Rates of chronic sadness and suicidality in adolescents have been rising in California—and nationwide—since about 2009. The COVID pandemic not only temporarily worsened this trend but also exposed longstanding inequities in both the prevalence of conditions and access to treatment. Significant gaps exist between the reported need for mental health care and receipt of services—especially for girls and older adolescents. Challenges include provider shortages and high costs. The state is investing $8 billion for children and teen mental health, including school-based services.

How are California’s teens faring?

In recent years about 3 in 10 California children ages 12 to 17 have reported serious psychological distress. One-third of students studied report chronic sadness, and 14.5 percent suicidal thoughts. Teens of color—especially Native Hawaiian/Pacific Islander and multiracial students—report higher levels of distress than their white peers. Girls report substantially worse mental health than boys. This gender gap emerges early and persists throughout high school. Teens in rural schools have worse mental health than their peers in more urban schools. Those in the lowest-income schools report about 8 percentage points more chronic sadness/hopelessness than their counterparts in the highest.

Teens in rural schools have increased likelihood of poor mental health

Increased likelihood (percentage points)

SOURCES: California Healthy Kids Survey, school years 2017–18 to 2023–24; US Department of Ed data on school urbanicity.

NOTES: Bars represent regression-adjusted associations of rurality against chronic sadness and suicidal thoughts in the past year. The excluded group includes schools in cities, suburbs, and towns. Effects are significant at the 99 percent level of confidence.

What school-based resources are available?

Teens spend most of their time at school, which makes it the ideal place to identify mental health needs and deliver services. However, they have a strong preference to talk to someone they know rather than go to counseling. Nevertheless, half who get help after reporting a need to see a counselor or therapist do so at school.

Schools have traditionally relied on core support staff—such as counselors, psychologists, and social workers—to serve struggling students. Some schools have dedicated resources to support student mental health, such as school-based health centers, wellness centers and community schools. These are three examples, but others exist and variation across schools is high.

How does district spending stack up?

Between 2018–19 and 2023–24, pandemic recovery funds helped drive the increases in district spending on student health, including mental health, from $934 million to $1.64 billion annually—mostly allocated to personnel costs. Spending is similar in low and high poverty schools. But rural districts lag behind their more urbanized counterparts. Regardless, as pandemic funds have expired and the state faces growing budget constraints, maintaining these expanded resources will be challenging.

What is needed moving forward?

Telehealth could be a cost-effective way to bring services into isolated and under-resourced schools in rural areas.
Teens’ reluctance to access professional help highlights challenges around trust, stigma, and mental health literacy. Schools may need to do more to clearly communicate available services, normalize their use, and build confidence in the community. Innovative approaches—such as peer-to-peer support programs in schools—offer promising models for meeting teens where they are.
More comprehensive school-level data on mental health personnel such as counselors, psychologists, and other professionals could help guide resource allocation toward schools with higher mental health needs and where gaps in access and funding are most pronounced.
Initiatives like community schools and wellness centers are relatively new. Documenting the range of mental health services can facilitate understanding what students experience on campuses with these supports.
Schools and districts will continue to need more technical assistance to conduct medical billing for school-based services at scale.
Continued evaluation of the California Youth Behavioral Health Initiative and community school grants will help refine strategies for effectively addressing students’ mental health needs.

Source

About the Authors

Shalini Mustala is a research associate at the Public Policy Institute of California, where she focuses on the health care safety net. Before joining PPIC, she worked as a planning engineer for the government of India, working closely with rural infrastructure policies. She has a background in civil and environmental engineering and holds a master’s degree in public policy data science from the University of Southern California.

Paulette Cha is a research fellow at PPIC, where her work focuses on the health of underserved populations, especially children and immigrants. Her research has been published in peer-reviewed outlets including the American Journal of Public Health and the Journal of Adolescent Health, and she has been cited in numerous media outlets such as the Sacramento Bee and the Orange County Register. Before joining PPIC, she was a joint postdoctoral fellow at UCLA and the University of Southern California, and she has past experience evaluating social policy interventions in health and education for low-income individuals. She holds a PhD in health policy/health economics from the University of California, Berkeley.

Shannon McConville is a senior fellow at the Public Policy Institute of California and a member of the PPIC Economic Policy Center. Her research interests include health care access, utilization, and outcomes among vulnerable populations and the impact of vocational training programs on economic mobility. Her current work focuses on examining safety net programs, assessing the effects of Medicaid coverage expansions on individuals involved with the criminal justice system, and analyzing the employment outcomes and economic returns of career technical education. Before joining PPIC, she was a research training fellow in the Health Services and Policy Analysis doctoral program at the University of California, Berkeley; a senior research associate at the Department of Health Research and Policy at Stanford University; and a project manager at the Lewis Center for Regional Policy Studies at the University of California, Los Angeles. She holds a master’s in public policy from the University of California, Los Angeles.

Chansonette Buck is the owner and executive editor of Appaloosa WordCraft, which provides research, writing, and editing for a wide range of organizational clients—including public policy think tanks and nonprofits. She is also an award-winning poet. She holds a PhD in English from the University of California, Berkeley.