourage children, youth and their families to understand the impact of toxic stress and seek needed care before a crisis. Together we can normalize emotional well-being so that it is viewed like healthy food, exercise and sleep.

Addressing the growing mental health crisis and social and emotional well-being of our state’s children and youth is paramount to their future and to the future of California. The U.S. Surgeon General’s report calls for a “whole of society” effort.   It will take all of us working together to deliver on California’s bold vision to ensure the mental health and well-being of all our state’s children and youth a reality.  


Dr. Mark Ghaly has also written about investing in behavioral health services for young people.

Linda Darling-Hammond has also written about California’s plan to bring students back to school for in-person learning in careful stages.

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