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Amanda Arellano felt a heavy weight pressing down on her chest. It was May of 2021, and the teenager struggled to breathe.

Maria Arellano rushed her 17-year-old daughter to the pulmonologist. Amanda has cerebral palsy, autism, epilepsy, asthma and a heart murmur. With COVID on the prowl, they couldn鈥檛 be too careful.

This wasn鈥檛 an asthma flare-up, the doctor told them. This was anxiety.

Sitting in a Jack in the Box near their home in Boyle Heights last month, Maria鈥檚 eyes filled with tears as she searched for the words to describe watching her normally gregarious daughter struggle.

鈥淚t makes you feel very powerless,鈥� she said.

Many California parents know this feeling well. Two years into the pandemic, our children are in pain. Rates of anxiety and depression have shot up so quickly that several national leaders鈥� including the U.S Surgeon General 鈥� have issued . School-based therapists report long waiting lists and an increase in fighting and behavior issues. Emergency room doctors say they are overwhelmed by the number of after trying to harm themselves.

On top of all this, the state is facing a shortage of mental health providers.

State officials know they have a serious problem and have vowed to address it. Along with county public health departments, school districts and other agencies that serve children, the state is grappling with a complicated challenge: Gov. Gavin Newsom鈥檚 administration plans to build a brand new system to solve these problems in the coming years. But pressure is mounting to help children like Amanda 鈥� now.

Dr. Mark Ghaly, a pediatrician who serves as the state鈥檚 secretary of Health and Human Services, told CalMatters he feels 鈥渃oncerned but hopeful鈥� about the state鈥檚 ability to meet the growing need, though he鈥檚 also 鈥渧ery aware that even the most short, short-term interventions are not as immediate as I think we would like.鈥�

Last year, Newsom鈥檚 administration allocated $4.4 billion in one-time funds to create a statewide Children and Youth Behavioral Health Initiative. The proposed sweeping transformation of the children鈥檚 mental health system will be funded by a sum many describe as 鈥渦nprecedented.鈥� The bulk of the money has yet to be distributed, but efforts to develop a vision and work with stakeholders are underway.

Tony Thurmond, the state superintendent of public instruction, recently told CalMatters he has visited 45 schools since July. Staff tell him that they don鈥檛 have the resources to help struggling students.

鈥淲e know that this is job number one, to help our students address the trauma that they have experienced and are experiencing during the coronavirus pandemic,鈥� he said. 鈥淭hat鈥檚 got to be our priority.鈥�

Children鈥檚 advocates are enthusiastic about the state鈥檚 commitment to the issue, but also worry that help won鈥檛 come soon enough.

A crisis was brewing before the pandemic; COVID set it to a boil.

•  doubled between 2014 and 2020, according to state data. 
• Incidents of increased 50 percent in California between 2009 and 2018, the state auditor reported. Children鈥檚 hospital officials told CalMatters last fall that mental health emergency room visits  during the pandemic. 
• Between 2019 and 2020, opioid-related overdoses among 15- to 19-year-olds in the state nearly tripled, according to a CalMatters analysis of state data.

Lishaun Francis, director of behavioral health for the advocacy group Children Now, appreciates the state鈥檚 long-term planning, but she wants action now.

鈥淚 think what people are looking for is an emergency response,鈥� she said. 鈥淭hat has never been the state of California鈥檚 plan.鈥�

On March 7, her organization joined a coalition of children鈥檚 advocates and health providers in sending a letter to Gov. Gavin Newsom, calling on him to formally declare the status of child and adolescent mental health in California a . The challenges facing young people in the state, they said, are 鈥渄ire and widespread.鈥�

鈥業t won鈥檛 be this way forever鈥�

For a moment, in March 2020, Amanda felt excited. Her school planned to close briefly; two weeks at home sounded like an unexpected vacation.

But school didn鈥檛 reopen that spring, or all the next school year. And many supports Amanda depended on 鈥� social therapy, music therapy, physical therapy 鈥� moved online or fell away completely.

Terrified of the virus, Amanda refused for months to venture out of the small blue house in Boyle Heights where she and her mother rent a room from another family.

Always a strong student, Amanda grew increasingly frustrated during virtual learning. Sometimes a shaky internet connection booted her out of Zoom class. Other times, teachers were hard to understand.

Alisha Jucevic

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CalMatters

鈥淚 don鈥檛 know what I can do to calm myself down,鈥� Amanda told her mother.

Maria would see tears in the long-lashed brown eyes of the daughter she鈥檇 always known to be creative, happy and resilient. She鈥檇 pull out photos they鈥檇 taken on pre-pandemic outings.

鈥淚t won鈥檛 be this way forever,鈥� she鈥檇 tell Amanda. 鈥淥ne day this will end.鈥�

Amanda tried meditation and exercise. She lost herself in video games, playing Roblox until her hands hurt.

As the months wore on, Maria saw the toll on her daughter鈥檚 self-esteem.

On Dec. 18, 2020, Amanda sent an email to a teacher, apologizing for missing certain assignments: 鈥淚 am very embarrassed,鈥� she began.

