A few months ago, the seemingly mundane moment of leaving school on a bike wasn't possible for sixth-grader Max MacAllister.
LEARNING LOSS: Solutions for students struggling with distance learning
"It was really hard and stressful."
Until January, MacAllister was learning remotely, like every other SFUSD student.
"There wasn't a lot of communication about when schools would open back up," explained MacAllister. "Barely any time I was happy in that time"
Kate Larsen: "Did you ever feel like you thought about hurting yourself?"
MacAllister: "To be honest, sometimes, yeah. But I would never do it."
"He was deteriorating emotionally and socially and the isolation was contributing to that," said MacAllister's mom, Renee Gonsalves. "He used to be a happy child, he used to smile at people. There was no smile left, no laughter in the house."
"His dad and I talked about it, that we were just worried about him hurting himself," Gonsalves continued. "I went to bed every night feeling really sad, that I wasn't doing a better job of being a mom."
So Gonsalves and her husband decided to move from their home of 30 years in San Francisco to Marin, where many schools, like MacAllister's new school, Hall Middle, have been open since the fall.
"Sometimes the best decision is not the easiest decision," said Gonsalves.
TAKE ACTION: Suicide prevention -- Local resources for those in crisis
Gonsalves is cited in the lawsuit that the city of San Francisco filed against its own school district, in an effort to reopen in-person instruction. She declared that her "11-year-old son sank into a major depression, often saying he hated his life."
Dr. Jeanne Noble, the director of COVID-19 response for the UCSF emergency department, is also quoted in the suit, saying, "The medical evidence is clear that keeping public schools closed is catalyzing a mental health crisis among school-aged children in San Francisco."
Dr. Noble spoke to ABC7 and said, "In the UCSF San Francisco children emergency department, we saw the highest percentage of suicidal kids on record, this past January."
According to UCSF data, in January 2020, before the pandemic, 381 patients were screened for suicidal thoughts through a series of questions at UCSF Benioff Children's Hospital San Francisco -- 14% tested positive.
In January 2021, nine months into the pandemic, 232 patients were screened and 21% screened positive for suicidal thoughts.
"Looking at the overall census, fewer kids are coming in but the kids who are coming in are more in crisis," explained Dr. Noble.
VIDEO: Bay Area experts share advice on talking to children and teens about mental health, suicide
UCSF Benioff Children's Hospital in Oakland reports a 63% increase of patients from 2019 to 2020 who had mental health emergencies.
"The number of teenagers in the pediatric intensive care unit at Children's Hospital of Oakland for overdoses or attempts at self harm, we don't have the exact numbers yet. But anecdotally, it looks like a couple of kids a week, which is really just sort of off the charts. And, you know, speaking with teenagers, and you know, my own kids, and the friends of my children, there is a lot of despair. And just, I think the fact that nobody feels like they know when this is going to end, when they'll actually be able to see and hang out with their friends on a regular basis and go to school and have a routine. It's, it's hard and you know looking into the future and being able to say, oh, well, things will be better in six months or 12 months, is very hard developmentally for a teenager who tends to really live in the moment. And when things are bad, it feels like they are going to be bad forever," said Dr. Noble.
SFUSD parent Siva Raj is worried about both his sons, but especially his 14-year-old. "His mental health - he's in bed. He does his entire school day in bed, he gets up and he goes to his desk and he plays games and then he goes back to his bed at 3, 4 a.m. at night."
Raj says without any human connection beyond his own home, his grades have plummeted and he's lost interest. "He has I think borderline depression, classic symptoms of depression. And I'm afraid to even acknowledge that in my head. He's refused to go to therapy."
Raj feels so strongly that his kids need to be in school that in February, he and his partner launched a campaign, which has gained national attention, to recall the San Francisco school board.
Siva Raj: "I mean they have one job to do, which is educate our kids and that one job they have completely failed at."
Kate Larsen: "What's at stake?"
Siva Raj: "It's our children! It's our children's future!"
Mental health data is complicated. Reporting is inconsistent across counties and health care providers. Santa Clara, San Mateo, and Napa Counties sent ABC7 data that indicates a drop in pediatric suicidality and mental health crises.
But Kaiser Permanente, the largest health care provider in California, sent a statement to ABC7 that says in part: "We have seen a rise in demand for mental health services, particularly among youth, since the COVID-19 pandemic began."
