Edgewood hosted a community conversation on youth mental health this spring, bringing together CEO Lynn Dolce and Medical Director Dr. Robin Randall for an honest, wide-ranging discussion about what they’ve observed in their more than 25 years of serving children and families in the Bay Area. What emerged was a picture of a mental health landscape for youth and families that has changed dramatically, and a set of insights every family in our community should hear.
The Problem Is Not Confined to One Population
Decades ago, Edgewood’s mental health focus primarily served foster youth navigating extraordinary levels of trauma. That is no longer the case. Today, Dolce and Randall see trauma, anxiety, and depression across all kinds of families and all kinds of neighborhoods. Violence, immigration fears, housing instability, social media, and the ambient stress of adult life are all reaching children far younger than we might expect.
“Six-year-olds often resonate with the anxiety of the adults around them,” Dr. Randall noted. The weight young people are carrying is not abstract, it is absorbed from the world they live in, day by day.
When To Look Beyond Your Pediatrician
Most psychiatric medications for children and teens in the United States are prescribed not by psychiatrists, but by pediatricians, many of whom are doing excellent work under enormous time pressure. For straightforward cases, that is often appropriate. But Dr. Randall was direct about when families need to go further.
“If you feel like you are doing the same thing over and over and nothing is changing, that is when you should see a specialist.”
Child psychiatry, he explained, stands at the intersection of physical and mental health in a unique way that brings full medical training to problems that can sometimes look psychiatric but have underlying medical causes. If your instinct tells you something is being missed, trust it.
The Whole Family Is the Patient
One of the most consistent themes of the conversation was this: treating only the child is rarely enough. If the family system doesn’t change, children often return to the same dynamics that contributed to their struggles in the first place.
Edgewood’s commitment to structural family therapy is built on this understanding. This type of therapy is required for all Edgewood therapists. As Dolce put it: “The difference between kids who make it and kids who do not is largely the support they get in their family. That is why we focus on the whole system, not just the child.”
Insurance systems, she noted, were not designed with this in mind. They are built around individual patients and symptom lists, not the kind of whole-family work that actually moves the needle. It is one of the quiet inequities families rarely see until they are navigating the system themselves.
High Need Exists Across All Income Levels
There is a common assumption that families with private insurance are insulated from the worst of what the mental health crisis brings. Edgewood’s experience tells a different story. A pilot program serving Kaiser-insured families found they often had as many needs as families in the public system — but far fewer built-in supports to draw on. Need does not sort itself neatly by zip code or insurance card.
Therapy Is Not a Sign that Something Is Wrong
Both Dolce and Randall spoke about the shift they have witnessed in how openly people talk about mental health — and how much further there is still to go. They were clear that seeking support is not an admission of failure. It is, as Dolce put it, “health-seeking behavior.”
“We want families to feel comfortable coming in, going out, and coming back when they need us again.”
Children change. Families change. Life brings new challenges at every developmental stage. There is nothing unusual about needing support more than once or needing different kinds of support at different times. The goal is to make that feel normal, not shameful.
What Gives Them Hope
After more than two decades of this work, both Dolce and Randall remain genuinely hopeful. They see mental health increasingly understood as inseparable from overall health. They see public figures and athletes helping reduce stigma in ways that matter to young people. And they see technology opening doors, including a UCSF partnership studying remotely delivered care for adolescent depression to reach youth who would never walk into an office.
For Edgewood, much of the work is now happening in the community itself: in schools, in homes, and in family resource centers like the Bayview Plaza site. Because that’s where youth and families are. And that’s where the work has to be.