For years, Gonzaga University senior Lynsey Romero busied herself with school, work and so many extracurricular activities that she had no time to dwell on the trauma she experienced growing up.
But when COVID-19 shut everything down last year, the 21-year-old foster youth found herself suddenly isolated and alone with her thoughts, and they led her to a dark place. Unable to find an available therapist, she struggled with anxiety and depression. Things got worse when two successive housing situations became intolerable.
“I was couch surfing for several months until I could afford to stay in an apartment,” she said.
Even before the COVID-19 pandemic, poor mental health had reached a crisis level in the state, particularly among young people. Last year, as in past years, suicide was the second leading cause of death for Washington youth ages 15 through 24, according to the state’s Department of Health.
In February, Washington Gov. Jay Inslee (D) issued an emergency proclamation declaring a youth mental health crisis. The proclamation cited a 73% increase in acute inpatient care at the adolescent psychiatric unit at Sacred Heart Children’s Hospital in Spokane. At Seattle Children’s Hospital, it had become a new “normal” for one to two children to be admitted every night for attempted suicide. In acknowledging the crisis, Gov. Inslee ordered the state’s Health Care Authority and Department of Health to propose solutions within the next year.
And despite $393 million in federal and state funds allocated in the most recent budget for behavioral health spending over the next two years, advocates and politicians say the money falls short in serving struggling low-income and homeless youth.
“It’s not nearly enough to meet young people’s needs,” said Rep. Lauren Davis (D), who works on behavioral health care in the Legislature.
Romero’s experience is not unusual among young people who’ve previously been in the state’s care, and struggle with both mental health challenges and homelessness. After she began couch surfing, Romero joined the approximately 13,000 unaccompanied young people who experience homelessness annually in Washington state, though she will soon age out of extended foster care, which has provided her with financial and housing assistance.
The most recent statistics from the Office of Homeless Youth show that in 2017, more than 1,440 of the 6,940 young people exiting state programs, including foster care, residential behavioral health and juvenile detention, become homeless after 12 months. The largest number of those exiting state care for the streets, 987, leave from residential behavioral health programs. Almost one-third of the young adult homeless population, the report found, have a history in foster care.
Theresa Nichole Calhoun, a client engagement specialist at the nonprofit Excelsior Wellness in Spokane, underscored how the pandemic has taken an additional toll on the mental health of young people. The organization’s outpatient programs are working to increase capacity, but they’re finding other agencies they refer to are also full.
Calhoun estimated that as a result of the mismatch between need and capacity, “three or four people a day are not served or are underserved,” by providers in her area.
The depression that upended Romero centered on her difficult childhood.
“My mother was a victim of alcoholism and drug addiction — I got the blunt end of that,” she said.
Romero, her younger brother and her mother had struggled through bouts of homelessness. The two siblings were close and supported each other. So it was tough when her brother’s father — who was close to both children — died of leukemia, and her brother went to live with his paternal relatives. That left Romero alone with her mom. “It was a big traumatic thing for me,” she said.
Alone with her mom, Romero said she suffered unbearable physical and mental abuse, and called Child Protective Services for help. As a result, at age 13 she entered foster care, where she cycled through three families before finding one that she stayed with until her high school graduation.
She went on to Gonzaga University, and last year, after COVID-19 shut down much of the college in Spokane, Romero was given a place to stay on campus. But she had to move to an unfamiliar dorm room in a new building. She didn’t know the others on her hall, and they had to keep their distance to avoid the spread of the deadly virus. As the lonely days and nights ticked by, Romero became consumed with thoughts of her mother, who had died homeless years before, without the two repairing their relationship.
When fellow students asked her to rent a room in an off-campus apartment, she was initially pleased. But she soon realized her new housemates weren’t being safe, and they weren’t amenable to compromise. The situation turned so hostile, “I became anxious at the thought of walking into my own home,” she said.
So she put her possessions in storage and left. Always a top student, her grades plummeted. “I didn’t even care,” she recalled.
Depression and isolation can easily pile up on young people who have no family network, and leave them with nowhere to go. That’s why youth advocates say adequate mental health care is such a vital part of homelessness prevention.
According to Rep. Davis and other critics of the state’s mental health spending, the high costs of infrastructure can leave prevention and less acute care wanting for funds. Current budget priorities include moving inpatient psychiatric care to community-based settings and building a teaching hospital at the University of Washington to expand the number of credentialed clinicians, a dire statewide need.
While Davis supports funding these projects, she said the state’s focus on “serious and persistent mentally ill” patients doesn’t always serve children, youth, young adults or families well — those in need of less intensive treatments, like counseling, support groups and outpatient drug and alcohol programs.
Davis, of King County, has long been invested in the topic, drawing inspiration from her best friend, who she watched suffer from untreated alcohol and opiate addiction before becoming sober. Before being elected, she helped found the Washington Recovery Alliance and Forefront, a suicide prevention nonprofit working with high schools and colleges.
She currently serves on a state working group responsible for children’s behavioral health, and said the group got what it asked for in this past year’s legislative budget. However, their initial request was formed early in the legislative session, when the expectation was that the budget would be tight — and governors, legislators and nonprofits were told to pare down their requests.
Davis said her group had hoped to get additional funds for behavioral health after the governor’s proclamation, but members were told they were too late. “Most people are celebrating that we got so much, and that’s true,” she said. “But I felt this is an area where the scope and need is so serious and time-sensitive; our investments did not meet that bar.”
Despite criticism of the state mental health budget’s shortcomings by Rep. Davis and others, some targeted funds will directly help struggling young people. The state budget will fund six more youth mobile health care units serving youth and their families in emergencies and preventing ER visits. A renewed $800,000 will pay for behavioral health services in residential group care settings for youth and young adults, along with 12 additional beds for long-term inpatient mental health care.
Officials have said a shortage of these psychiatric beds has led them to house foster youth in hotels and Department of Children, Youth and Families offices, as previously reported in The Imprint — a practice that will come to an end this year.
Young adults will also have access to mental health programs serving all those over age 18, including peer counseling, programs for pregnant mothers and a new statewide centralized helpline designed to respond to suicide and mental health crises.
Diana Cockrell, a state Health Care Authority manager who oversees youth and young adult services, said there is growing attention to the challenges of early adulthood for those with few resources and little support — a recognition of the need for age-appropriate counseling and programs distinct from other adults who have chronic, long-standing challenges.
“There’s a lot more conversation and intentionality and curiosity about transition-age youth,” she said, “and what might need to be different.”
With the help of friends and family members, Romero was able to “slowly push aside” her guilt and regret about her mother’s death. A few months ago, her depression, which comes and goes in waves, subsided, and she “kicked it into high gear” to raise her grades in most of her classes. Ever resourceful, she took an incomplete in one class so she could finish her other schoolwork with greater success.
Then, a few months ago, she tried again to find a therapist but this time didn’t take no for an answer when they told her there was a wait. She also found a stable housing situation off-campus.
Things aren’t perfect now, she said, but they are better. Romero will graduate next year, with a double major in psychology and criminology. She plans to work with people like her younger self.
“I wasn’t listened to and I had to advocate for myself in foster care,” Romero said. “But for folks who struggle and who can’t find their own voice, I want to be the voice for them. They deserve to be liberated.”
