Arizona youth are experiencing a mental-health crisis. Underequipped local providers are trying to keep up.
In early 2021, Ohad Lowenstein was feeling depressed and anxious.
Childhood trauma he experienced growing up in Beersheba, a city in southern Israel that has been caught in the crosshairs of the Israel-Palestine conflict, was resurfacing. He worried what would happen if his family didn’t secure their green cards before their visas expired. The pandemic had forced Lowenstein – a “super social guy” by his own estimation – into isolation. He had struggled with the transitions between virtual and in-person school during his junior and senior years at Desert Mountain High School in Scottsdale.
“It escalated pretty quickly for me,” Lowenstein says, recalling his deteriorating mental health. Alcohol and marijuana became ways to cope, but when he was caught imbibing at school and suspended, it was a wake-up call. At home, he opened up to his parents about how he was struggling, and they agreed to get him into therapy. The problem was, the soonest Lowenstein could be seen by a mental health provider was months away.
The experience of Lowenstein, now 19, is common. Valley providers universally lament not having enough staff to meet the needs of youth struggling before and during the pandemic. While the phenomenon is felt across the country, it’s particularly acute in Arizona, where there is one mental health provider for every 660 people, compared to the national average of one provider for every 350 people, according to Mental Health America’s State of Mental Health in America report.
“Our biggest barrier – and this is pre-pandemic, but has only gotten worse since the pandemic – is there are so many kids in need and not enough staff to support those kids,” says Karen Hoffman Tepper, president and CEO of Terros Health, which provides mental health, substance use and crisis services in addition to primary care across the state. “There are kids who have unmet needs, and that is the reality – and it’s a devastating reality.”
A Centers for Disease Control and Prevention survey of high schoolers found that in 2020, 44.2 percent of students experienced persistent feelings of sadness or hopelessness, 19.9 percent had seriously considered suicide and 9 percent had attempted suicide.
“As far as the need goes, we are in crisis mode right now,” says Kim McWilliams, senior director of clinical excellence and children’s operations at Terros Health. Pandemic-exacerbated losses in learning, socialization and development – along with family stress – have impacted all young people. More than 140,000 children in the U.S. have lost a caregiver. “Every single child has experienced trauma now because of the pandemic.”
While the pandemic has laid bare the mental-health needs of young people, providers also say Gen Z is simply more comfortable talking about their mental health.
“This generation coming up is actively breaking that stigma,” says Dr. John Brewer, vice president of behavioral health services for Phoenix Children’s.
A new partnership between Boys & Girls Clubs of the Valley and Terros Health aims to further reduce that stigma. The organizations’ Whole Child Approach Program began at the end of 2022 and will reach all 30 clubs, serving some 20,000 young people by 2025. “The fact that they’re so comfortable with [talking about their mental health] is great,” says Boys & Girls Clubs of the Valley CEO Marcia Mintz. “The scary part, that it’s so prevalent, should be a huge wake-up call for us.”
Through the partnership, Terros wellness coaches will share activities and promote skills to support children’s and teens’ mental wellness. Those activities will be integrated into things the club already does, such as time for art, games or life skills, with the goal of helping young people process feelings and build coping skills.
This partnership will expand access at scale, Mintz says. Because the same team will be interacting with the same kids daily, it will paint a fuller picture of how a young person is doing and provide someone they can talk to – and who can offer more mental-health resources when needed. That’s something many Arizona schools struggle with, due to a severe lack of school counselors, social workers and psychologists (see sidebar). The Arizona Department of Education is a funder of the Terros-Boys & Girls Club partnership, along with three Arizona foundations.
Amaya Jones attended a Boys & Girls Club while growing up in Phoenix. She experienced her first panic attack in the seventh grade, landing her in an emergency room. “It was never really dealt with,” the 19-year-old says.
“It took a while more for me to realize it was a real problem.”
Her anxiety heightened with the start of the pandemic and the death of George Floyd. She was having depressive episodes. The outlets she turned to – going out with her friends – evaporated during the pandemic. “The pandemic really opened my eyes to inner mental issues I had,” she says. “Having all that time made me realize how much I was struggling mentally, how much I was trying to cover up what was really going on.”
Her mom tried to help her connect with a counselor virtually, but the site they were using didn’t work well, Jones says. Now a sophomore at the University of Arizona, she connected with a therapist over the summer who has helped her with coping mechanisms like breathing techniques, along with medication.
Jones met some of her best friends at the Boys & Girls Club – people who she has been able to confide in about her struggles during the pandemic. “I discovered I wasn’t alone, and a lot of other people were feeling the exact same things that I was,” she says. “We were all going through it, and we had each other to lean on.”
She spent last summer at the club as a youth development specialist. She’s glad to know mental-health resources are being added, saying, “that could be very beneficial.”
“Counseling is expensive,” she adds. “That was something that was also a struggle for me. You want the help, you need the help, but you can’t afford the help.”
