When her high school suddenly switched to an online format in 2020, Gisselle Becerra Murillo started skipping classes.

Becerra Murillo, who recently graduated from Cabrillo High School, said that she felt constantly drained, and unmotivated to do anything.

“Those years that I had online school, my grades really went down, because I wasn’t really showing up to class,” said Becerra Murillo, 18. “I was mostly just spending my time in my bed, sleeping.”

Even when COVID-19 pandemic restrictions began to lift, she still didn’t want to leave the house.

“That just took a big toll on me,” Becerra Murillo said.

After returning to school in-person, Becerra Murillo said her mental health has improved. But for many teenagers, experts have continued to notice a stark increase in mental health needs—a trend that began prior to the pandemic, but that has been exacerbated by the stress of the last three years.

At The Guidance Center, a Long Beach nonprofit that serves about 3,200 youth and families each year through free mental health services, there has been an upward trend in eating disorders, said Patricia Costales, CEO of The Guidance Center.

Not only that, but about 30% of children at intake—meaning their very first appointment—are sharing that they have suicidal thoughts, according to Costales.

“Those percentages are completely unprecedented for us,” Costales said, “and those don’t even include the kids who aren’t comfortable enough to tell you in their first appointment.”

Lingering impacts of the pandemic

Since returning to school in-person, Becerra Murillo has noticed more shyness and anxiety among her peers.

“Because after those …  two years of no socializing, just through a camera or through texting and stuff like that, that basically took away some of those really important socializing skills that we had,” Becerra Murillo said.

During the pandemic, kids and teens were inundated with all kinds of “scary” news, which kickstarted a stress response cycle, activating a fight, flight, or freeze response, said Noemi Alsup, a therapist who works with teens at Rose Junie Therapy.

“If that system is continuously running, it does something to the body where it makes us think it’s unsafe,” Alsup said. “There’s lingering effects from that system being on overdrive, and now, we’re being told that things are normal … and so our brains need time to heal in that way. So it’s about telling and soothing the brain and saying, ‘We’re safe now, so how can we start healing from this process?’”

The fact that, for these teens, the pandemic came during such a key developmental stage in their lives only magnified its impact on their mental health.

Teenagers are in the midst of discovering their identities and exploring how they relate to and differ from their peers, friend groups and families, explained Alsup. For teenagers, relationships are one of the most, if not the most, important parts of this developmental phase, she said.

And because the brain is still developing in adolescence, teens respond differently to stress than adults.

Marwa Azab, a professor of psychology and human development at Cal State Long Beach, said that in adolescence, the brain is in a vulnerable state chemically, in terms of its neurotransmitters, but also in terms of connections in the brain or the circuitry, which is why adolescence is commonly when mental illnesses such as depression, anxiety or schizophrenia begin.

“You’re already at a very vulnerable stage, where your emotional system is more developed than your higher-up executive system that’s helping you with managing your emotions,” Azab said. “And of course, three years at their age is equivalent to decades at my age, right? Because developmentally so much happens, like a 12-year-old is so different than a 15-year-old, but the 30-year-old is not that much different than the 32-year-old.”

Alsup, for her part, said she has noticed a rise in anxiety-related issues and depression, largely stemming from isolation, which has meant more teens seeking out mental health support, even after pandemic restrictions lifted and students returned to school.

“They have returned back to school, but school looks really different,” Alsup said. “Maybe their social groups that they participated in were dismantled. Maybe they’re not in that hierarchy of the group anymore. Maybe friends left, maybe friends moved—there’s all kinds of relationships that might have changed.”

The past three years have been a clear demonstration—to teenagers, but also to us all—of just how much of our lives can be outside of our control. But to Azab, one of the largest errors has been not communicating enough with teens about the tumult the pandemic caused and how to grapple with it.

“We have not, as a society, taught our teens to be comfortable with uncertainty,” Azab said. “That is the best protection for anxiety disorders as they get older.”

After the difficulties of navigating school online, students have been expected to return to school and perform as though the pandemic didn’t happen, Azab said.

Alsup agreed.

For many teens, she said, their families may not be open about talking about mental health, which in turn makes it more difficult for teens to express themselves.

“We place these adult expectations on teens and young children for the expression of their thoughts and feelings, when adults sometimes can’t even express their thoughts and feelings well,” Alsup said. “I think it’s about that modeling, and setting that example.”

Beyond COVID

Although the pandemic certainly exacerbated and brought to light many issues, mental health concerns among teens have been rising since prior to the pandemic, Costales of The Guidance Center said.

“COVID gets a lot of blame rightfully for a lot of stuff, and definitely did not help the mental health of our youth and children,” Costales said. “But we were in a youth mental health crisis prior to the pandemic as well.”

Gun violence, homelessness and racism, for example, are all issues that some teens have had to face since well before COVID hit.

Costales attributes the increase in mental health needs partially to these larger societal issues—gun violence, for instance, is not something that older generations had to worry about when going to school, she said.

For youth battling food insecurity or facing homelessness, and the subsequent anxiety and trauma that comes along with it, their sense of security and safety will also be impacted, harming their mental health, Costales said.

For teens who are still developing their sense of themselves in the world and their social relationships, a sense of security is all the more important, Costales said.

“We can’t protect our kids from being shot at school,” she said. “We have parents working two jobs still living in a car—these are all factors that can be outside of the control of a parent, but that definitely impacts the wellbeing of their developing children.”

