Eva Ludwig
*Source names have been redacted for privacy.
(650)-579-0350 — the number printed on the back of every San Mateo County student ID — is full of holes, not only because of its 0’s and 9’s but because of the gaps where support is missing. For years, StarVista’s 24/7 crisis hotline has answered over 13,000 calls in 2016 alone and connected teens, parents and neighbors to help at their breaking point.
This summer, however, StarVista announced it would close its crisis services, citing the same problem that shadows so many community-based programs: no sustainable funding. The loss came at an ironic moment. September is National Suicide Prevention Month, when governments and schools double down on awareness campaigns, slogans and assemblies. But the shuttering of a long-standing lifeline raised a harder question: what good are resources on paper if the people they’re built for don’t feel they can use them?
Traditionally, San Mateo County has invested $15.3 million between 2013-2020 through county-approved Measure K sales tax in suicide prevention over the past decade. Between 2010 and 2015, the county recorded 370 suicides, with the largest age category being among adults aged 45 to 64, followed by young adults aged 20 to 44. These stark numbers underscore why policymakers have directed millions of dollars into programs ranging from awareness campaigns to psychiatric facilities. The county’s 2017–2020 Suicide Prevention Roadmap organizes these efforts around three pillars: prevention, early intervention and crisis response.
Prevention encompasses awareness campaigns, school assemblies, stigma-reduction initiatives and digital resources like suicideispreventable.org. Early intervention includes wellness centers, school counseling staff and allcove San Mateo — a youth behavioral health hub where students can connect with both peer navigators and licensed professionals. Crisis response deals with the most urgent stage: specialized hotlines, psychiatric facilities and the newly implemented 988 National Suicide & Crisis Line.
Each of these tiers is designed to reach individuals at different points on the spectrum of risk. Prevention is comparatively inexpensive, building a culture of openness before someone reaches a breaking point. Early intervention requires steady investment in staff and infrastructure. Crisis response, meanwhile, is the most resource-intensive and highest stakes — requiring round-the-clock clinicians, inpatient beds, transportation and sometimes law enforcement involvement.
Yet even in a county that prides itself on funding crisis services, access remains inconsistent. Crisis facilities, such as a planned youth healing center for adolescents and transition-age youth, are still in development, demanding massive commitments in staffing and infrastructure. Despite these efforts, urgent care remains elusive and, in many cases, ineffective.
“The county’s been talking about having more support for youth, especially pre-adolescent youth, for probably at least eight to 10 years since I’ve been in the circles,” said San Mateo County Board of Education Trustee Chelsea Bonini. “It’s been carved out in the budget to have these types of facilities. It’s just not been effective.”
This contradiction — significant resources allocated to emergency care but with results that lag unbearably — has devastating consequences for families.
“My family has had to deal with mental health emergencies,” Bonini said. “San Mateo County does not have psychiatric ER beds where children under 12 can be stabilized, so they are often transported by ambulance to facilities in other counties. It is a very traumatic experience for a child and their family, especially when families can only visit their children at these facilities during prescribed visiting hours.”
Meanwhile, the everyday supports that might prevent students from ever reaching a point of crisis remain thinly funded.
“Unfortunately with resources dwindling, most of the dollars get spend on crisis intervention and postvention, which has since been added to the [San Mateo County Schools Suicide Prevention Protocol],” said San Mateo County Director of Coordinated Youth Behavioral Health Mary McGrath. “Where it should be spent is prevention and going further down the line … The goal is that when youth have challenges, there are adults, friends and support systems in place to help get through the challenge and not let it destroy them.”
The irony is stark: crisis response consumes the bulk of the budget, yet prevention and early intervention — proven to be more cost-effective and transformative — remain under-resourced.
The county’s own 2021–22 Schools Suicide Prevention Protocol reflects this tension but also highlights the promise of early intervention. Staff are trained to recognize warning signs, check in with students and refer them to counselors. The philosophy is clear: identify problems early, before they escalate.
“When I was really struggling, I wouldn’t know where to look, or what to expect,“ said Pearl Yeh-Lee, head of the Pathways Subcommittee of the San Mateo County Behavioral Health Commission’s Youth Action Board and senior at Nueva. “One time, I was calling into a warmline and asked whether I should stay in bed or try to finish my homework. They were like ‘oh, we can’t give you advice.’ That really surprised me, and made me feel even more lonely.”
Experiences like Yeh-Lee’s underscore the importance of equipping the entire school community to recognize warning signs.
“I gave this training to all the bus drivers,” McGrath said. “A few weeks into school, I got a call from the Head of Transportation. One of the special ed[ucation] bus drivers, who drives the same kids every day, had found a note from a student saying he planned to kill himself that afternoon. Because the driver knew his students so well, he recognized whose note it was and immediately called his supervisor, who then reached out to me. The student had trusted that his bus driver would find the note — more than any other adult in his life. We were able to get him support, and he started to thrive afterwards. That’s why it’s so important that everyone knows the signs, not just the teachers in the classroom.”
The county has also built networks of collaboration around youth well-being.
“We hold regional school-based mental health collaboratives monthly or bimonthly, depending on the area, and we invite all school counselors, wellness counselors, any nonprofits that work with kids, allcove, [and] even private therapists,” McGrath said. “We all come together to talk about the challenges we’re seeing and how we can connect and partner together to provide social support around the youth — the teachers in identifying those and getting the kids to help.”
