The pandemic didn’t cause the mental health crisis facing our youth. It made it impossible to ignore.
Between 2007 and 2017, the rate of youth admission into hospitals statewide for self-harm increased by 104 percent, according to Alex Briscoe, principal of advocacy group California Children’s Trust.
Pandemic-related school closures isolated young people from what he described as their “social capital,” their classmates, sports teams and after-school programs that gave them joy and fulfillment.
“When you isolate people, bad things happen,” Briscoe said.
To address these concerns, expanded mental health services will be provided at three San Francisco Unified School District schools this fall, the first step in a broader attempt to mitigate the emotional and behaviorial challenges borne by thousands of students who didn’t see the inside of a classroom for more than a year due to the pandemic.
Challenges so steep, in fact, that they were cited as part of a lawsuit filed by City Attorney Dennis Herrera earlier this year against the school district demanding it reopen in-person instruction.
“As a result of the pandemic and the challenges that have come along with it, our students and their families have been having an even more difficult time, and there’s a heightened need for more mental health services for our young people,” Mayor London Breed said in a statement.
According to a national analysis from the Kaiser Family Foundation, 31 percent of parents said their child’s mental or emotional health had worsened since before the pandemic, and mental health care claims for teenagers increased sharply over 2020 with the most frequent diagnoses being depression, anxiety and adjustment disorders.
The long-term stakes of these realities are high. Kids with untreated behavioral health needs are more likely to face lifelong challenges including those related to developmental and physical health, substance abuse and to high school dropout rates.
“A lot of mental health issues develop by adolescence, and if they go unaddressed it’s very likely they can persist into adulthood, but also limit overall quality of life,” said Nirmita Panchal, a policy analyst at the Kaiser Family Foundation.
Children of color are at disproportionate risk, as even before the pandemic they were both more likely to suffer from mental illness but also less likely to access care.
Of SFUSD’s roughly 57,000 students, an overwhelming 85 percent of them identified as non-white in the the 2018-2019 school year. Asian students make up the greatest share at 34.1 percent, followed by Latino children at 27.4 percent and African American children at 6.6 percent.
That means educators are bracing for a student body to return this fall whose mental health has been devastated by the isolation of the COVID-19 experience. Many come from communities that haev also been unduly burdened by high rates of sickness, death and instability such as joblessness within their communities.
“In the context of the pandemic, as schools reopen over the course of the coming year, they must prepare to provide extraordinary, intensive, and sustained support for the social, emotional, and developmental needs of children and youth,” said Maria Su, director of San Francisco’s Department of Children, Youth and Their Families.
Schools have been ground zero for youth services for decades. When schools shut down for the pandemic, children were cut off from key health resources such as support systems and wellness services, access to basic necessities such as healthy lunch the discerning eyes of educators trained to identify possible signs of problems at home.
SFUSD sought to provide continued access to services and support during its year-plus-long shutdown of physical buildings. It created virtual social emotional learning activities, learning hubs, and family wellness check-ins, among other things, but admission and screening data from local hospitals indicates it hasn’t been adequate to stave off increases in suicidal thoughts and hospital admission for kids in crisis.
The University of California at San Francisco saw the highest rate of suicidal kids on record in January 2021, and referrals at Edgewood Center for Children and Families for residential services increased by nearly 50 percent during the pandemic, according to reporting from ABC7.
Moving forward, clinical experts and policymakers agree that preventative and peer-based interventions offered directly to students at schools are key to making lasting improvements to the well-being of youth.
Traditional healthcare providers tend to lack “developmentally appropriate or youth-friendly services” and too often fail to combat stigma or give support in culturally relevant ways for non-white students and families who make up the majority of SFUSD students, Su said.
She added this reality makes schools the “necessary and ideal venue for providing a solution at scale.”
Though SFUSD brought back some students on April 12, it won’t open all campus doors until this fall.
When it does, it will partner with city agencies to provide beefed up mental health resources at 13 middle schools and three elementary schools over the next four years to curb thepandemic’s lasting impact on The City’s youth.
These services will be rolled out at existing Beacon Centers, programs in which nonprofits operate on campuses and work closely with educators to offer wellness resources specific to each school and its students and their families.
“We must partner with community-based organizations who look like the kids we’re trying to serve and whose sole purpose is social and emotional welfare of kids,” Briscoe said. “This partnership is an essential blueprint of re-imagined health systems.”
An anonymous donor gave $15 million to support this expansion, but true change requires a much greater investment on a policy level here in San Francisco and statewide.
Despite its wealth, California is in the bottom third nationally for health spending at roughly $2,500 per child enrolled in Medicaid, and it ranks 44th in in terms of access to care for children.
Young Californians in need of mental health treatment are also less likely to access it than their peers nationally. Among adolescents who reported a major depressive episode between 2016 and 2019, 36 percent received treatment for depression, six percentage points below the national rate, according to the California Health Care Foundation.
Many say the pandemic has forced a reckoning among the public and its policymakers, and that the newfound prioritization isn’t only reflected in San Franciso’s recent efforts.
Governor Gavin Newsom’s budget for the upcoming fiscal year proposes sweeping changes to the existing behavioral health system that would make mental health services available to every Californian under the age of 26.
It includes $1 billion to fund an initiative to pair schools with community health organizations, more than double the $400 million proposed in the first draft of the fiscal year’s budget, and funds to hire more mental health staff and expand services on campuses.
“It’s fair to say there’s an awakening happening,” Briscoe says.