The Santa Clara County Board of Supervisors unanimously approved on Tuesday $600,000 over three years to support two "critical" staff positions at a yet-to-open youth mental-health center currently being developed by Stanford Medicine's Center for Youth Mental Health and Wellbeing.
The funding, which is contingent on the opening of at least one center within Santa Clara County, is an "important first step" toward providing critical early intervention and support services for youth and adolescents in the area, said Steven Adelsheim, director of the Center for Youth Mental Health and Wellbeing.
Adelsheim has been spearheading a growing, yearslong effort to open a clinic based on a national youth mental-health initiative in Australia called headspace, which provides early-intervention services from physical and mental health to alcohol and other drugs, work and academic issues to 12- to 25-year-olds at either a low cost or for free. The clinics are also founded upon a "by youth, for youth" sentiment: They are designed and operated with strong youth input, including from established youth advisory boards.
The goal of the headspace model, which was created and funded by the Australian government in 2006, is to increase young people's access to mental-health support by providing a physical, stand-alone space they feel comfortable going to for help with anything, from a bad breakup to diagnosed depression. headspace also provides confidential online and telephone support services, as well as school-based programs and training for health professionals and research efforts.
The "essence" of the model is getting young people early help for mild to moderate mental-health issues, but strong relationships with outside providers also ensure that anyone in need of more serious psychiatric support or intervention receives it, according to a description of the initiative on the Center for Youth Mental Health and Wellbeing website.
"Given the fact we have quite a bit of data that says early identification makes a huge difference for young people whether we're talking about early treatment for anxiety or depression or treatment for psychosis, it's really clear that early treatment is important," Adelsheim said in an interview Thursday. "This is really a first step in developing that first public mental-health part of the process that we really don't have, not only in our system for this county but I think really in the United States."
The Board of Supervisors voted unanimously to provide $200,000 annually to fund two positions at the clinic: a youth support specialist and supported employment and education specialist. A total of $170,000 will be allocated each year to cover their salaries and benefits. The remaining $30,000 will support "youth-led marketing" efforts "to combat stigma and reach youth in need," reads a report from Supervisor Joe Simitian, who brought the funding recommendation.
The youth support specialist will work with a youth advisory board to develop the initial messaging and marketing campaign for headspace, run focus groups to solicit youth and family input and develop a peer-support model, according to Simitian's report. The supported employment and education specialist will serve as a conduit between headspace and schools and help young people coordinate their treatment plans with their educational and employment goals.
Funding these two positions is particularly critical because unlike a therapist or primary care provider position, they are not reimbursable through Medicaid.
The positions "are in my view important I dare say essential to the success of the effort, yet they're the kinds of positions that might not ordinarily be funded by conventional insurance or even grantmakers," Simitian told the Weekly Thursday.
"In talking with Dr. Adelsheim, what excited me about the headspace model was that it really does seek to meet teens where they are, to engage them in a way typical service providers cannot," he said.
Simitian's recommendation notes that one in five adolescents has a diagnosable mental disorder, yet less than half of adolescents with these disorders received any kind of treatment in the last year, according to the U.S. Department of Health and Human Services' Office of Adolescent Health.
The same is true in Santa Clara County. Out of the county's 168,420 children between the ages of 11 and 17, only 8,122 youth ages 0 to 25 are using mental-health services in the county, according to a National Center for Children in Poverty report.
Simitian said headspace's early-intervention model will make a difference in a county where the system is currently "geared toward crisis management."
"Time after time, the saddest part of the story is that a kid didn't reach out earlier, didn't have the opportunity to get help when it might have mattered and really made a difference or saved a life. Again, one of the appeals of headspace is that it is designed to engage youngsters who are struggling at an earlier time, before the crisis arrives on their doorstep," Simitian said.
Several local community organizations that provide youth mental-health services expressed support for the headspace funding in letters sent to the Board of Supervisors, including Momentum for Mental Health, Counseling and Support Services for Youth (CASSY), Asian Americans for Community Involvement (AACI) and EMQ FamiliesFirst.
"The headspace model provides that first step in a public mental health system to allow young people to come in on their own to obtain mental health support for mild to moderate mental health issues in a site that also integrates primary care, early addiction intervention, and school/employment support," wrote David Mineta, CEO of Momentum for Mental Health.
"The non-clinical appearance and nature of these spaces are critical to providing a safe, welcoming, and easily accessible space for these youth to share their issues with supportive staff," wrote AACI Executive Vice President Sarita Kohli. "Often times, it is the availability of someone to listen and support them that makes all the difference in saving a life."
Stanford hopes the new center (or centers) would provide services to 1,000 adolescents and young adults annually over the first few years, according to Simitian.
Meanwhile, both public and private fundraising efforts continue. The Center for Youth Mental Health and Wellbeing has applied for Mental Health Services Act (MHSA) Innovation funds through the county, Adelsheim said. The funds support programs that have the "potential to transform the behavioral health system" with "new approaches that can inform current and future practices," a county description reads.
The Lucile Packard Foundation for Children's Health, Lucile Packard Children's Hospital Stanford and Stanford Medicine's Department of Psychiatry and Behavioral Sciences have all committed to contributing staff time and resources for program development and fundraising, according to Vicki Harrison, manager of community partnership for the Center for Youth Mental Health and Wellbeing.
Stanford Medicine also previously received funding from the Robert Wood Johnson Foundation to conduct a feasibility study of opening a headspace-like center in the U.S.
Simitian wrote in his report that Stanford plans to open one or two pilot centers over the course of the coming year. Adelsheim said this timeline will depend on fundraising efforts.
"Our hope is this initial support from the county and the board will help move that much more quickly," he said.
"We're hopeful we can be an active partner with both the county and the other community mental-health partners in building this whole continuum of mental-health support for our young people, which is just so badly needed," he added.
Process for inpatient unit also moves forward
Running parallel to the headspace effort is one to open a youth inpatient psychiatric unit in Santa Clara County. The county has not had such a unit for more than 20 years, so an average of 20 adolescents each day are receiving inpatient psychiatric care outside of the county, from San Mateo to Sacramento, according to Simitian.
Simitian brought to the Board of Supervisors last May a request to have staff analyze the feasibility of opening such a unit within the county's borders, kickstarting a serious effort to close what many parents and youth have described as a serious gap in local mental-health services.
In April, the county issued a Request for Information (RFI) to solicit ideas and suggestions for a local child and adolescent inpatient unit, then a more full Request for Proposal (RFP). Palo Alto's Lucile Packard Children's Hospital, Mountain View's El Camino Hospital and Kaiser Permanente submitted a joint response to the earlier Request for Information.
The county also received RFI responses from Fremont Hospital, which currently operates a youth inpatient facility but would open a new additional unit in Santa Clara County; EMQ Families First, a statewide nonprofit that offers mobile crisis services in Santa Clara County and also operates a small short-term crisis stabilization unit in Campbell for suicidal children and teens; and Bay Area Children's Association (BACA), a San Jose nonprofit that provides child and adolescent psychiatric services. BACA jointly responded to the RFI with PrairieCare Medical Group, a Minnesota-based psychiatric healthcare system.
Final responses to the Request for Proposal are due Wednesday, June 22. The county will review them in July, Simitian said.