Phebe Cox grew up in what might seem like an unlikely mental health danger zone for a child: Tony Palo Alto, California, in the heart of Silicon Valley. But behind his facade of success and family wealth, he said, there is an atmosphere of crushing pressure on students to perform. By 2016, when Cox was in high school, Palo Alto had a teen suicide rate four times the national average.
Cox’s family lived by the railroad tracks where many of the suicides occurred. He received counseling. But that option, she told KHN, is not always readily available to teens in crisis, and she and her peers viewed school mental health services as their last option because of concerns about confidentiality or anonymity.
A new program, designed largely by the people who use it, offers an alternative. Called Allcove, offers freelance health and wellness sites for people ages 12-25, often walk-ins, at little or no cost. Although Allcove is designed to support a wide range of physical, emotional and social needs, its main goal is to deal with mental health challenges before they escalate into deeper problems.
Allcove is still in its infancy, with two newly opened sites in the Bay Area and five more in the pipeline around California. It is inspired by a 15-year-old program in Australia, Headspace, which has 130 such clinics. Headspace has also inspired programs in other countries, including Puzzle in Ireland and Foundry in Canada. All of them, including Allcove, also offer online and telephone services.
Allcove’s core values resonate with Cox, who is now 19 years old and a student at Pitzer College in Claremont, California, and one of dozens of youth who have offered advice on the structure and services of the program.
“Right away, I knew it was going to be something big,” Cox said. “I felt pretty helpless when I was a teenager, but Allcove is about the students and the needs of the students.”
About half of all mental illnesses in a lifetime starts at 14 years oldand 75% before the age of 25, according to the researchers. However, access to mental health care is lacking in the U.S. According to the National Alliance on Mental Illness, some 30 million adults and children with mental health conditions are not treated, and 129 million people they live in areas with a shortage of mental health professionals. A 2017 survey found that Californians five times more likely to go outside of your private insurance network for mental health office visits than for medical or surgical needs.
Allcove tackles some of that by providing fully staffed safe spaces for teens and young adults to discuss and deal with their health, both mental and physical, along with substance abuse issues and educational support. California law allows those 12 and older to obtain outpatient mental health or counseling services without the consent of a guardian.
Allcove’s Palo Alto and San José sites are full of vibrant color and plenty of open space, the result of input from a youth advisory group that numbers a dozen or more members and changes about once a year. Within Allcove, clients can access group or individual care, ask a doctor about a problem, and even get help preparing for college.
Unlike the Australian program, Allcove does not yet have an ongoing funding source. Allcove is “a big boost, and we [at the state level] I mean, ‘How can we help him?’ ”Said Toby Ewing, executive director of the California Mental Health Services Oversight and Accountability Commission, which manages the fund that seeded the top two sites with $ 15 million.
Funding can eventually come from a combination of state, private, and nonprofit sources, as well as Medi-Cal reimbursements, said Dr. Steven Adelsheim, a psychiatrist who directs the Center for Mental Health and Youth Wellness at Stanford University. .
Adelsheim previously spent nearly 30 years in New Mexico, helping that state build a network of school health centers. His experience convinced him that many students would likely avoid mental health services at school. He said they were reluctant to discuss these issues with their own counselors, that they could be the same people who write the students’ letters of recommendation for college, and that they could unknowingly violate privacy.
That discovery led Adelsheim in 2014 to obtain exploratory funding from the Robert Wood Johnson Foundation to create Allcove. (KHN, which produces California Healthline, also receives financial support from the foundation.) “There is a compelling need in the US to reach children with early help and intervention,” Adelsheim said.
The idea struck a chord with Santa Clara County officials, who had seen Palo Alto ravaged by teen suicide clusters during the 2009-10 and 2014-15 school years. “The saddest part of the story is that a teenager didn’t reach out earlier, didn’t get a chance to get help when and where they needed it,” said County Supervisor Joe Simitian. said announcing the opening of Allcove in June. “The appeal of the Allcove model is that it is designed to engage young people who are struggling, long before they reach a crisis point.”
When Cox moved from high school to Henry M. Gunn High School in Palo Alto, his therapist told him about the Adelsheim project and suggested that Cox run to be on the Allcove youth council. One of Cox’s contributions was to suggest that the hours of the week be extended to at least 7 pm, “because young adults are doing things and on the go all day. It is the nights, and even the weekends, when we are faced with things or feel most helpless. For many of my friends, at night is when things can get overwhelming. “
Both Foundry, the Canadian program, and Allcove also address physical health. Foundry CEO Steve Mathias said his program’s emphasis is “on health and wellness, not just mental health, which is part of wellness.” Adelsheim said: “Sometimes a child may come in with a physical complaint, and only after a few visits is the mental suffering brought to light.” When that happens, Allcove can make a “cordial transfer” to an on-site mental health specialist.
The most significant difference between Headspace and Allcove may be the financing. Headspace is part of the Australian Government’s Mental Health Initiative and is therefore budgeted for. Allcove is essentially building on the go, and its long-term growth capacity will depend on money.
Of California Proposition 63, written in 2004 by then-Assemblymember Darrell Steinberg (now Sacramento Mayor), levies a 1% tax on personal income of more than $ 1 million to fund community mental health services. This year, the tax can bring in $ 2.4 billion, Ewing said. Most of it goes to existing programs, but about 5% each year (more than $ 100 million in 2021) fuels an innovation fund to foster new approaches to mental health.
Santa Clara County raised $ 15 million from that fund to launch Allcove. The state has also helped fund the Allcove sites, in Sacramento, San Mateo and Orange counties, and two in Los Angeles County.
“We have invested more than $ 30 million in this model,” Ewing said. “We are assuming it will be a success.”
Success, Adelsheim and Cox say, would mean the establishment of hundreds of Allcove centers across the state, readily available to youth. The hope is that, if caught up, Allcove could become a household name for young Californians and eventually others across the country.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operational programs in KFF (Kaiser Family Foundation). KFF is a nonprofit organization that provides health information to the nation.
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