“I think our families are under pressures like we haven’t seen in previous generations,” said Costales. “If we want to have children who are less stressed out, less depressed, then we need to support the whole family unit.”

And of course, some of the longstanding contributors to poor mental health, such as racism and other forms of discrimination, have disproportionate impacts on some teens.

According to a report from the U.S. Centers for Disease Control and Prevention documenting mental health trends among U.S. high school students from 2011 to 2021, 45% of LGBQ+ students surveyed in 2021 seriously considered attempting suicide—far more than heterosexual students. (The report did not have a question assessing gender identity and did not include data specifically referencing transgender students.)

Black students were more likely to attempt suicide than students of other races and ethnicities, said the report.

Another survey conducted specifically to assess the well-being of high school students during the pandemic concluded that 36% of students said they experienced racism before or during the pandemic, with the highest levels reported among Asian students (64%) and Black students and students of multiple races (both 55%).

The report noted that experiences of racism among youth have been linked to poor mental health, academic performance and lifelong health risk behaviors. The pandemic, Azab said, likely exacerbated those impacts.

For teens who were already experiencing high levels of stress, Azab said, “it wouldn’t be surprising that you won’t do very well in the pandemic, as opposed to a teen who has an amazing support system at home, whose parents can afford to get many people to help them. They will have a very different experience during the pandemic. They might have actually grown during the pandemic.”

Making mental health care accessible

Although financial accessibility can be a huge barrier to care, Azab noted that even if mental health care were free or affordable, not everyone will be able to dedicate the time to a weekly therapy session, Azab said.

“If you don’t have the resources to eat, you’re not going to think about therapy,” Azab said.

Ultimately, there’s an issue with access to care, said Costales of The Guidance Center.

“There aren’t enough therapists, there aren’t enough service providers—therapy’s massively expensive for most families. It’s cost prohibitive,” said Costales. “So without places like us, these families wouldn’t be able to access care.”

The need is so great that the Guidance Center is frequently at risk of being overwhelmed and over capacity, Costales said.

“That’s one of my greatest nightmares, is a waitlist or if we’re not able to get everyone in right away,” Costales said. “That is a reality, that sometimes there is a wait.”

But there is one way to make resources available to all teens: through schools.

To Costales, making schools, where teens spend most of their time, a more nurturing environment is a piece of the solution.

Creating a truly welcoming environment for all teens, though, may be harder than it sounds. In California, schools have fewer educators, counselors, nurses, support staff and administrators than almost any other state in the country—and the professionals on campus do not reflect the diversity of the students served, according to a report card created by the nonprofit Children Now.

Only 57% of California’s ninth graders reported having a caring relationship with at least one adult at school, while students who are in foster care, homeless, LGBTQ+, not yet English proficient, or Latino are the least likely to report a caring relationship with an adult at school, the report said.

Statewide support, such as the Children Youth Behavioral Health Initiative, has made a substantial difference in addressing the disparities, by funding schools’ wellness programs and supporting the creation of a more nurturing environment, Costales said. Just earlier this month,  California awarded $30.5 million to 63 groups to support youth mental health through community and evidence-based practices as part of Gov. Gavin Newsom’s $4.7 billion Master Plan for Kids’ Mental Health.

“I’ve been actually pretty proud of our state and the efforts they’re making to try to impact school campuses and cultures,” said Costales.

Locally, the “It’s About T.I.M.E.” initiative is one way that The Guidance Center is helping schools move away from discipline and policing to more nurturing support, which Costales said is an integral step to combating negative outcomes. The program assists schools in adapting more trauma-informed practices and policies, and it has expanded across the Long Beach Unified School District over the past eight years.

The Guidance Center is also currently in the second year of a pilot program with Long Beach Unified School District elementary and middle schools, where a therapist and resource specialist from the nonprofit will be called in cases of mental health crises, rather than a police officer. To meet the rising need, The Guidance Center has also obtained grant funding to pay for its staff to become certified in sophisticated treatment models, including dialectical behavior therapy or DBT, and assessing and managing suicide risk, or AMSR.

Additionally, The Guidance Center also provides school-based therapy sessions in over 60 schools within the Long Beach, Lynwood, Paramount and Los Angeles unified school districts.

“The families are often more willing to let their child be in treatment if it’s through the school, instead of coming to a building that says ‘mental health’ on the outside,” Costales said. “It eliminates a little bit of stigma, and it’s just much more accessible if it’s at school.”

At Cabrillo High School, where Becerra Murillo attended, there was a space to meet with psychologists on site—while the resource benefitted some students, more is needed, she said.

However, “there’s only so much they can do,” acknowledged Becerra Murillo. “They have lots of students, and it would probably be really hard for them to do one-on-one check-ins, but that would be really, really helpful.”

According to Beccera Murillo, outside organizations like nonprofits could help fill in the gaps where schools and other support are unable to meet the need. For Becerra Murillo, getting involved with the Youth Leadership Institute made a positive impact on her life, she said.

“I think our current generation of young people is amazing, and I just have nothing but respect for how involved they are as a group,” Costales said. “I think that generation is as a whole, more able and willing to seek mental health care and to normalize needing mental health care than any prior generation.”

And for anyone struggling right now, Costales urges them to “100% let somebody know. Ask for help. Call a hotline. There are resources out there and please please, please ask for help. You don’t have to feel this way alone, and that treatment really does work,” Costales said.

“The biggest thing I can tell people to do is to talk—talk to each other, talk to your kids, talk to your friends, talk to a professional.”