Opinion
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- Written by: Jeff Ribordy, M.D.
Caring for our mental health is important at all stages of life. It is especially pivotal for the youngest, most vulnerable members of our community. Empowering our community with the resources and support available to care for their mental health has proven to have a widespread impact.
The most recent comprehensive national data on mental health status for pediatric members enrolled in Medicaid indicates that the percentage with any diagnosed mental health or neurodevelopmental disorder increased from 10.7% in 2010 to 16.5% in 2019.
While these data are pre-COVID-19, studies have shown significant increases in attention-deficit / hyperactivity disorder, trauma- and stressor-related disorders, anxiety, autism spectrum disorders, and depressive disorders among Medicaid-insured children during this period.
Multiple studies have shown post-COVID-19, the proportion of children with anxiety, depression, and suicidality increased significantly, with 1 in 5 youth now experiencing a mental health disorder.
For California specifically, data from 2014 – 2015 found that 14% of children insured through Medi-Cal had a documented mental health diagnosis. Rates were substantially higher among those with child protection system involvement. With this increase in diagnoses come additional problems with access to needed mental health care.
One positive outcome of the COVID-19 pandemic was the increased ability for health care providers to utilize telemedicine to provide needed care. This is demonstrated by data showing that during the pandemic, overall mental health service use among Medicaid-enrolled children declined by 9.1% from 2019 to 2020, but telepsychiatry visits increased by 829.6%.
Psychiatric and mental health counseling are particularly well-suited for telehealth care and a way to improve upon current access concerns related to these vital services.
Another way to increase mental health care for children is by providing education to primary care providers so they are readily available to provide this care.
One such program is Cal-MAP from UCSF’s Department of Adolescent and Child Psychiatry department. Their mission notes it is “designed to increase timely access to mental health care for youth throughout California's communities, especially in the state’s most underserved and rural areas.”
Cal-MAP employs a team of psychiatrists, psychologists, and social workers to collaborate alongside primary care providers as they support mental and behavioral health concerns in youth up to age 25. In addition to supporting primary care providers, Cal-MAP offers resources for families impacted by mental and behavioral health challenges in the community.
Mobile apps can also provide California youth and families with access to mental health services and support. Launched by the California Department of Health Care Services, there are currently two such apps available, BrightLife Kids and Soluna.
These apps are described as “free, statewide behavioral health platforms that offer children, youth, young adults, and families access to timely, culturally responsive, and confidential mental health support.” The services provided by both BrightLife Kids and Soluna are available to all California families, regardless of income, immigration status, or insurance coverage.
With innovative approaches leveraging telehealth services, collaborative efforts, and technology, there is hope that access to much needed mental health care for our pediatric members is improving. Access issues certainly remain a challenge, particularly in our rural California counties, but together, we are raising awareness, one conversation at a time.
Dr. Jeff Ribordy, a pediatrician, is a regional medical director at Partnership HealthPlan of California. Partnership is a community-based, safety-net health care organization that contracts with the state to administer Medi-Cal benefits. Partnership provides quality care to over 900,000 Medi-Cal members. Starting in Solano County in 1994, Partnership now serves 24 Northern California counties – Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and Yuba. Learn more about Partnership at PartnershipHP.org.
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- Written by: Dr. Nicki Thomas
Have you ever seen the look on a young child’s face when their parent comes to school to volunteer? I have, and it’s heart-warming.
When parents volunteer at their child’s school, it not only helps the school meet student needs, it also sends a message to kids.
Volunteering says, “What happens here at school is important and worth my time. I care about education — and I care about you.”
We all know actions speak louder than words, and students pay attention. When our actions and our words align, our messages have a bigger impact.
Our students thrive when parents, caregivers, and community members help schools by providing additional support and creating memorable experiences. From general campus assistance to specialized committees, there are many ways you can make a meaningful difference.
General volunteering
All KVUSD schools are actively seeking general volunteers to help on campus and during field trips. Whether you can help us for a special event from time to time or are able to volunteer on a regular basis, your contribution matters.
General volunteering can involve working in classrooms, supervising during lunch and/or recess, helping with afterschool or evening events, working in the school office, and more.
Right now, Mountain Vista Middle School has a special need for lunchtime volunteers to help supervise students, organize activities, and play games with the kids. Structured play during lunch builds teamwork, friendships, and creates positive energy on campus – plus it's a lot of fun!
Parent-Teacher Organization (PTO)
At the elementary schools, we have active parent-teacher organizations. Kelseyville Elementary and Riviera Elementary PTO members attend monthly meetings to discuss ideas. They also sponsor fundraising efforts to support field trips, assemblies, and other school activities.