That’s why Heather Wall started Ground Work – a nonprofit that helps people who are uninsured and underinsured get access to mental-health services. A licensed clinical social worker who runs a private counseling practice serving children and families in the East Valley, Wall says “the need is everywhere.”
And, the best time to get care of any kind is when you need it. By the time the need for care is identified, the situation can be dire. When adolescents are left waiting – or are unable to access resources – things can worsen, and they may end up in an emergency room.
In 2021, 44 Arizona youth died by suicide. Though this is a decrease in youth suicides by 9.2 percent from the pandemic year of 2020, it remains the third leading cause of death of children.
If you or someone you know is thinking about suicide or is in crisis, call or text:
602-248-8336 / 1-800-248-8336 for the Teen Lifeline; 988 for the 988 Suicide & Crisis Lifeline
Brewer says Phoenix Children’s has seen a “massive uptick” of patients presenting mental-health issues in its emergency department, peaking in 2021 – and that the issues children are presenting with are worse than previously seen. Patients are getting younger, he says, noting that, too, is a nationwide trend, and those young people (Phoenix Children’s generally serves youth age 18 and younger) are coming to the emergency room with more serious suicidal ideation.
“The children’s mental crisis hit, and it was like COVID. No one had seen it, no one really knew what to do about it,” Brewer says.
One change the hospital made to meet the need was to move to 24/7 mental-health coverage in the emergency department. Now, a child in the ER can receive a mental-health evaluation in four hours or fewer. Children’s Bridge Clinic then connects kids with mental-health services in about a week – and helps them maintain that care and any medication they need until they can see a provider.
Teen Lifeline, an Arizona-based, confidential crisis hotline for teens that’s staffed with peer counselors, is another resource that has seen more demand since the pandemic. The lifeline’s call and text volume has increased nearly 50 percent since 2019, receiving more than 22,000 calls and nearly 20,000 texts in 2021.
“For the hotline, the idea of that peer connection is more important than ever,” says Teen Lifeline clinical director Nikki Kontz. “Their job is to listen, to be there with no judgment.”
Dani (whose last name has been withheld to protect her anonymity as a peer counselor) began volunteering at Teen Lifeline after losing a friend to suicide during her senior year of high school. “I lived in a little bubble world where suicide didn’t happen and mental health wasn’t real,” the now-20-year-old says. “After I lost my friend, that’s what made me think about it.”
Peer counselors go through a minimum of 72 hours of training before they start taking calls and texts. In the two years that she’s taken calls and texts, Dani says she often hears that teens feel that no one is listening to them. A recent caller told Dani she was feeling a buildup of problems on all levels – with her family, with friends, at school – and was considering self-harm or suicide. As they spoke, they discussed how the caller could work on repairing these relationships, starting by speaking with a school counselor. Kontz says in cases where the caller shares they are feeling suicidal or considering harming themselves, they always make sure the caller is in a safe place and schedule a follow-up call within 24 hours. Peer counselors are supervised by master’s level clinicians, Kontz adds, and they can jump in if a peer needs additional support.
Though the Arizona Department of Education funded the hiring of 140 school counselors and social workers with federal COVID-19 relief dollars, the roles are only funded for two years, and the state continues to rank worst in the U.S. for access to mental-health services in public schools. See how Arizona fares in student-to-provider ratio vs. the ratios recommended by the American School Counselor Association.
“No matter what end of the phone you’re on, just being able to talk about it does make a difference,” says Dani, who is now studying social work at Arizona State University.
Talking with someone who can relate has also been a help to Lowenstein. While waiting for a counseling appointment, his school referred him to notMYkid’s Project Rewind program – aimed at addressing substance-use issues – as a way to shorten his school suspension. When he and his family learned that notMYkid offered behavioral health resources, too, he signed up, particularly because he could get an appointment in “a matter of days.” Lowenstein saw a therapist there and joined notMYkid’s peer support program, where he could connect with other teens and a peer support specialist – someone who has had similar experiences and can be there to talk and offer perspective. “For me, it’s like having a big brother that I can talk to,” he says. “I can have that safe space.”
Now, Lowenstein has tackled the first hurdle of getting his green card by receiving authorization to work. He has been hired by notMYkid as a peer support specialist. “I have the opportunity to bring the perspective of a teenager,” he says. “I feel in today’s world it’s hard for men to ask for help if they’re struggling mentally. I’m hoping to make this change in perspective about men’s mental health.”
Ultimately, destigmatizing asking for help may be the silver lining of the pandemic, Terros’ McWilliams says. “This pandemic changed everything about children’s mental-health needs,” she says. “The public is more aware of mental-health needs, and that it’s OK to say, ‘I’m not OK.’”
All providers said they were hiring and had plans to expand in the coming years. Terros Health is expanding its Café 27 Youth Center – which offers mental-health and substance-use treatment services for 12- to 17-year-olds – to locations in Mesa and east Phoenix. NotMYkid is exploring expansion in rural communities and has space to bring on more mental-health providers.
“There’s no magic bullet on this,” Mintz says. “It will take all of us collectively.”