For months, she explained, 鈥淚 have felt constant headaches and I have felt very dizzy; I have been extremely fatigued. Never, since I started school, have I left assignments without finishing them. I have always been a good student. But in this moment with the pandemic, my life has been impacted in many ways, especially with Distance Learning.鈥�

Her teacher reassured her: 鈥淵ou are an amazing student that inspires everyone you meet.鈥�

But the anxiety continued. In February 2021, Maria wrote to the school psychologist, asking for help.

鈥業t鈥檚 getting worse鈥�

Young people鈥檚 suffering has been widespread, as revealed in a January report on . Based on surveys of 1,200 California middle and high school students between April 2020 and March 2021, 63% of the students reported having had an emotional meltdown; 43% said they had a panic or anxiety attack; and 19% described suicidal thoughts, according to the report published by American Civil Liberties Union California Action, California State University, Long Beach and the California Association of School Counselors.

鈥淲e know from the numbers it鈥檚 getting worse,鈥� said Amir Whitaker, senior policy counsel for ACLU Southern California, who is the report鈥檚 lead author. 鈥淲e鈥檙e not done yet.鈥�

Whitaker leads the Youth Liberty Squad, a group of high school students around the state who are advocating for better school-based mental health care. Many have experienced their own anxieties and traumas these past two years. As life edges closer to normal, they find details of their lives changed in unsettling ways.

Lizbeth Zambrano-Sanchez, a Los Angeles senior, notices the painful silence in math class after her teacher asks a question that once might have prompted conversation.

Sonia Banker, a San Francisco 12th grader, describes a new awkwardness in social interactions: 鈥淭here鈥檚 this feeling that when you talk with someone, it feels harder.鈥�

Joel Salas, a Los Angeles senior, spent a month isolated in his bedroom after the rest of his family contracted COVID-19. His mother fell extremely ill, and he ended up caring for her while studying and working five or six hours a day at his parents鈥� taco stand.

One of the biggest challenges for him now is the unrelenting uncertainty.

鈥淵ou don鈥檛 know what鈥檚 happening next,鈥� he said. 鈥淵ou don鈥檛 want to get your hopes up, because another wave might come.鈥�

Another challenge is what鈥檚 left unsaid. Many of his classmates lost family members, he said. People rarely talk about it.

Amanda, who is also a leader within the Youth Liberty Squad, felt terrified when school resumed in person last August. What would happen if she was exposed to the virus? To protect herself physically, she distanced herself from her classmates.

Amanda鈥檚 mother, Maria, understands these fears. She also knows a teenage girl needs friends.

Workforce shortage means long waits for care

The trauma of the pandemic 鈥� the grief, fear, loneliness and boredom 鈥� has layered upon concerns about food and housing insecurity, gun violence, climate change, political polarization, racism, transphobia, deportation and, now, the war in Ukraine.

One in 330 California children to the pandemic, according to a report released in December by COVID Collaborative.

Counselors who work in schools say more students are acting out. Some children struggle to get out of bed at all.

Josh Leonard, executive director of the East Bay Agency for Children, which provides mental health services for children, calls this 鈥渁 natural predictable response to the stress and anxiety at the moment.鈥�

鈥淜ids are struggling profoundly,鈥� he said.

But big systems are not nimble enough to address the building emergency, he said. As waiting lists grow, workers at overwhelmed schools and mental health agencies like his are not always proactively reaching out to children and families, he said. Why bring children into the system when no one is available to serve them?

Martin do Nascimento

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CalMatters

Alyssa Hurtado, a social worker with Leonard鈥檚 agency who works at a Newark elementary school, did her best to stay connected with families during the school closure. After more than a year of remote learning, many of her young clients now struggle with separation anxiety. Others have difficulties with motivation and concentration.

鈥淜ind of like, 鈥榃hat鈥檚 the point?鈥欌�� she said.

Hurtado herself is stretched thin. Five children are on a waitlist to get services at her school. In the meantime, she鈥檚 also been helping to cover a vacancy at another school.

Across the agency, Leonard says 10 therapy positions remain unfilled out of a total of 50. Each of those positions would allow the organization to see 18 to 20 additional children. He and other nonprofit leaders say it鈥檚 difficult to compete with counties, school districts and big fish like Kaiser. Telehealth companies that sprang up during the pandemic have lured some clinicians away. Others are opting for the flexibility of working for themselves, avoiding onerous paperwork requirements by seeing patients who can pay out of pocket. Still others are moving to places with lower costs of living.

Those who remain often carry the extra load and face burnout.

鈥淓very applicant has 20 different job opportunities right now,鈥� said Stacey Katz, CEO of WestCoast Children鈥檚 Clinic in Alameda County, who is also trying to fill 15 to 20 openings.

鈥淣o one likes you to say you have a 鈥榳aiting list,鈥欌�� she said, describing pressure she and others say they receive from counties to avoid using that term. 鈥淚 don鈥檛 know what you call it when there are 176 people waiting for services.鈥�

The clinic鈥檚 public policy director, Jodie Langs, chimed in: 鈥淚f we鈥檙e calling this a crisis in mental health, let鈥檚 respond to it like a crisis.鈥�

Hope on the horizon?

