More than 1 in 5 students in the Mountain View-Los Altos High School District rely on mental health counseling available on campus. But what happens to those much-needed therapy services when schools are shut down during a public health crisis?

Therapists and school officials have for months grappled with the question, finding ways to best transition one-on-one therapy from private rooms to Zoom videoconferences and phone calls. With school now back in session, high school administrators say they theoretically have the bandwidth to serve all the students who need help. The question is how many students will take advantage of it.

“Who are we going to miss, what are the risks and how do we find them?” said Marsha Deslauriers, executive director of the nonprofit Community Health Awareness Council (CHAC). “If we don’t have enough clients, are the kids okay and how are we going to do future outreach? If we have too many, how are we going to address that?”

Like many schools in the Bay Area, Mountain View and Los Altos high schools have sought to fill chronic gaps in youth mental health care through in-house counseling services. The low barrier of entry and extensive referral system led to the two schools receiving a combined 1,424 mental health referrals during the 2018-19 school year, and many of those students received counseling services through CHAC on campus.

Anxiety, depression, academic difficulties and family issues are consistently among the top problems facing teens each year.

With campuses shut down through at least the fall semester due to the coronavirus pandemic, CHAC has had to completely rework its mental health counseling to an online-only model, with hopes of extending therapy to students working from home. Deslauriers said the organization has been using virtual therapy since the shelter orders in March, and has spent months ironing out tech glitches and staying compliant with security and privacy rules under the Health Insurance Portability and Accountability Act (HIPAA).

While student counseling services typically go dormant during the summer break, they remained available this year and served 197 students, Deslauriers said. Similar to the effort to “flatten the curve” of new COVID-19 cases, she said the organization was concerned about a peak in mental health needs that must be flattened during the months off.

Converting to telehealth with virtual therapy does come with challenges. Privacy is a huge issue as students try to find a quiet environment isolated from family members, said Ingbritt Christensen, a counselor at CHAC.

“It used to be that we would bring a client into our domain where we have control of their environment,” Christensen said. “Now it’s totally switched. I have clients who do sessions in their car on the driveway because there is no room in their house where they can have privacy.”

It’s also tricky to build a relationship with students on a purely digital platform. Many of the students served over the summer already had in-person services beforehand, Christensen said, but its particularly difficult to forge that bond with a client when meeting online for the first time.

“It’s definitely challenging, but it’s better than the alternative of no care,” she said.

The transition to telehealth coincides with big improvements to the school district’s mental health program as well, said William Blair, the district’s wellness coordinator. Hired on-site therapists that used to be on campus two days a week will now be available during the full school week, and the district recently partnered with the nonprofit Uplift Family Services to have a social worker dedicated to connecting needy families to services.

These were changes already in the works, Blair said, but take on an extra level of importance as more teens — struggling their way through the disruption of COVID-19 — are expected to show symptoms of anxiety and depression.

“There is a lot of uncertainty, and there is this undercurrent of toxic stress that people may be experiencing,” Blair said. “I think with the school closures, there are additional stressors in students’ lives.”

Students have had their lives turned upside down by the pandemic, Christensen said, often losing their sense of daily structure and normal sleep cycle. One of her clients who normally excels in school simply refused to get online for distance learning, and that some students are having trouble adjusting to a completely revamped education platform.

For others, it comes down to financial problems. CHAC provides therapy to the general public on a sliding scale based on income, with reduced fees for lower-income families, and Deslauriers said the nonprofit has seen a big spike in people looking for subsidized care since the pandemic began in March.

“Lots of people are losing their jobs, and we have some kids who are the sole bread winner of the family,” Deslauriers said. “And we know that our marginalized communities have been most adversely affected by this pandemic.”

For now, school and CHAC officials are watching closely at how many students actually tap into the digital counseling services for the 2020-21 school year. In the past, as much as 40% of the mental health referrals have come from staff and administrators who no longer see students face-to-face on a daily basis. The hope is that parents — particularly the parents of friends — will notice unusual behavior and point them in the right direction. Referrals can be made at bit.ly/mvlasupport in English or bit.ly/mvlaayuda for Spanish.