Update May 19, 2021: This story has been updated to include data shared by the City of Berkeley after publication about the number of students served by the health center.
The pandemic may be receding locally, but experts warn that its toll on the mental health of Berkeley youth will persist — the trauma of a year of loss and isolation not ending with a shot in the arm.
“I go for days at a time now without seeing a single COVID patient in the E.R., but I continue to see kids in crisis. It’s just not right,” said Dr. Jeanne Noble, director of UCSF’s emergency department.
Even before the pandemic, suicide was the second leading cause of death among children and teens, and the CDC estimates that one in five children have mental health disorders in any given year. The past year has added social isolation, grief, Zoom fatigue, racial trauma, and instability due to job loss and poverty on top of the usual challenges. Young people are suffering from depression and anxiety like never before.
“My kids were always healthy, they were always happy. Suddenly, I saw one of my daughters slide into this really, really dark place. I just felt helpless,” said one father whose oldest child attends King Middle School.
From May to December last year, Oakland Benioff Children’s Hospital provided emergency mental health care to 651 children, a 76% increase from the previous year. In January, a fifth of adolescents who came to the San Francisco Benioff Children’s Hospital emergency room were suicidal, the highest percentage on record. Statewide, 134 young people killed themselves in 2020, a 24% increase over 2019. (There is fluctuation from year to year. In 2017, 128 young people died by suicide in California.)
Now, health professionals and Berkeley Unified counselors are bracing for a new wave of students needing care when students will attend in-person school full time in the fall. While the return to school will relieve the isolation, and a classroom setting will make it easier for teachers to identify and refer students who need help, the transition period back can be difficult.
“I think there’s a misconception that once the schools reopen, everything’s going to be better,” said Dr. Christine Garcia, San Francisco regional director of the Edgewood Center for Children and Families. “I think that’s true to a certain extent. What’s missed is that many of us have been through these quite intense and traumatic experiences.” Garcia’s eighth-grader is enrolled in Berkeley Unified and has struggled with depression and anxiety this year. Her nonprofit has seen referrals for residential treatment rise by about a third during the pandemic.
In Berkeley, students can receive mental health care through counselors at each school. The district employs 27 counselors total, who offer drop-in appointments and group therapy. Outside agencies provide additional counseling at the elementary schools. The district also embeds mental health support in its advisory curriculum and through other classes. BUSD did not provide requested details about how many students each counselor serves and how many counselors are solely focused on student mental health.
There is also the city-run Berkeley High Health Center which, since March, has provided online-only therapy for Berkeley’s high school students with MediCal insurance. It is staffed by three counselors, two masters’ students in training and a supervisor. High school students can also receive academic and intervention counseling.
Jonathan Maddox, who oversees the city’s mental health services for children, said the Berkeley High Health Center has seen far fewer students since the pandemic began. Since the beginning of the pandemic, the health center has provided mental health care to 184 students and provided crisis support to an addition 39 students.
With students at home, fewer adults are referring them to the health center, Maddox explained, and students may be experiencing Zoom fatigue that makes online therapy unappealing.
In Oakland, counselors got creative about ways to reach students at the start of the pandemic, ordering food through DoorDash and bringing art supplies to their doors. It worked, according to Saun-Toy Trotter, who has been the program manager for Oakland’s school-based behavioral health services for 15 years. The school-based mental health services are now at capacity, serving 195 adolescents from July to April of this year.
Maddox’s team at the Berkeley High Health Center is beginning to talk with Berkeley Unified about offering more mental health services for students next year, though Maddox said it’s too early to say what those services might look like. The health center has not yet discussed offering in-person therapy, but he expects that to change next year.
Berkeley High also has a club, the Mental and Emotional Education Team, devoted to supporting student mental health, but it has not been active this year. On May 10, the city’s Youth Commission formed a sub-committee to specifically address the mental health of young people.
The May revision of Gov. Gavin Newsom’s budget promises an additional $600 million for schools to provide better behavioral health care, including mental health services, on top of COVID-19 relief funds. The district has not announced how it will spend additional funds to support students’ mental health, but it has promised an emphasis on socio-emotional learning curriculum for the upcoming school year.
‘Super scared all the time’
Miles Miller, a senior at Berkeley High, said he struggled with his mental health this past year and a half. When COVID-19 transmission rates were high, Miller saw virtually none of his friends. “My mood and my mental health hit an all-time low,” he said, adding that his work ethic plummeted and he had difficulty concentrating. Miller said he noticed many of his classmates dealing with new mental health challenges, too.