Advocates recognize the tension of this moment. They commend the Newsom administration鈥檚 leadership and its willingness to invest in solutions. But they also say the state is playing catch-up, having failed for years to address the spiraling need.

For many of these advocates 鈥� and for the families and children they serve 鈥� the state鈥檚 promises are only as good as the change they see on the ground.

Alex Briscoe, head of California Children鈥檚 Trust, an initiative to reform the state鈥檚 children鈥檚 mental health system, calls current state leaders 鈥渆xtraordinary鈥� and their investment 鈥樷�渦nprecedented.鈥� But he also notes that California has 鈥渁mong the worst track records in the nation鈥� when it comes to children鈥檚 mental health.

from The Commonwealth Fund put the state at 48th out of 50 in terms of the percentage of children ages 3 to 17 who received needed mental health care. A 2020 progress report published by Children Now right before the first shutdown gave the state a D grade for , noting that mental illness was the leading reason kids here were being hospitalized. The 2022 report gave the state a D-plus.

鈥淚 don鈥檛 want to suggest nothing鈥檚 happening, but it鈥檚 unclear yet what it will signify,鈥� Briscoe said.

Photo courtesy of Sophie Sylla

Ghaly and others in the administration say they are working hard to develop a strategy. They aim to create an integrated system that focuses on prevention and equity and brings together public, commercial and private systems that often are siloed and highly fragmented 鈥� 鈥渟omething with a lot of entry points, a lot of front doors,鈥� he said.

鈥淭he truth is we don鈥檛 really have a cohesive children鈥檚 behavioral health system,鈥� Ghaly said. 鈥淚 see a lot of opportunity to stitch something together.鈥�

The administration is still mainly in the first phase of a three-phase plan it expects to roll out over five years. State leaders are gathering stakeholders, setting goals and figuring out big-picture issues. In the coming years, they plan to translate that into major initiatives 鈥� including a virtual mental health platform that would be available to all young people. They also envision a public awareness campaign to address stigma, a school-based treatment model that will be available regardless of insurance status and the training of a bigger, more diverse workforce.

Ghaly is aware of the urgency and says some initiatives are already underway. The state has rolled out CalHOPE, an online platform that offers mental health support. It has formed a partnership with the to provide educational materials about mental health. It has allocated new funding to support partnerships between schools and counties. As part of a statewide effort to transform Medi-Cal, the health insurance program for low-income Californians, state officials recently announced that children and youth do not need a diagnosis in order to access specialty mental health services.

鈥淚s it enough? Does it touch as many kids as we would like? No. But it is certainly trying to move the needle quickly,鈥� Ghaly said.

Thurmond, the state schools superintendent, is supporting a legislative proposal to use loan forgiveness and deferrals to attract 10,000 new clinicians into schools and community-based organizations in the next few years.

Thurmond said his commitment derives from losing his own mother when he was 6 years old.

鈥淚鈥檓 a believer that when there鈥檚 trauma, you must acknowledge it,鈥� he said. 鈥淵ou must have an available workforce to address it.鈥�

As these big initiatives roll out, though, what can be done now?

Some believe the answer lies, in part, with kids themselves. Students can be trained to act as peer counselors, and to be on alert for signs of suicide, many experts say. That can serve a double benefit 鈥� providing real-time support now, and helping build a pipeline of mental health providers from diverse communities.

鈥淪tudents are not being tapped into enough,鈥� said Whitaker of the ACLU.

That is beginning to change. In the past few years, Cal-HOSA, an organization focused on training students for careers in health, has piloted student mental health programs in 25 schools around the state. Students receive training to provide peer counseling support. The experience also allows them to consider careers in mental health.

鈥楳y life is so bright鈥�

In the pandemic鈥檚 early months, Maria Arellano found herself in a situation familiar to many parents: She was Amanda鈥檚 principal, teacher, nurse, tutor, playmate and advocate.

Maria knew how important it was for her daughter to use her own voice.

She suggested Amanda join some youth advocacy organizations, and also start making music videos, to 鈥渢ake out everything she was carrying within.鈥�

In August 2020, Amanda posted one of these videos, 鈥�,鈥� to her YouTube channel. Images of distraught medical workers and patients on ventilators scroll across the screen while she sings.

鈥淵ou gotta calm yourself now, everything鈥檚 going to be alright (how?)

鈥淭he pandemic is on. Everyone鈥檚 anxious now.鈥� 

A year and a half later, much has changed in Amanda鈥檚 life. She is vaccinated. The final months of senior year are upon her: Prom. Senior trip. Graduation.

As mask mandates fall away, Amanda feels frightened. But, with the help of her mother, her therapist, and the strength she is discovering through her own advocacy, she is working to find peace within the new reality.

This past December, Amanda put up another video on her YouTube channel, with :

鈥淚 feel alive with all my might,鈥�

鈥淢y life is so bright. My life is so bright.鈥�

 is a nonprofit, nonpartisan media venture explaining California policies and politics. 

Behavioral health coverage is supported by a grant from the California Health Care Foundation.