What California can do to improve children’s mental health

California’s kids are struggling. An unprecedented level of toxic stress and trauma from the pandemic has exacerbated a pre-existing child mental health crisis.

Even before the onset of the pandemic, suicide and self-harm rates among adolescents were increasing. Now, almost two years into the pandemic, social isolation, emotional disconnection, economic stress and the physical effects of COVID have taken a toll on our youth and exacerbated an already critical problem.

The Little Hoover Commission, California’s independent government oversight, is urging the state to strengthen its system to support children’s mental and emotional well-being. The state must appoint an accountable leader, set clear goals, encourage coordination, and use schools as central places to help children. This ensures that the state uses funds dedicated to the mental and emotional well-being of children efficiently and in a way that produces the greatest impact in both the short and long term.

COVID has had a uniquely pervasive impact. It has been a major source of stress and anxiety while pandemic-related safety measures – including social distancing and distance learning – cut many children off from their usual sources of support.

Chronic stress affects many children’s ability to regulate emotions and behaviors, pay attention, and start and complete tasks. Educators see this firsthand.

As many children returned to in-person learning this fall, school districts reported rising absenteeism and student misconduct. Worse, in early 2021 emergency room visits for suspected suicide attempts were nearly 51% higher for teenage girls and 4% higher for adolescent boys than the same period in 2019.

Major national organizations declared a child mental health emergency this fall. The US surgeon general released an advisory last month with recommendations to support children amid the mental health crisis.

But California has long struggled to adequately support children’s mental and emotional well-being.

Its child mental health support system struggles with a number of systemic obstacles — including decentralization and labor shortages — that prevent children from accessing much-needed mental health services. In 2018, California ranked 48th nationally for the provision of child mental health services.

Additionally, access to health care is often the biggest challenge facing youth from minority and low-income communities, who have also borne the brunt of the impact of the pandemic.

The good news is that Gov. Gavin Newsom and the Legislature have taken significant steps to improve California’s child mental health support system. Last year, they founded the Children and Youth Behavioral Health Initiative — a $4.4 billion investment to develop a comprehensive mental health care system for Californians from birth through age 25.

In our report “COVID-19 and Children’s Mental Health”, the Commission calls for additional reforms to ensure the behavioral health initiative fulfills its potential:

First, establish a central authority for overall child mental health leadership. This national leader should be tasked with creating clear plans for the coordination and implementation of the Children and Youth Behavioral Health Initiative.

Second: Set yourself clear results goals. The state should set children’s mental health goals based on key metrics related to overall mental well-being, access to care and the quality of care.

Third, promoting coordination around child mental health care and services. The state should increase the support and technical assistance it provides to counties, health plans and other mental health providers. By cultivating a culture of collaboration and support, state and local governments can better work together to advance statewide goals.

Finally, center schools as places to support children’s mental well-being. The state should encourage schools to develop comprehensive plans to coordinate student mental health services, use and share data, and integrate new and existing funding to create sustainable mental health programs.

Under the current California child mental health support system, too many children slip through the cracks. To fully meet our children’s mental health needs, we must first address the system’s shortcomings—before it’s too late.

Pedro Nava is chairman of the Little Hoover Commission. Sean Varner and David Beier are members of the commission’s subcommittee examining the economic recovery from the pandemic. You wrote this comment for CalMatters.

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