Fix youth mental health crisis with collaborative action

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Decades ago, as a hotline volunteer with Safe & Sound, I spoke with exhausted parents in crisis because there were no preventive supports to proactively alleviate their poverty and trauma. 

As a volunteer for the Child and Adolescent Psych Services Department at San Francisco General Hospital, I witnessed traumatized children waiting for mental health visits in a cramped, dark waiting room next to adult patients in psychiatric distress. The physical setting did nothing to destigmatize mental health, nor encourage a welcoming experience. 

While much of this is changing, the statistics remain alarming. 

In our otherwise forward-focused state of California, the data are sobering. California Children’s Trust reports that we rank 43^rd in the nation in providing pediatric behavioral, social and developmental screenings. Just 35% of young Californians who report needing mental health services receive it, and only 5% of children on Medi-Cal access behavioral health support. 

In our state, which is plagued by housing, food and employment insecurity, it’s stunning to come to terms with how many children need — but do not receive — the mental health support they are entitled to and for which we pay federal taxes. 

Systemic change requires ground-breaking collaboration. Finally, there may be hope. President Joe Biden’s administration is directing resources into prevention and treatment for marginalized communities. From the White House to Sacramento, politicians are leading change, bolstered by policy advocates identifying the systemic bottlenecks, researchers proving scalable interventions and the public seeking a response to the mental health crisis among children and families. Science, policy, practice and leadership are converging.

The California Children’s Trust recently shepherded a collaborative effort to reshape mental health support for marginalized children, making these services a strategy for combating the effects of racism and poverty. This resulted in Medi-Cal creating a new Family Therapy Benefit so families can obtain unlimited preventive therapy and maximizing funding for public health institutions and providers. 

State Surgeon General Dr. Nadine Burke Harris, who has dedicated her career to understanding the impact of toxic stress resulting from racism and poverty, is rolling out initiatives that address health disparities. UC San Francisco’s Dr. Nicki Bush is researching the intergenerational transmission of risk and of resilience, identifying disease prevention strategies, protective factors and interventions that promote resilience within a family. Project Healthy Minds is destigmatizing mental health by engaging Hollywood celebrities in sharing their struggles and offering young people resources where they spend their time: online and at home. 

All In For Kids, led by Futures Without Violence and generously supported by Genentech and Blue Shield of California, is funding new cooperative efforts that prevent and treat childhood trauma, a core source of mental anguish. And, finally, psychiatric care settings are changing, such as the Child, Teen and Family Center at the new Nancy Friend Pritzker building, created under the leadership of Dr. Matt State.

The evolution in the mental health field and political landscape offers a rare opportunity to make systemic change. We must act quickly to create an integrated, whole-family, preventive approach that recognizes that children live with grownups; to successfully treat a child, we must address the family’s needs.

Successful interventions will be those that address the systemic inequities that create toxic stress, accompanying therapy with employment, housing and food assistance. Services should be trauma-informed, led by experts with close proximity to the communities served. They should be housed in institutions that families trust, such as schools, pediatric and primary medical care clinics, not in disparate offices scattered around communities. Philanthropy should generously and bravely invest in creative solutions. 

Together, we can address this crisis. The health of California’s youngest and most vulnerable residents depends on it, and in turn, the healthy development of our state and society depends on it.