Marin County reported a significant increase. In January 2020, Marin Health Medical Center's ER, saw four children, 18 and younger, who were suicidal. A year later, in January 2021, they saw 14 children, 18 and younger, who were suicidal. And from 2019 to 2020, Marin Health Medical Center, overall saw a 40% increase in suicidal children. Marin County says part of the increase may be due to COVID protocol, which meant all mental health crises were sent to the ER starting in April 2020, rather than to a separate mental health crisis unit.
TAKE ACTION: Get help with mental health issues
In February, two Marin County middle school students died suddenly. A letter sent to Marin public school families said, "a middle school student in Marin County tragically took their own life yesterday." While most Marin schools are now open, officials say that student was still in distance learning at the time of their death.
"When you lose a student, it is absolutely unbearable," said Mary Jane Burke, the Marin County Superintendent of Schools.
"As someone who has had a family member die by suicide within the last couple of years, I will tell you, it takes your breath away. You can't breathe, you don't even know what it is you wish you could have done differently."
Her advice to families:
"Pay attention, communicate even when they don't want to, ask questions, try to get a good sense of how they're feeling..... If you're worried, you'll know you're worried. Ask for help, to me that's the most important thing anybody can do."
Burke says Marin schools have been investing in multiple strategies to improve student and teacher emotional health, including more counselors, more student group time, and more interactions with families. "For our students to totally flourish in life they've got to have relationships and the ability to interact with not just their peers, but adults, and you just can't do that in a virtual environment."
RELATED: Kids are hitting a pandemic wall
Lynn Dolce is the CEO of Edgewood center for children and families in San Francisco. She says referrals to their residential services have gone up 47% during the pandemic. From July 2020 to January 2021, they received 364 referrals.
"Kids have come in through our crisis stabilization, Kate, with suicidal ideation. And they've said things like, you know, I know that if I am suicidal, I could actually get back into the residential treatment program and be around kids again, which I really need to do, because I'm really missing that social interaction. Those are my words, not the kids words. But that tells a story that is really disturbing to me, that they would know that's how they would come in and be around other kids."
Kate Larsen: "When a family does need outside help? What is the best first step?"
Lynn Dolce: "The best first step is to call the crisis line, you know, call the Edgewood CSU. The staff is there 24 hours, seven days a week. They will help you through any kind of conversation you need to have with your child."
The Edgewood CSU Main Line is (415) 682-3278
Dolce is a family therapist and says engaging with your child is critical. "I know this is really uncomfortable for some of us. But I think it's important to ask the hard question about suicidal ideation. I think it's okay to say to your child, you seem down? Are you thinking of hurting yourself? Do you ever think about suicide? Do you know people who do think about suicide? Let's start using the word to destigmatize the word. It is so scary. If your child says yes, I think about that. It is more scary when your child has made an action toward that end, and you don't you weren't expecting it."
RELATED: COVID pandemic's mental health burden heaviest among young adults
"Prior to COVID, suicide became the second leading cause of death for children 10 to 24 years old, and we have continued that trend of seeing increasing mental health needs and crises," said Dr. Regina Graham, a trauma adolescent and adult psychiatrist and the medical director for psychiatry and mental health at UCSF Benioff Children's Hospital Oakland.
Dr. Graham says families should secure potentially lethal means, like firearms and medication. "A significant portion of suicide attempts are done impulsively. And so if there's just a few more seconds that someone may have between having a feeling and actually acting, which might be because something is locked, and they can't get access to it, it could save a life."
Graham also says suicide and crisis hotlines are important resources for families who need help.
There is hope. Gonsalves feels like MacAllister and their family are now out of crisis. "I can see him talking and engaging with the other kids and laughing and just being a kid again."
RELATED: South Bay students' free meditation classes help other kids cope with COVID-19 pandemic
She says the mental health of her entire family has improved now that MacAllister is at school in Marin. "I have my relationship with my son back, that's the most important thing."
MacAllister meanwhile is back to enjoying school... for the most part. "Wearing masks the whole day is hard to learn, but it's a lot better than doing it on Zoom."
He wanted to share some advice with kids who might be struggling. "It can get better, but you're just going to have to get through it first. It's going to come in waves."
If you or your child needs help right away, call the National Suicide Prevention Line at 1-800-273-TALK (8255), call 911, or take your child to the nearest crisis center or emergency department.
See more stories and videos about Building a Better Bay Area here.