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California should prioritize the mental health of children

As schools across California reopen – many for the first time in a year and a half—mental health professionals expect a groundswell in demand for students in need of assistance. It is normally a time when school staff identify children beset by psychological challenges. Now it is exacerbated by pandemic-caused anxieties, from having to catch up academically and socially to returning after long absences to in-person learning, according to a recent National Public Radio story.

The NPR account also exposes California’s shameful lack of appropriate treatment capacity for young people with the most intensive mental health needs. These are youth who have been victims of sex trafficking, young people whose devastating experiences of trauma lead them to involvement with the criminal justice system, and children with the most complex mental health conditions. Add to them many youngsters who have not coped well with impacts from COVID-19.

While the pandemic has intensified the mental health needs of young people, one thing has not changed: California is grossly ill-equipped to serve youth in crisis. Only 11 of the state’s 58 counties have inpatient child psychiatric hospital beds to treat severe illness for kids under 12. The result is that only children whose parents who can afford out-of-state care receive treatment. That leaves tribal and other minority communities with little if any access to needed care. I am working to change that with AB 226 – now on the governor’s desk—which would authorize creation of crisis treatment options in residential settings for youth supported by federal Medicaid funds.

Even before COVID, California was experiencing a crisis in children’s mental health care. Hospitals were straining to accommodate significant increases in kids arriving at emergency departments in psychiatric crises. San Diego’s Rady Children’s Hospital reported an increase of 1,746 percent in the number of mental health emergencies seen in the ER over an eight-year period. Since 2008, mental health needs have accounted for the largest share of hospital admissions of children under age 17 in our state.

The pandemic only boosted the urgency for California to develop crisis care capacity for youth—not just foster youth, but all Medicaid-eligible youth. The Centers for Disease Control report mental health-related ER visits as a share of all pediatric emergency visits rose starting in April 2020. Compared with 2019, the proportion of mental health-related visits for children ages five to 11 and 12 to 17 years increased approximately 24 percent and 31 percent, respectively.

Emergency rooms are often ill-equipped to treat kids’ complicated mental health needs. A January 2015 report from one of California’s leading mental health organizations, “Kids in Crisis: California’s Failure to Provide Appropriate Services for Youth Experiencing a Mental Health Crisis,” documented families’ despair as children waited for days or even weeks in emergency room hallways and exam rooms. These youth often went without mental health treatment while staff tried finding beds at inpatient psychiatric facilities.

AB 226 would create opportunities for counties and their community non-profit partners to establish short term treatment options for youth in crisis. Rather than being crowded into emergency rooms, children can work through their crises in residential settings surrounded by support and then transition back to families and communities. This intensive but short-term treatment model is also designed to prevent the need for inpatient psychiatric hospital care.

With the budget he signed in July, Governor Gavin Newsom championed a visionary new Children’s Behavioral Health Initiative that will provide mental health screenings, school-based support and other services to youth with the goal of detecting mental health conditions early and preventing them from worsening. AB 226 strengthens this initiative, ensuring there are services for youth at every level of need.

Rather than emergency rooms or psychiatric hospitalizations, California should provide places close to home with therapeutic support that can help young people work through crises. I urge Governor Newsom to sign this critical bill.

James Ramos represents the 40th Assembly District, is the first California Native American elected to the Legislature and has authored legislation to create the state’s Office of Suicide Prevention and bolster support for victims of school bullying.

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