Find Your Center
Sahithi - California
Mental health became a concrete reality when I told my French teacher in December that my friend had identified a method for committing suicide. Even though I had been engaged in mental health activism for months, that day mental health moved from an abstract policy issue to something consuming me with worry. The stark fact that my friend’s life hung in the balance because of numbers – because there are only 26.7 psychiatrists per 100,000 people in Santa Clara County 1, because 79% of youth with mental health issues do not receive services 2, because therapy was expensive and something to keep hidden – unnerved me.
I am so grateful that my friend is still alive and safe today. However, her individual story highlights the systemic barriers in our mental health care system that put her in a position of risk. One of the most significant roadblocks is that of cost. Because of the low reimbursement rates provided for therapists and psychiatrists by insurance companies, far fewer mental health providers accept insurance than other health care providers . For example, a 2015 study found that only 55% of psychiatrists accept insurance 3, pushing individuals to pay hundreds per session out of pocket, a cost-prohibitive arrangement for many.
The reason behind low reimbursement rates is the same reason why so many youth fail to make use of the few services that are available – stigma. I come from a culture where mental illness is shunned and whispered in silent gossip. This attitude of shame deep-rooted in families and cultures means that many youth never know that mental health services are an option in the first place. This is only exacerbated by the perception that seeking services is only for those in a state of crisis and that asking for help constitutes weakness. The current gaps in early intervention and the overly-clinical model of mental health care in which youth perceive support as synonymous with the psych ward turns young people away from help-seeking behaviors. These problems are only worse for marginalized communities, such as Asian, black, Latinx, immigrant, and LGBTQ+ communities. The net impact of this is the continuation of untreated mental illness, potentially lasting into adulthood and pushing youth into the criminal justice system.
I have had the amazing opportunity to address my community’s mental health needs through participating on the youth advisory group (YAG) for allcove 4 , a project currently in planning by the Stanford Center for Youth Mental Health and Wellbeing. allcove aims to create free, confidential youth mental health centers with pilot sites in Santa Clara County. In my role, I ensure that allcove is inclusive and welcoming of children, adolescents, and transitional-age youth in my community. To this end, I have provided feedback on the design of our brand, delivered recommendations for the ambiance and services of the centers, and worked to promote allcove’s mission of mental wellness in the community.
After a year on the YAG, I can attest that allcove is the missing puzzle piece to our mental health system. The allcove model is unlike anything America has witnessed before and has the potential to revolutionize mental health care, evidenced by its classification as an innovation project under California’s Mental Health Services Act. allcove is unique as an organization in centering youth not only in its mission but also in its boardroom. Not many groups allow youth to be co-creators, but allcove’s sustained commitment to youth voice means that centers reflect the needs of young people. Another ingredient key to allcove’s design is that centers are firmly rooted in their communities. Through partnerships with community-based organizations to provide integrated services like physician visits, educational support, and housing assistance, allcove works as a one-stop center leveraging and expanding existing resources. Moreover, each center would have its own YAG, meaning adolescents and young adults who know the challenges of their area intimately direct these centers. The third and most important feature of the allcove model is access and inclusivity. One way the YAG has promoted this is through presentations to parents and teenagers of vulnerable populations to expand the conversation around mental health. Mental health services are often branded as clinical, which can discourage people from seeking help. Instead, we combat this stigma by designing allcove centers with open windows, pastel colors, and hangout areas to feel like community spaces rather than clinical ones. By creating a space where youth can simply talk whenever things get too much even if they do not have a diagnosis, we incentivize early intervention before a crisis starts. After all, mental health is more than the absence of mental illness.
Our goal is to have allcove implemented across the nation. The allcove model is deliberately decentralized, with centers built at the municipal and county level with community support. The expansion of centers through different counties and states would add a crucial component to our care models. Because of this, an individual can make an impact by speaking with county behavioral health services, city governments, and private hospitals about the allcove model. In fact, Stanford has gotten groups all over California interested in replicating our centers simply through conversations at conferences and gatherings. Whenever we have shared about our work, we meet mental health representatives interested in taking this back to their own communities.
Reflecting back, I am so thankful for my time on the YAG. This has been a one-of-a-kind environment where youth are trusted to be experts in our own lives, leading to diverse and innovative solutions. Something I will always appreciate is the role of empathy in designing allcove. We YAG members always tried to put ourselves in the shoes of someone going through a silent struggle, considering how we could build an environment that would be most welcoming to that person who really needed this. I love how allcove lets me engage directly with my community. Finally, I want to end with a story from the Spartan-Keyes Neighborhood Association in the city of San Jose. We identified a location on Keyes street that we thought would be perfect for our new center. I had been informed that our entry meant that the residents would miss out on retail space, so the association leaders we were presenting to might be a little upset. However, as we talked more about what allcove was doing during the meeting, they listened to us enthusiastically. I was so afraid these silver-haired women were going to interrogate us. Instead, their eyes lit up with excitement as one of them said, “This is the neighborhood where I was born. I just wish we’d had something like this sooner.”
- Forestieri, Kevin. “Nowhere to turn for kids in crisis.” Mountain View Voice, 2018.
- Senate Bill 12. “Mental health services: youth.” California Legislative Information, 2019.
- Bishop, Tara F et al. “Acceptance of insurance by psychiatrists and the implications for access to mental health care.” JAMA psychiatry vol. 71,2, 2014, doi:10.1001/jamapsychiatry.2013.2862.
- Allcove is not capitalized in this essay to keep in line with allcove’s branding.