By Dr. Bryan H. King
Mental illness is the Voldemort of modern medicine. Relegated to the shadows and not to be named in public, its painful impacts on thoughts, feelings and behavior get amplified by isolation, misinformation and confusion. Historically, it is very hard to do something positive about a problem that society both shames and coaches us to ignore.
Senate Bill 224 could ameliorate some of these Voldemortian effects. The bill, which is headed to Gov. Gavin Newsom’s desk for possible signature Oct. 10, mandates that education about mental illness and mental health be incorporated into the standard curriculum for California middle and high school students.
Ironically, in an unintended nod to the power of stigma, the bill uses the term “mental health challenges” in lieu of mental illness. It would be strange to refer to cancer as a physical challenge. Or diabetes, or heart disease, or asthma. And we generally don’t blame the victims of these illnesses for their conditions. A child with a compound fracture often returns to school after a hospitalization with a cast that is bright enough to compete with the sun. The entire class may take a moment to hear about how the injury was sustained, or the experience in the hospital and then take turns writing well wishes on the fluorescent cast.
When a child returns to school after a psychiatric hospitalization, they may actually be told to lie about why they were out. Stephen Hinshaw, the eminent psychologist and former chair of the psychology department at UC Berkeley, shares in his poignant memoir “Another Kind of Madness” how during his childhood his family actively ignored the repeated, long disappearances of his father that corresponded to hospitalizations for bipolar disorder — leaving the children to wonder if somehow they were responsible for their father’s unexplained absences.
But even in the shadows, especially in the shadows, mental illness is a major problem for all of us. Suicide is the second leading cause of death for adolescents in the United States. Every year, we lose more children to suicide than to cancer, heart disease, diabetes and lung disease — combined. Fully a fifth of all children and youth experience a mental disorder every year, and only a fraction of them receive any treatment. Sadly, this statistic has not changed in over 20 years. But in the past decade, the number of girls who died by suicide doubled. And as highlighted in the recent report of the Little Hoover Commission, the COVID pandemic has worsened mental health across the board and amplifies the call to action to address mental illness in youth.
According to the California Healthy Kids Survey, 19% of ninth graders, 18% of 11th graders and 26% of non-traditional students in the state endorsed seriously considering suicide in the previous year. Pre-pandemic youth suicide rates in several Bay Area counties were higher than the state average. San Mateo, Solano and Sonoma counties were over 30% higher. The most recent California school staff survey reveals that 30% of San Francisco students reported chronic sadness and hopelessness in the previous year. The Little Hoover Commission Report observes that the perfect storm of stress, anxiety and trauma created by COVID will generate a tsunami of need for child and adolescent mental health services in California in the coming years.
But there is hope. Education can help move mental illness out of the shadows and build a path to treatment. When a child fears that there are monsters in the closet, our response is not “that’s because your closet is a mess” or “let’s put a lock on the closet door.” Instead, we boldly open the closet door to reveal that we are not afraid of monsters because we know they don’t exist — “and by the way, you should probably clean your closet.”
SB 224 calls for reasonably designed instruction on the overarching themes and core principles of mental health. Children will be taught signs and symptoms of common mental disorders, including depression and anxiety and post-traumatic stress disorder. Children will learn about evidence-based services and supports that effectively help individuals recover from illness, as well as mental wellness and protective factors like problem solving and coping skills. There will be an opportunity to teach the warning signs of common mental health problems to foster early intervention including how to access the many existing services within school districts. The bill specifically targets stigma, and will move us closer to the day when children who are experiencing mental illness receive the same support and acceptance from the community as do children with casts on their arms.
California can take a leading and long overdue role in supporting our children and youth by bringing mental health and mental illness awareness and education into sharp focus. The real “challenges” are taking those first steps, and SB 224 will move us substantially forward on this important journey.
Dr. Bryan H. King is the Pritzker Family Distinguished Professor, vice chair for Child and Adolescent Psychiatry and vice president of Child Behavioral Health Services at UCSF Benioff Children’s Hospitals.