The struggle has been acute for some students. Noelle, a fifth grader, has talked about killing herself, and her sister, Nina, a third grader, has said that she does not want to live. (To protect families’ privacy, pseudonyms are used in this story for those students and parents referred to only by their first names.)
“My mental health has been horrible this year. It’s very, very, very scary and most of the time, I have no idea how to handle it, how to do anything, I’m just super scared all the time,” Noelle said.
Alicia’s eighth-grade child, Jaylan, has been hospitalized three times since March for self-harm and imminent risk of suicide. Each time they came home from the hospital, Alicia meticulously swept the house of anything that could be weaponized, from paper clips to glass bottles.
This winter, when Jaylan started talking about feeling lonely and wanting to go back to school, Alicia joined BUSD Parents, a group that has been pushing the district to reopen schools, in an attempt to ease her child’s pain, which began before the pandemic but worsened during it. The group has argued that distance learning exacerbates inequity and harms students’ mental health, while others don’t see in-person learning as the antidote.
This spring, the group conducted its own survey, drawing over 800 responses from Berkeley Unified families. The majority of parents who responded to the survey were somewhat concerned (47%) or extremely concerned (44%) about their child’s social or emotional health.
“The world disappeared for my kid and it didn’t look like it was coming back,” Alicia said. “None of this was necessary. It feels like my kid’s recovery would have happened faster and wouldn’t have got so bad if my kid wasn’t stuck in an isolation chamber.”
Still, many students have found their own silver linings, relying on social media to stay connected with friends and exploring new hobbies. For some students, attending school on Zoom has even brought relief from social anxiety or bullying. A national survey found that half of students reported less bullying during the pandemic than in prior years.
When school moved online, Vicki Davis watched her seventh-grade daughter, who has Fragile X syndrome, become more comfortable participating in class. Her daughter thrived in a virtual girls’ group set up by her counselor, a structure that she didn’t have before.
Mixed feelings about return to classroom
Elementary schools in Berkeley began opening five days a week March 29, middle schoolers returned for hybrid learning April 12, and high schoolers could come back to school about three hours a week April 26.
For Miller, even those few hours in person at Berkeley High have made a positive difference in his life. “It wasn’t an immediate fix to my mental health problems, but walking out, I felt good. I was kind of amazed how it made me feel after I left,” said Miller, who is the student director on the school board. Along with Laura Babbitt, Miller pushed for more in-person time for this spring.
“It’s been a godsend,” Garcia said about the four hours of in-person instruction each week. “Their mood is better. They’re more motivated to attend online Zoom classes.”
Going back to school in person can be a piece of the puzzle of getting children’s mental health back on track, but the transition can bring new challenges, too. Noelle was looking forward to going back to school, but struggled to cope with stress in the new environment.
“Going back to school has been … even harder than distance learning. I don’t know why I thought it might be better, but it’s been very, very hard for me and I don’t know what to do about it,” Noelle said.
Jaylan, whose mental health had been improving from November to January, cut themselves again one afternoon shortly after coming back to school in person. “It’s not a straight line recovering from depression and self-harm, but I wish my kid did not have the past year that they just did,” said Alicia, Jaylan’s mother. She hopes that returning to school full time will, by offering a familiar schedule, cause less stress than the inconsistency of hybrid learning.
Still, schools will need to provide mental health support to ease the transition for students returning to school full time.
“I think there’s a nationwide paradigm about what returning to in-person schooling is going to look like, and the influx of mental health needs that are going to be identified in students,” Maddox said.
The increased attention on students’ mental health means an opportunity to reimagine support for students who have been left behind. “We don’t want to return to normal because public education has a lot of room to grow to meet every student’s needs, in particular students who are most vulnerable,” Trotter said. “My hope is that the fall is going to have a lot of structure, a lot of recognizing of social-emotional needs.”
For Berkeley Unified students, it remains to be seen how mental health services will look different in the coming year.
If you are experiencing a crisis, you can reach the Crisis Text Line by texting HOME to 741741. You can call the Suicide Prevention Line at 1-800-273-8255. In a life threatening emergency, please call 911 or go to the nearest emergency room.
Correction: An earlier version of this story incorrectly described Jonathan Maddox’s title. He oversees mental health services for children in Berkeley, not the entire city.