School Site Council (SSC)
All KVUSD schools have site councils where parents, community members, and all who want a voice in determining the direction of our schools are welcome. This important committee plays a key role in school planning and decision-making.
English Learner Advisory Committee (ELAC)
All KVUSD schools also have English Learner Advisory Committees, where members support the unique challenges and opportunities of our English learner students by advising school officials on programs and services.
Get started today
If you’re interested in volunteering, pick up a volunteer application from Lisa Pendleton at the KVUSD District Office, located at 4410 Konocti Road in Kelseyville.
The volunteer application process includes fingerprinting and a TB test to ensure student safety. The district pays for fingerprinting and the associated background check done through the Department of Justice.
If you want to drive students (other than your own children) to or from a school function, there are a few additional requirements, including insurance and a DMV report. To learn more about each school’s specific volunteering needs, contact the school directly.
Remember, your involvement helps create a stronger school community and provides valuable support that enhances the educational experience for all students.
Dr. Nicki Thomas is superintendent of the Konocti Unified School District.
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- Written by: Becky Salato
In June, just a week after celebrating their high school graduation, four friends were out riding dirt bikes in Morgan Valley, a remote part of the county, when two of them came around opposite ends of a blind corner and collided.
Logan was thrown from his bike, landing on his back on a pile of rocks and knocked unconscious. Zach’s foot was sliced open.
As unlucky as this was, there was an element of good fortune. A third friend, Brady, had completed the emergency medical services class at Lower Lake High School, part of the Public Safety Career and Technical Education, or CTE, pathway.
Brady’s training kicked in and he immediately began assessing how much danger his friends were in.
He ran toward Logan, his best friend since childhood, while calling the fire chief, Willie Sapeta, to request that dispatch send emergency medical responders.
Most kids would call 911 — and that would be the right move — but since Logan’s dad was the fire chief (and Brady’s godfather), he called him directly.
Chief Sapeta and his wife, Rachelle, had just finished dinner when the call came in. As soon as Brady said there’d been an accident, Chief Sapeta and Rachelle jumped into action. The chief called for two air ambulances and other emergency support.
Their son, Logan, was well known to many emergency responders because he was an Explorer, a junior fire fighter who accompanies fire fighters on calls to do “mop up” and other support functions.
Once those calls were made, the chief said he threw the phone to Rachelle to keep talking to Brady, and he grabbed his keys so they could meet the emergency vehicles on scene.
In the moments after the accident, Logan was unconscious and had snoring respirations, meaning his tongue could block his airway. Brady moved Logan’s jaw to open the airway and then held Logan in a “c-spine,” a position that restricted his mobility to prevent further injury.
Brady instructed the other uninjured friend, Michael, to check on Zach’s foot. While Zach’s injury was serious, it didn’t appear life threatening, so Brady asked Michael to hold Logan still while he performed a spinal step-up check. As Brady ran his fingers along Logan’s spine, he felt a bump that could indicate a spinal injury.
Logan began to regain consciousness, but Michael kept him still and didn’t let him stand. According to the doctors who cared for Logan later, this prevented Logan from becoming a paraplegic.
Once emergency responders arrived on the scene, Logan and Zach were evacuated by medical helicopter: Logan to UC Davis Medical Center and Zach to a hospital in Santa Rosa before also being transported to UC Davis. Thankfully, both boys are expected to make a full recovery.
Chief Sapeta has been a firefighter for 45 years, so he has seen plenty of serious injuries, but he said he now has a whole new appreciation for what people go through when this kind of accident involves your loved one, especially your child.
As he talked about how thankful he was that Brady kept his head and used his training, we got to talking about the partnership between Konocti Unified School District and the Lake County Fire District.
Chief Sapeta has been supporting the school district since long before I arrived. For 20 years, he provided Carlé students with hazardous material training, so they could be certified by the California Specialized Training Institute and work in the field. After that, we began the emergency services training.
A big part of why the emergency medical training provided through Lower Lake High School is so successful is because Fire Battalion Chief Marc Hill works with CTE teacher Miriam Garner to teach many of the classes, imparting skills he has acquired during his many years of experience as a firefighter.
Chief Sapeta is a huge advocate for the kind of hands-on training that provides students with a way to support themselves and give back to whatever community they’re a part of–and becoming a certified emergency medical technician, or EMT, opens a lot of doors.
He mentioned that in addition to working on a fire crew or ambulance, EMTs can work in hospitals and other medical settings, as well as on location where accidents are more likely to happen like Hollywood sets where stuntmen are working, and oil rigs where the nearest emergency room isn’t anywhere close. Chief Sapeta has several Lower Lake High School graduates working for him at the fire department.
