Are the Kids All Right?

Examining the state of mental health in children through the eyes of local experts.

The U.S. Department of Health and Human Services estimates one-in-five, or about 20 percent, of kids experience some kind of mental health issue by the time they graduate from high school. It’s a number that is neither as good nor as bad as some might believe. But a number parents should pay attention to. 

Anxiety, depression, attention-deficit/hyperactivity and eating disorders are the most common issues kids face, according to experts, and those issues have been on the rise for more than a decade. In 2022, the number of kids across the U.S. who experienced a major depressive episode ticked up again. That might not seem like a crisis, but for the 306,000 additional kids and their families, it was more than enough. For California, the total number of kids who had an MDE was 459,000. 

Youth mental health issues are creating a growing challenge to school budgets and health care systems, but the cost of not getting treatment remains far, far greater. Reversing trends begins with an accurate picture. 

A Look at the Data

“So much is being overlooked,” says Courtney Harkins, a counselor at JSerra Catholic High School in San Juan Capistrano, who also has a private practice as a marriage and family therapist. “These kids were just coming in with so much more anxiety and depression. And yes, there’s been an increase in ADHD, anxiety, depression, suicide, bullying and PTSD. But what was missing from that, is during COVID, there was a 120 percent increase in adolescents and young kids being hospitalized for eating disorders. I mean that was just huge.”

Thomas Schaffer, president of Campus Clinic in Irvine, a preventative health care platform for school campuses, finds other issues. 

“The most concerning feature of the data that I’ve observed are the rates of potential self-harm,” Schaffer says. “I was just kind of jaw on the floor, but we’ve replicated that across many different schools and districts now and it’s consistently 17 percent to 20 percent. It makes me wonder if we weren’t doing the screeners, what would we be missing in terms of the opportunity to prevent significant harm and as I kind of think about that, it’s just kind of  startlingly sad.”

Causes for the rising mental health issues are still being determined, with social media, the Internet and excessive cell phone usage — essentially texting — often being named as likely sources, but Harkins offers another important underlying issue. 

“We have to talk about the fact that Orange County has a 70 percent divorce rate,” she says. “I see a lot of kids of divorced parents struggle. Everyone knows someone who’s divorced, and the kids get through it, but it still doesn’t stop the fact it is very painful and still causes problems for kids. When you have an unstable family core, you’re gonna get an increase in mental health struggles. You can’t get around them. They call it attachment theory, safe haven. A secure base and a safe haven is one of your best bets for reducing or getting through challenges without really heavy mental health breakdown.”

Debra Schroeder, founder and executive director of Vibrant Minds charter school in Anaheim, has also found a rising incidence of students — which they refer to as “scholars” — acting out. 

“The majority of the scholars with whom we work are on target when it comes to their social-emotional status,” Schroeder says. “However, it seems as if there are more scholars who come to school without boundaries or self-regulation, physical or social. It is more common when compared with past years for our youngest scholars to say ‘no’ to adults, as well as hit, push, bite and shout obscenities.”

Working with them, Schroeder says, “takes an exorbitant amount of time from the staff, and there are more staff members onsite, including one-on-one instructional assistants, counselors and/or school psychologists.”

Contributing Factors 

Schroeder attributes the problem to “myriad factors. One pattern that stands out is the tendency for adults to negotiate with, plead with and bribe children in an effort to get their behaviors in check. For our children with few boundaries, there is seldom a hard no from the adults in their lives. Also, some of our children with social-emotional issues have unfettered access to the Internet and cable content, and they cannot unsee what they have seen. While I think it’s important to protect our young children’s innocence, it is harder to do so when they are exposed to so much maladaptive content. And, the stress of adults definitely adds to the social-emotional imbalance of the children in their lives.”   

But when it comes to access to care, California ranks in the middle of the pack in various categories. According to Mental Health America, we’re only 36th in the rate of kids with issues who are getting some form of care, and it’s not necessarily a matter of money: We’re also 33rd in kids on private insurance plans that fail to cover mental health treatment.

Campus Clinic partners with school districts to build program-driven health care on campus that prioritizes student and faculty wellness — so while the news isn’t great, there are programs and organizations trying to help kids and families. One key objective for Campus Clinic is slashing the time between diagnosis and treatment. 

Schaffer points to troubling figures from the National Alliance on Mental Illness, that the average time between the first signs of mental health issues and first treatment is 11 years. “I mean, a lot can happen to exacerbate that problem over that 11-year period. The cost of treatment 11 years after the first onset of symptoms is significantly higher than if you were to respond to that first symptom. 

