Californians Want Better Mental Health Care. Can the State Deliver?

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California’s top health priority should be making sure that people who need mental health treatment can get it, over 90 percent of respondents said in a recent poll.

More than half of those surveyed by the California Health Care Foundation said their communities do not have enough mental health providers to meet the need. People of color often feel the lack of access more acutely, researchers found, with 75 percent of black and 57 percent of Latino respondents noting that their communities don’t have enough mental health providers, compared to 49 percent of white participants. Women were also more likely than men to say that access to treatment was limited (57 percent vs. 47 percent).

Among respondents who had sought mental health care in the last year, 42 percent of those with the government health plan Medi-Cal and 21 percent with employer-sponsored health plans said they had to wait longer than they thought was reasonable to get an appointment.

It’s the second year in a row that mental health care has ranked as a top priority for Californians in the annual survey, regardless of political affiliation. In recent months, California Gov. Gavin Newsom, lawmakers and state health officials, have made various proposals to improve mental health access.

During his state of the state address earlier this month, Newsom called for changing how the state spends money for mental health services gleaned through a 1 percent tax on millionaires. The funds, authorized by the Mental Health Services Act, should be focused on helping those who are homeless, at-risk youth and people involved in the criminal justice system, he said.

Meanwhile, the Department of Health Care Services is leading a major effort to reform California’s health care program for people with limited incomes, known as Medi-Cal. Proposals include making it easier for counties to claim federal funding for mental health and allowing people to seek mental health services even if they haven’t been diagnosed with a mental health condition.

Additionally, earlier this month, California Assemblyman Marc Levine (D-Marin County) introduced a bill that would require prompt mental health follow-up appointments for Californians who are hospitalized because of a severe psychiatric crisis. 

These proposals “pull in the right direction,” said Catherine Teare, a policy analyst at the California Health Care Foundation. Changes to mental health funding under Medi-Cal, for example, could make the system more efficient and facilitate the integration of mental and physical health care, she said.

However, homelessness should not be reduced to a mental health issue, when the real driver of the problem is a lack of affordable housing, she said. And some challenges with the state’s mental health care system, such as a severe shortage of mental health providers, must still be addressed, Teare said.

Children’s mental health needs are also being overlooked by state officials’ proposals, said Alex Briscoe, a former Alameda County health department director, and principal of the California Children’s Trust, a broad coalition of organizations calling for mental health system reform. Statistics show a rising need for mental health services among children and young people, yet the Department of Health Care Services isn’t focusing specifically on reforming children’s mental health care, Briscoe said.

Addressing and preventing mental health concerns in childhood and young adulthood—when most mental illnesses first appear—could reduce the chances of people developing debilitating conditions that can push them into homelessness, Briscoe argued.

“The state’s refusal to independently and specifically address reforms to the children’s mental health system is deeply frustrating and doesn’t reflect what we believe is an epidemiological crisis of despair,” he said. “We continue to see striking increases in utilization and acuity for children: 104 percent increase in emergency visits for self injury over 10 years, a 70 percent increase in suicidality for 10 to 17 year-olds. I could go on.”

Teare believes the survey results reflect two main concerns: the growing visibility of people experiencing homelessness and mental illness; and personal frustrations with trying to get mental health services.

At the same time, Californians are more aware of their right to obtain mental health care as part of their health plans, Teare said. The Affordable Health Care Act, enacted under President Barack Obama, expanded access to mental health and addiction services by requiring health plans to cover treatment.

Reduced stigma around mental illness may also be encouraging more people to demand services, Teare said. Almost 9 out of 10 poll respondents said they favored increasing the number of mental health care providers in parts of the state where they’re in short supply, and enforcing rules that require health insurance companies to provide mental health care at the same level as physical health care.

“People seem to have higher expectations of the sort of mental health care that they should get, and the sort of access they should have,” Teare said.

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