Sarah Pistorino saw a therapist through the end of her freshman year at Sacred Heart Preparatory School. Then summer came — and with it, the end of her academic stress and fatigue — so she pressed the pause button on her therapy. But when school started up again in the fall, she felt a decline in her mental health. She now continues therapy through the summer months.
"When there is no stress about school, it allows me to talk about other things going on in my life," she said. "When you remove (school) from the equation, it allows you to talk about some of the deeper issues and more personal things going on."
Pistorino's experience is not uncommon and illustrates the need to continue mental health care during the summer, providers say. As local youth-counseling organizations work to spread that message, they're seeing a rise in demand during a time of the year when many teens and families historically haven't sought as much mental health support.
Both of Bay Area Clinical Associates' (BACA) intensive outpatient programs in Menlo Park and San Jose are full this summer. Therapists at Redwood City-based Adolescent Counseling Services (ACS) are completely full except for a few hours reserved for emergency appointments, which is typical, ACS Executive Director Philippe Rey said.
Children's Health Council (CHC) in Palo Alto typically sees a 30% to 40% dip in demand for services over the summer. This summer, though, demand is down only by about 20%.
"Mental health doesn't go away over the summer," said Ramsey Khasho, chief clinical officer at Children's Health Council.
"People are really realizing — and what we tell parents — is summer is a really good time to actually continue the treatment because there's less stress and distraction. They can focus on getting better and building coping strategies that they can use during the school year when stress levels go up."
It also provides more consistency for therapists who otherwise have to make up for lost time when teen patients stop therapy over the summer and then return in the fall — often when they're having some sort of crisis, Khasho said.
While CHC encourages families to take summer vacations, "It's all about building the skills when people are relatively well," he said.
All of these organizations offer the same services over the summer as they do during the school year, including individual and family therapy and support groups. ACS sees an increase in attendance at its LGBTQ support groups over the summer, which Rey attributed to students being disconnected from school resources like gay-straight alliances.
While teens might initially feel relieved to be out of school, over the summer they may grapple with feelings of isolation and unstructured time, Rey said.
"The lack of structure creates a lot of chaos and sense of loss," he said. "We see that in the parents, too."
Teenagers said their peers still perceive summer as time off from not only school but also from personal work on their emotional well-being.
"I think a lot of my friends would like to think that, 'As soon as school's out, I'm OK; everything is back to how I remember being before I ever had any mental health challenges,'" said Meher Sandhu, a rising senior at Castilleja School and youth board member at SafeSpace in Menlo Park, a teen mental health advocacy and support nonprofit.
"When you have that mindset of 'It can go away as soon as the stress drops and as soon as the grades are in the grade book,' that is going to continue the cycle of people not wanting to address their own mental health challenges," she said.
Walter Li, who graduated from Menlo School this spring and is also on SafeSpace's youth board, said he sees school stress as the trigger rather than underlying cause of his peers' mental health struggles, underscoring the need to continue care over the summer.
For youth mental health organizations, summer is also a time to lay the groundwork for the coming school year. They are all trying to hire more therapists, psychologists and psychiatrists to build capacity — a challenge given a national shortage in mental health providers and the Bay Area's high cost of living, they said.
"The demand continues to knock on the door and we continue to hire to meet the demand," Khasho said.
They're also working this summer to develop new services to meet emerging needs, such as an outpatient family skills group for local middle school students and their parents starting this fall at CHC and a vaping-prevention program Adolescent Counseling Services is launching with the Palo Alto school district. (Rey said ACS' longtime substance-abuse program has seen an explosion in demand for vaping and nicotine addiction over the last two years.)
Bay Area Clinical Associates is hoping to add tele-health services in the next six months to a year — using video to make therapy more accessible if teens live far from one of the organization's clinics or even if traffic makes getting to appointments difficult, said Joel Oberstar, BACA psychiatrist and vice president of operations.
At SafeSpace, summer is a time for teenagers who are passionate about mental health advocacy to plan projects for the upcoming school year. They're holding retreats, training peers on empathetic listening and making presentations to the community.
They're also filming interviews for the second year of a video campaign meant to lift the stigma around mental health. This year's project features three segments: one talking to teens and their parents and grandparents about mental health; a second on teens who have sought support from therapists and school counselors; and a third that will feature interviews with more than 20 teenagers about providing or receiving help from a friend during a mental health crisis.