“You can put ambulances at the bottom of the cliff and you can address problems that are significantly bigger and higher cost or you can install guardrails at the top. And that’s exactly what we believe in — putting preventative, proactive solutions in place that can immediately pick up on mental health needs and connect them with resources. One of our guiding objectives is to reduce the 11 years down to 11 minutes.”

Schaffer says universal mental health screeners deployed at schools or even across the districts are able to “survey entire student populations for depression and anxiety, then our outbound resourcing team can connect the need with the resource very, very quickly.”

He says that though the tools of diagnosis haven’t really changed, the ability to get more kids screened is “probably the most important thing that we can be doing.”

The delay in proper diagnosis and treatment leads to “the risk of hospitalization, the risk of self-harm, the risk of harming others and the contagion effect on those around the individual dealing with untreated mental health issues. You can reduce the environmental impact they have on others and reduce the cost and the impact they have on the individuals themselves,” Schaffer says. 

But there is only so much the schools can logically and legally do. “This consistent trend to put more and more responsibility on the backs of administrators and educators,” Schaffer says, “at some point, they’re just gonna break and they’re already breaking.”

Working the Problem

Nevertheless, schools are working to meet the problem. 

Refugio “Cuco” Gracian, executive director of cultural proficiency, access, equity and social-emotional learning at Capistrano Unified School District, says the district’s CUSD Cares initiative is about people talking to each other. 

“The goal of CUSD Cares is to effectively support student and staff well-being and create a positive impact on student outcomes by intentionally developing connections, a sense of community and regular opportunities for celebration,” Gracian says. “We are experiencing a greater level of awareness and interest from CUSD teachers and staff, students and parents to support mental health and well-being. Our students are much more conscious of their mental state and have the vocabulary to express how they are feeling.”

“Cares is one component in our overall student support framework — Multi-Tiered System of Support — designed to support the whole student, including emotional, social and behavioral needs that can impact a student’s ability to thrive academically. It is a three-tiered system that provides all students with the appropriate level of support in each area, and allows for teachers, administrators and parents to work collaboratively to address the issues. Students are provided with the best support they need at that time, including additional academic help, being placed in small groups for more one-on-one assistance, or working with a school counselor.”

Schroeder says “a school environment needs to be a place where each child is seen, heard, loved and accepted for whom she or he is by peers and staff. There needs to be messages of hope and a sense of belongingness. A growth mindset is critical so children learn to acknowledge the growth they make rather than comparing themselves with others. It is all about having children strive for their personal best and believing that their futures are bright. As adults, we must model gratitude, joy and optimism so our children look forward to growing up.”

And despite the dismaying stats, Schaffer thinks parents shouldn’t be discouraged and can look ahead. 

“There is a lot to be optimistic about,” he says. “I was meeting with the parent of one of our patients and the parent had never participated in therapy growing up. They had a strong stigma informed by culture. And because our therapist was going to be on their school campus every week and the parents didn’t have to call off work, we made it so easy for them to access and there was no cost. They love it and their academic performance has improved, their behavioral issues have been reduced and many of the situations they dealt with have resolved through the therapy. It’s the outcomes that speak for themselves. That’s what we’re all here for.”

And this is all talk therapy, Schaffer says. 

“That’s not to say medications and certain compounds don’t have their place, but you can see tremendous outcomes through talk therapy. It is an evidence-based way to literally rewire their neural pathways in their brain such that they’re not in fight or flight. And you can provide individuals with resources they can use in their everyday life that absolutely modify sentiment and behavior without the use of chemicals. Countless studies demonstrate this.”

Therapy can also mean many different things. Some of the most positive places kids can go are green spaces. Irvine’s Tanaka Farms, a living example of Orange County’s agricultural past, hosts families and kids’ groups on a regular basis. 

“The farm has been a mainstay for many families and many schools throughout the years,” says Kenny Tanaka. “We have partnered with the MaxLove Project, mostly kids with cancer, and they have said it has made a major impact on many of the kids’ lives. We have seen kids come out to the farm, and some that haven’t walked or got out of their wheelchair in a long time, actually stood up and took some steps here on the farm. Kids have a great time getting their hands dirty and pick vegetables. Many families say the kids will only eat vegetables they pick here.” 

Harkins believes the best medicine remains at home. 

“I think most people are going have times in their life where they struggle with anxiety and depression, like that’s kind of the human condition. Support your child through that and just because they’re struggling … it doesn’t necessarily mean they need a therapist or medication. Sometimes it can be a symptom. Don’t be surprised if your child struggles with it because they also have fluctuating hormones their body is trying to regulate. It’s not uncommon that they’re going to be struggling, but schools and family can add to the problem,” Harkins says. “One of the best things we can give our kids is a steady, consistent, reliable, warm household.”

By Shawn Price