CTE is a great example of how education is continually evolving toward more experiential learning. Konocti Unified is expanding in this direction, and so are many other districts.
Traditional classroom learning remains valuable, of course, but as our world keeps changing, so do the needs of our students. Providing students with real-world scenarios and allowing them to test their skills outside the classroom is incredibly valuable.
The story of what happened to Logan and Zach illustrates this. This accident could have had a very different outcome. If the boys didn’t have such deep friendships (reinforced by their time together in school), if they didn’t have this emergency response training (made possible through community partnerships), things could have gone very differently. I am so grateful for a community that embraces our students and helps them grow and learn, and I am so happy this story had a happy ending.
As a postscript, after having completed their emergency medical training at Lower Lake High School, Brady and Logan plan to pursue careers in public safety, Brady as a firefighter here in Lake County and Logan as a heavy machine operator for Cal Fire.
In recent weeks, Brady received notice that he passed the national emergency medical technician certification exam, and he is now in the process of obtaining the driver’s license endorsement that will allow him to drive an ambulance while he continues his training.
Everyone involved agrees that even if you don’t plan to go into public safety as a career, it’s a great idea to take a first aid/CPR class.
As Brady said, “You just never know what’s going to happen.”
Becky Salato is superintendent of the Konocti Unified School District.
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- Written by: Paul Barthel
Most often, my public reflections center on the fair and ethical treatment of animals. That cause has shaped much of my work and my voice. But today, I step away from that familiar ground to reflect on something both personal and tragically widespread.
Until recently, I had never encountered the term polypharmacy. I did not know it referred to the practice of prescribing multiple psychiatric medications simultaneously, nor that it could carry profound — and sometimes dangerous — consequences. I learned the word only after my partner, Nancy, took her own life at the age of 54.
Her death opened my eyes to a crisis that affects countless families across the country: the quiet, often unseen toll of polypharmacy — the layering of one psychiatric drug upon another until dependence, confusion, and risk overtake the promise of healing. Millions now live at the mercy of pharmaceutical regimens that may stabilize for a time but too often destabilize in the long run.
In the weeks since, I have been searching for answers — about her care, her prescriptions, and whether the very treatments intended to help her may have contributed to her death.
Reviewing her records and psychiatric evaluations was sobering. I found a succession of potent medications — antidepressants, benzodiazepines, mood stabilizers — prescribed by different providers across multiple facilities, often with little regard for her prior usage, the cumulative effects, or the potential for dangerous drug interactions.
Each new prescription seemed to exist in isolation, detached from her broader history and the complexity of her condition.
Over time, Nancy developed a dependence on the very medications meant to manage her symptoms. When one physician declined to renew a prescription, she would sometimes turn — desperately — to another provider or hospital. This cycle became a struggle for stability that remained elusive.
At times, she endured it in silence — sleeping for days, withdrawing from loved ones, isolating herself from family and support. For those of us who loved her most deeply, the weight of her absence is compounded by lingering questions: what more could we have done, and might her death have been preventable?
The last months of her life illustrate the problem. After she broke her leg, Nancy was prescribed an opioid painkiller. Was there any careful consideration of how this would interact with her psychiatric medications, or whether it could destabilize her? If there was, we never heard it. The reflexive answer was always another pill.
Research confirms what we witnessed firsthand. Polypharmacy significantly increases the risk of adverse drug events, particularly in fragmented systems where patients see multiple prescribers. The FDA’s own black box warnings note that certain antidepressants may increase suicidal ideation, especially during dosage changes. Yet in practice, these warnings are too often minimized or ignored.
We can do better. Four reforms could save lives:
Mandatory interaction reviews. Every psychiatric prescription should be screened for drug–drug interactions before initiation and at every refill.
Enhanced informed consent. Patients and families deserve clear explanations of both benefits and risks, including the possibility of worsening suicidal thoughts.
Integrated care models. Medication management should be one part of a broader treatment plan that includes non-drug supports.
Continuity of care. Patients need a consistent primary prescriber or care coordinator to reduce dangerous fragmentation.
Psychiatric medications can save lives — but they can also endanger them. My partner’s story raises urgent questions: Why are we so quick to add medications without fully considering their long-term impact? Why is accountability so rare when harm occurs?
I cannot bring Nancy back. But I can use her story to demand a better system—one where prescribing psychiatric drugs is treated with the same rigor and caution we apply to other life-threatening conditions.
Lives depend on it.
Paul Barthel lives in Cary, Illinois.
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