San Diego vs. Siskiyou: Researchers Find Stark Disparities in Senior Mental Health Care Across Counties

The World Health Organization estimates that 15 percent of adults age 60 and older live with mental illness, including depression, anxiety and dementia.  Photo: Thinkstock

California is not adequately serving the needs of seniors with serious mental illnesses, according to a new study and documents released Thursday by the UCLA Center for Health Policy Research.

Services vary widely from county to county, the state lacks sufficient data to determine the demographics of the people served, and racial and cultural barriers are preventing people from getting needed services, the study said.

While California’s 2004 Mental Health Services Act funneled $13 billion into the state’s mental health system between 2004 and 2014, it’s unclear how much money went to residents age 60 and older.

“There is very little information available to answer critical questions,” the researchers wrote in a policy brief. “How much of the amount was spent in the interests of older adult mental health? What benefits were gained from services delivered to older adults?”

The act is funded by a 1 percent income tax on earnings of $1 million or more. The money is intended to allow the state to develop a mental health system that focuses on wellness and recovery rather than crisis management.

Services for adults who are 60 and older in California are particularly important as the demographic is expected to increase by 64 percent in 2035. By that date there will be about 12 million seniors in the state.

The study cited World Health Organization estimates that 15 percent of adults age 60 and older live with mental illness, including depression, anxiety and dementia.

Kathryn Kietzman, one of the authors of the study, said she was struck by the range of programs offered by the six counties included in the study: Los Angeles, San Diego, Alameda, Tulare, Monterey and Siskiyou.

Some offered excellent programs, like San Diego’s training for geriatric specialists. But other counties, while they served seniors, had less in the way of programs specifically tailored for that age group.

Services for seniors also varied within counties.

“Rural areas were hard pressed to be able to specialize at that level due to resources,” Kietzman said, explaining that services were more often found in cities. “You have to drive three hours to bring services to some folks.”

Participants in the study’s focus groups mentioned that cultural beliefs that stigmatize mental illness and the lack of service providers in their ethnic groups prevent some from receiving mental health care.

For some cultures, mental illness may be seen as shameful, Kietzman said.

“Some cultures may want to keep that in the family,” she said. “It would be a source of public shame to say you’re mentally ill.”

Kietzman added that some cultures prefer to just interact with people in their own culture. “They say we don’t need professionals, and we don’t trust professionals,” she said.

The study said that older adults of color will represent a majority of seniors in California (55 percent) by 2035.

Jessica Cruz, chief executive officer of the California chapter of the National Alliance on Mental Illness, said she found the study beneficial.

In an email, she said the state should reach out to communities in order to figure out the best way to provide mental health services.

“We must again partner with agencies and ‘cultural brokers’ that can bridge the gap between traditional providers and those individuals needing mental health services,” she wrote.

Cruz believes the most important recommendation made by the researchers is the one to require standardized needs assessment and data reporting.

“If we cannot accurately identify services being provided, with demographic information and performance indicators, we as taxpayers of the Mental Health Services Act cannot assure the money is being spent correctly,” she said in the email.

“There should be a statewide standard of service being provided by counties, that includes programs that span across the age spectrum. This way, no matter what county you live in California, there is a standardized mental health service being provided.”


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