Opinion: Our Kids Can’t Wait

OPINION

Our Kids Can’t Wait

San Diego County spends less on children’s mental health than any other major county in California. Here’s what that really means – and what we can do about it.

By Stephanie Gioia-Beckman, Senior Director of Workforce and Community Impact, PIC, and Alfredo Aguirre, LCSW, former Director of San Diego County Behavioral Health Services and Advisory Board Chair of the Strategic Behavioral Health Initiative

Imagine your child is struggling. Maybe they’re not sleeping. Maybe a teacher pulled you aside to say something isn’t right. But the wait for behavioral health care is six months.

Six months is a long time in a child’s life. It’s half a school year. And the research is clear: a child who waits six months for mental health care is not the same child who would have been seen on day one. What might have been addressed with early support too often becomes a crisis by the time care finally arrives.

This is a common experience in San Diego, though it doesn’t have to be.

Where San Diego Stands

San Diego County runs one of the largest behavioral health systems in California – a $1.5 billion operation. That’s a serious investment, and it supports a lot of people.

But when it comes to children and youth specifically, San Diego ranks last among every major county in California.

Right now, only about 19% of every behavioral health dollar that supports programs and services in the Proposed County Behavioral Health Services (BHS) Budget and Behavioral Health Services Act (BHSA) Integrated Plan goes toward kids. Los Angeles directs 32% of its budget, and San Bernardino commits 44%. The statewide average for the eight largest counties in California is 30%.

The result? Only about 3 out of every 100 Medi-Cal children in San Diego get a single specialty mental health visit in a year. The County’s own data shows that suicide-related crises are now the number one reason children end up in the emergency room – more than any illness, more than any injury. San Diego youth are 1.5 times more likely than the average County resident to land in an emergency room for a suicide crisis.

The Proposed Plan Moves Us Backward

San Diego County is currently finalizing a three-year plan for how to spend its behavioral health dollars. The Proposed BHS Budget and BHSA Plan, as currently written, would cut funding for children and youth programs by $17.2 million over three years – while increasing spending on adult services by $10 million. This is a County that already ranks last among major California counties in what it invests in children’s mental health. This plan would push us further behind.

To be clear: adults need and deserve quality mental health care too. This is not about pitting generations against one another. But a community that already underinvests in children – and then cuts further – is, by definition, paying more than it has to, and getting worse outcomes in return.

Early Intervention Works – and It Saves Money

The science on this is simple. Most mental health conditions, including anxiety, depression and trauma responses, begin before age 25. Half begin before age 14. Children are especially responsive to treatment.

When we catch problems early, we help kids recover faster, stay in school, stay connected to their families, stay out of trouble, and build the kind of resilience that carries them through adulthood.

When we don’t intervene early, those same kids often end up cycling through emergency rooms, crisis services, and, too often, the justice system. Those interventions are far more expensive – financially and humanly – than the early support that might have prevented them and impacts low-income families with the fewest options.

This is not a theoretical argument. It’s why California passed the Behavioral Health Services Act – a landmark reform that specifically requires counties to direct meaningful funding toward early intervention for children and youth. San Diego has an opportunity, right now, to meet that challenge. The draft plan and proposed budget, as written, does not.

What We’re Asking For

The Strategic Behavioral Health Initiative is a coalition of healthcare providers, schools, community-based organizations, university training programs, subject matter experts, and families across San Diego.

We are calling on the County to make three commitments:

  • Raise the floor. Allocate at least 30% of behavioral health services and program spending to children and youth – bringing San Diego in line with the state average of the largest counties. This is not about leading the state. It’s about no longer trailing it.
  • Invest upstream. Put more dollars into schools, pediatricians’ offices, and community programs and make it easy to get help before a situation becomes a crisis.
  • Be transparent. Publish clear, year-over-year data so the public can see where the money goes and whether things are improving. Accountability shouldn’t require a freedom of information request.

A Shared Problem, a Shared Solution

Here’s what makes the current situation even more concerning: the County has already done the hard work of defining what better looks like. San Diego’s Youth Optimal Care Pathway (OCP) released earlier this year calls for reaching more children earlier, building school-based services, integrating with pediatric care, and closing the gap between the kids who need help and the kids who get it.

That vision moves us in the right direction. The problem is that the proposed budget does not.

The County’s own OCP sets a goal of improving access to behavioral health Medi-Cal services for children by bringing service utilization rates up to the state average among Medi-Cal-enrolled youth, which means more providers, stronger connections between schools, pediatricians, and community providers, and removing the barriers that keep families from getting in the door. That requires investment, not cuts.

We are offering to help. We’ve proposed a joint workgroup – County staff and community partners meeting regularly – to track whether implementation is keeping pace with the OCP’s goals and surface problems before they become crises.

Investing in children’s mental health now is the most cost-effective decision this County can make. Every dollar spent early pays back many times over. The only question is whether San Diego has the will to augment the budget to reflect that reality.

The County’s plan and budget will soon be finalized. San Diego still has time to choose whether it will continue falling behind – or finally invest in the mental health of its children at the scale this moment demands.

The Strategic Behavioral Health Initiative (SBHI) is a cross-sector collaborative working to build a behavioral health system that reaches every child in San Diego County. Learn more at SBHIsd.org.