But early intervention is also where funding is thinnest. Schools may have one counselor for hundreds of students. Wellness centers are often understaffed or only open during school hours, leaving little flexibility for teens with packed schedules. allcove, while highly regarded, has limited locations, meaning students from Daly City or East Palo Alto may find it inaccessible.
At the same time, funding patterns exacerbate the imbalance. Large research centers at universities and hospitals, like Stanford, University of California, San Francisco and Kaiser, frequently secure multimillion-dollar grants for suicide research. Meanwhile, smaller-scale programs that interact with students daily, such as local hotlines and school-based counselors, scrape by on short-term contracts.
In 2024, California took a step towards balancing this system with Senate Bill 1318. By July 2026, every district must revise its suicide prevention policy so that the first response to a student in crisis comes from a mental health professional, not law enforcement, and are expected to be led by counselors, psychologists, social workers or nurses with Pupil Personnel Services credentials. For San Mateo families who have long described crisis care as traumatizing or inaccessible, the change promises a response rooted in compassion rather than discipline.
“We need to go further upstream to when kids are younger,” McGrath said. “We need to teach them caring and caregiving skills, how to manage emotions and that all feelings are ‘okay’ to have.”
The law alone cannot conjure professionals when there are none. Countywide efforts are beginning to fill the gaps through United for Health, a collaborative of public agencies, nonprofits and schools, coordinating community-based supports that extend beyond the school day. The county is also drawing on the state’s California Health, Behavioral and Youth Initiative (CHBYI), which expands access to behavioral health services for young people. Together, these programs create scaffolding around the bill: building pipelines of care while forcing districts to publicly confront workspace shortages and budget priorities.
The county’s Suicide Prevention Committee task has urged for broader community participation to bridge these gaps. Yet, community-facing resources, especially those embedded directly in schools, remain chronically underfunded and are frequently unused or are not taken seriously by students.
“[The school] has assemblies like, ‘Hey guys, don’t kill yourself,’” said senior Jasmine*. “It feels superficial, like when they check if we have our A–G requirements. It’s always, ‘By the way, if you maybe want to shoot yourself, remember you can talk to us.’”
The message is there, but it feels hollow; students hear the words but rarely experience meaningful support. From the staff perspective, the problem is often the same.
“Oftentimes, the people that are doing the assemblies don’t know what they’re talking about,” McGrath said. “A lot of times, it’s either scare tactics or it’s a lot of people talking at them. The best way to do this is if there was just more interaction.”
The problem, students and experts alike say, isn’t that support doesn’t exist — it’s that the systems meant to provide it often feel performative, superficial or disconnected.
“The school resources are always kind of shameful because everyone can see when you’re walking to the wellness office,” Jasmine said. “The counselors are complete strangers. Some people might be really emotionally reserved and not want to share such personal information with someone they barely even know.”
Students want guidance that is concrete and accountable, not just surface-level reminders that support exists.
“It’s scary to admit to yourself that you want to die,” Jasmine* said. “You can’t get help without agreeing to get help. If you shove someone into rehab who doesn’t want to get clean, they’re not going to stay clean the second they come back. It’s the same thing with mental health.”
McGrath echoes this, calling for systems that are interactive, nuanced and tiered. Students need ongoing engagement, accountability and multiple avenues of support.
“It would be incredible if we could build in a system where there is a follow-up process,” McGrath said. “There should be options of different levels, so if [a student] is upset because they’re feeling isolated versus grief, as opposed to having one person there are more.”
Even when services are available, they often go unnoticed or underutilized.
“This isn’t unique to schools, either,” said Frieda Edgette, San Mateo County Behavioral Health Commission Member, Co-Founder and Advisor of its Youth Action Board and allcove Community Consortium Chair. “I’ve seen this in the business world … People don’t know these services [like 988] are available. Recently, the county launched a public awareness campaign putting up large billboards and they have seen an uptick in calls since that promotion..”
The Youth Mental Wellbeing Pathway created by Yeh-Lee is a possible solution in development that aims to cut through the confusion of finding care. Rather than dropping families into a maze of hotlines and websites, Pathways begins with three simple yes-or-no questions about safety, diagnosis, and insurance. From there, it steers users towards the right door: calling 988 in a crisis, reaching the county’s ACCESS Call Center, connecting through a doctor, or turning to school-based counselors.
“The pathways tool is essential because currently, online resource directories can feel overwhelming and confusing,” Yeh-Lee said. “Pathways hopes to serve as an empathetic and personalized alternative, tailoring specifically to people’s unique circumstances, providing specifically San Mateo County resources, and sharing what to expect when reaching out. Think of it like a Buzzfeed quiz that directs you to behavioral health support.”
By clearly mapping who to contact, what resources are available and what to expect, Pathways helps youth take that first step with guidance, turning an overwhelming system into an accessible and supportive network.
“The most important step I took for my mental health was building a stellar support system made up of mental health professionals, school resources, friends, family, and my pet chickens,” Yeh-Lee said. “I hope that Pathways will allow others to create their own network by lessening any barriers to entry.”
Outcomes are difficult to quantify, and in the world of policymaking, metrics often drive funding decisions.
“It’s hard to count the suicides that didn’t happen,” McGrath said. “There’ll be an increase in the number of students seeking help, and then once they’re getting that help, the number decreases again … It indicates they’re feeling empowered and safe enough to get to a trusted adult.”
This success often looks invisible – a life quietly steered away from crisis, a call to 988 that never turns into an obituary. That leaves policymakers, educators, and communities with a fundamental question: how much does a life cost?
