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PAGE 57 18, we’ve been shunted back to [name redacted] for the psychologist that my younger child is still seeing on a regular basis.” In addition to service availability, participants noted a number of factors increasing the need for mental health services. COVID-19 was most frequently cited, with participants expressing concern about the extent to which mental health challenges will have lasting consequences. Key informants for the John Muir report described mental health status in the Tri-Valley as critical due to the fear, anxiety, stress, job loss, isolation, and lack of trust that resulted from the pandemic.9 Similar consequences were raised in relation to youth and the extent to which mental health issues might be compounded by social media. Throughout the landscape scan interviews, parents reflected on ongoing behavioral health challenges among children and adolescents, expressing feelings of overwhelm. The landscape scan interviews also brought forth themes about mental health stigma. It was noted that societal stigma makes accessing mental health services a challenge for many. While telehealth emerged as a potential solution during the pandemic, respondents noted that it does not cater to everyone’s needs or digital capabilities. The unhoused, individuals with severe mental illness, immigrant and refugee populations, and older adults were also mentioned as having distinct needs for mental health services. A relationship was often drawn between people with severe mental illness and who are unhoused, with much discussion on how the factors exacerbated each other. One nonprofit employee spoke of the long-term mental and emotional effects of housing instability, noting the connection between being in a near-constant state of crisis and a person’s immediate mental health, functionality, and decision-making capacity. Mental health crises are often exacerbated by insufficient emergency mental health centers and services. “Trying to find emergency psychiatry services, or trying to find a psychiatrist of any kind is hard… trying to do it on an emergency basis because you have a loved one who you’re afraid of, who could be a harm to themselves or others... it’s practically impossible.” Participants noted that when concerned community members and even parents need help when a person is experiencing a mental health emergency, they often must rely on police and jails instead of inpatient emergency mental health care. “The severely mentally ill, that whole population that’s out there, you know, so many of those folks end up getting housed in the jails in other places because they get arrested because there’s not enough capacity to serve those folks. So that that’s another issue that I would say can be challenging, is residential (services) for folks.” In addition to the connection between mental health and unstable housing, participants discussed a need for comprehensive emergency and/or in-patient services for those using substances. This topic is further explored under substance use. Additional mental health and related services challenges were noted for some immigrant and refugee populations, such as the need for linguistic and culturally responsive services. Many come from countries where they experienced war and other trauma and may have left loved ones who are still experiencing suffering and hardships. The unique challenges of bi-cultural children of refugees and immigrants and generalized difficulties with a new culture also call for mental health services to help people adjust. COVID-19 was frequently cited as having a profound effect on older adults’ mental health, including by exacerbating loneliness and isolation for those who lived alone. Many older adults did not access mental health services, perhaps due to a shift to virtual appointments, which call for the ability to navigate online platforms. This, combined with physical isolation due to mobility challenges that many older people have, may have increased anxiety and depression. One service provider noted: “I think that our biggest hurdle is getting the seniors to understand that while they need to be cautious of what is out in the world, they also need to not live in that fear and kind of move forward and engage back in those interactions because EASTERN ALAMEDA COUNTY HUMAN SERVICES NEEDS ASSESSMENTSS Page 115 of 554