Santa Clara County's Board of Supervisors voted unanimously to find new ways to link children and teens with mental health services through public schools, which could range from referrals to hiring and embedding clinicians on campuses.
The idea, proposed by Supervisor Susan Ellenberg, is intended to fill gaps in youth mental health care, particularly prevention and early intervention programs that can catch symptoms early.
Depression and anxiety account for the vast majority of mental health diagnoses in children and adolescents in Santa Clara County, and more than one-quarter of students surveyed in middle school and high school reported feeling depressive symptoms within the last year.
"There is a lot of great work going on in this county, but we know also that there are still some kids who are unable to access the support that they need," Ellenberg said at the Oct. 22 board meeting.
The program could be a partnership between the county and the Santa Clara County Board of Education to hire and coordinate a team of mental health clinicians providing mental health support for students. Doing so would assure a "baseline level" of support at every school, an even-handed approach to serving all of the county's roughly 400 schools. Other strategies include information campaigns and referrals to link families to mental health resources.
Supervisor Dave Cortese praised the idea as a way to reach "universal" clinical coverage in schools and prevent behavioral health problems from getting out of control.
"The idea is to intercept folks, young people especially, before they get caught up in a criminal system or a system that mimics the criminal system, which I think is what happens ... when things get too far and diversion hasn't happened," Cortese said. "Unfortunately the response looks like handcuffs, lockdown, badges and guns showing up at peoples' doors or outside the school somewhere."
To date, the county's involvement in schools has primarily been through its School-Linked Services (SLS) program, which hires staff to proactively work with families in select schools and refer them to services, whether for food assistance, transportation, physical or mental health care.
Mountain View Whisman School District is among the 13 participating school districts, and more than 900 students received at least one referral or attended at least one event or workshop through the program during the 2018-19 school year, according to a county staff report. More than half of those families had children attending Castro Elementary School or Graham Middle School.
Ellenberg's proposal would take the county's involvement a step further, with a program that would encompass all 31 school districts in the county and specifically focus on mental health care for children. The initial proposal calls for simultaneously beefing up referral services to outside health care providers, as well as creating in-house mental health services provided through the schools.
Supervisor Cindy Chavez said the county should proceed cautiously and avoid overwhelming the limited number of child psychiatrists in the area with referral services that they can't reasonably accommodate. Past studies found that there are only 26.7 psychiatrists per 100,000 people in Santa Clara County, compared with 30.8 in San Mateo and 76.6 in San Francisco -- and only a portion of those psychiatrists are licensed to treat children and teens.
"I do think that's a big part of our challenge, particularly for children who are demonstrating mental health issues at a young age," she said. "We're going to have to collaborate with a lot of partners to get those services spread around."
The other question hanging over the discussion was how to pay for it. One possible avenue is the state budget, which recently earmarked $50 million this year to encourage county behavioral health departments -- largely responsible for publicly funded mental health care -- to partner with local schools. The opportunity to request that funding is expected to begin in the next few months, Ellenberg said.
Locally, school districts in Mountain View have primarily relied on nonprofit partnerships to link children to mental health services. All three of the city's school districts contract with the Community Health Awareness Council (CHAC), which provides thousands of hours of counseling services to children and their families each year. The Mountain View-Los Altos High School District also independently hires staff for therapy services at an annual cost of around $1.3 million.
It's unclear when the county's program would take effect, but the 5-0 vote asks county staff to consider implementation as soon as the next school year. In a statement after the vote, Ellenberg called the vote a win for children and families in the county.
"I am proud to champion this most important work," she said. "And I am proud to have my colleagues' support. We are taking a holistic approach to supporting the success of all of our families and their children. Today's wins are only the beginning."