For teens and young adults, getting access to mental health care can be nearly impossible. Costs are exorbitant and insurance companies are reluctant to pay for it, and few professionals in the shrinking field of child psychiatry are able to take on new patients.
Santa Clara County is looking to change that starting this year, launching two clinics — one in Midtown Palo Alto and the other in San Jose — with an ambitious approach that's never been tried in the U.S. Each is a one-stop shop where anyone aged 12 to 25 can walk in, find out what they need and get help. No prior diagnosis or referral is required, and neither a lack of insurance nor ability to pay is a barrier.
The network of clinics, called allcove, has been in the works for nearly a decade and finally opened last week, each staffed by a broad team of clinicians, psychiatrists, psychologists and nurses. Anyone who walks in will have access to mental health support, primary care, substance-use addiction services and peer support.
Those with more pressing needs that can't be addressed at allcove, like housing, intensive treatment and care for early psychosis, will be directly referred for help elsewhere.
Inside Palo Alto's center, at 2741 Middlefield Road, it's hard to tell allcove is a mental health clinic at all. Brightly colored furniture and large open spaces greet those who arrive, with more art slated to fill the reception area in the coming months. More than a dozen youth who make up the center's Youth Advisory Group made nearly all of the major design choices, pushing for an approach that's inviting to all.
So deeply involved were members of the advisory group that every hire — from clinical staff to the receptionist — were all vetted by youth, said Ana Lilia Soto, youth development manager for allcove. Doing so ensured that those who work at the clinic would be compatible with the teenagers and young adults coming in to seek help, she said.
"We have this thought of infantilizing youth instead of looking at their complexities, so we want to make sure that youth voices were expressed in the hiring," Soto said.
Though less flashy and filled with cubicles, the staff room inside allcove is a special place at the clinic and something that's hard to come by anywhere else, Soto said. It's rare to have a group of medical and mental health professionals all working in the same room together and able to freely communicate about the mutual patients they're serving, she said.
Stanford psychiatrist Steven Adelsheim, who spearheaded the effort to create allcove, said the "integrated care" model is important and should include things like physical health as well. Oftentimes medical ailments can be the reason for young people to walk through the door, but the physical symptoms indicate an underlying mental health condition that can be rooted out early.
"Lots of times a young person would come in with their headache or their stomachache and by the second or third visit you get to the underlying mental health issue," Adelsheim said. "Then you can do the warm handoff to the counselor next door and help make those connections."
The success of allcove will hinge on teens and young adults showing up at the door when they need help, so the Youth Advisory Group is trying to spread the word as much as possible. Jeremy Peng, a Palo Alto High School student and member of the group for the last year, said they recently spoke at Gunn High School to let them know allcove is available to them and encouraging them to visit after school in the fall.
The hopes, they said, are to attract people before they're in a state of crisis and for allcove to spring to mind as a place to go for youth dealing with problems in their lives. So far, he's found that sincere enthusiasm is the best way to lure his peers.
"That's the most important marketing to youth: You have to be passionate yourself to let people know that it is a community resource," Peng said.
County health officials have been pushing to create what would become allcove since 2016, responding to an alarming local mental health crisis. Suicide has long been the second leading cause of death among young people, and for more than a decade Palo Alto had the highest suicide rate among young people in Santa Clara County, including two suicide clusters. The worries prompted an epidemiological study by the Centers for Disease Control and Prevention in 2017, which looked into the root causes.
Among the findings, the CDC found many young people in Palo Alto who died by suicide had "severe" mental health problems including schizophrenia, psychosis and chronic and severe depression. Circumstances leading up to their deaths included a recent crisis, an ongoing mental health problem, a history of treatment for mental illness or a history of suicidal thoughts or ideation.
Federal data shows that half of all cases of mental illness begin by age 14 and that an estimated 20% of teens ages 13 to 18 are living with a mental health condition. The vast majority do not receive treatment for years, if ever, and the average delay between symptoms and intervention is eight to 10 years.
County Supervisor Joe Simitian, who strongly supported the effort to create allcove, said the common thread is that teens are not reaching services early on before their condition becomes a crisis. He said the new approach — in which youth can simply walk in and get care with no preconditions — is exactly what's needed for those who need help.
"If you can find a way to literally just let a teenager or young adult walk in the door and assure them they are in the right place, whatever brought them there, that's a gift," Simitian said.
Allcove mirrors a similar network of mental health clinics launched in Australia in 2006 called headspace, which was the basis for spinoff programs like the Foundry Program in British Columbia and Jigsaw in Ireland. But getting it to work in the U.S., with its myriad complexities related to costs, medical billing and the private insurance market, made it difficult to emulate locally.
County health officials, partnering with Stanford's Center for Youth Mental Health and Wellbeing, pitched the idea to the state in 2018, receiving the greenlight to spend $15 million in state funding on the project.
The funding comes from California's Mental Health Services Act, which provides millions of dollars to counties each year to bolster existing services and dabble in new ideas. Since the law's passing in 2004, Santa Clara County has largely failed to spend down the money and came narrowly close to losing the funds. The allcove program is a major milestone in finally spending that money.
The original plan described a "ramp up" period ending in June 2018, suggesting there was a significant delay in opening allcove. Among the reasons, according to Simitian, was the difficulty pulling together all of the partners and resources for a clinic that can provide everything from physical and mental health care to education and employment services. The pandemic also pushed back the start date, but that could be a good thing, he said.
"The fact that allcove is coming online as we're through the worst of the pandemic is fortuitous timing," Simitian said. "The emotional and mental health of a lot of young people have really taken a beating."
From the outset, state health officials from the Mental Health Oversight and Accountability Commission are closely watching how well allcove works. If it is a breakthrough model that can overcome the many hurdles preventing youth from accessing mental health care, the two allcove clinics could very well be the beginning of a new nationwide approach.
"My hope is that one day we look back on that Friday as not just the opening day for those two centers ... but as the beginnings of a statewide and national movement to improve the kind of integrated care and mental health services we provide to folks across the country," Simitian said.