Supply, Demand and Access: California’s Mental Health Care Crisis

By Bart Magee, Ph.D.

According to recent reports, California continues to struggle to meet the mental health needs of its citizens. Among US states, California ranks poorly in terms of access to mental health care (30). The percentage of people needing but not receiving treatment is 61%, ranking the state near the bottom at 47. This is an ongoing tragedy. We know that untreated mental health disorders is one of the strongest predictors of illness and disability and costs billions of dollars a year in lost wages and productivity. And every day we witness real human suffering and recognize other innumerable costs: homelessness, incarceration, premature death. 

What’s getting in the way?
 
According to the California Health Interview Survey, the high cost of care was the most frequently cited reason (64%) for people not seeking treatment for a mental health need. While many people may have coverage for mental health services, barriers such as high co-pays and deductibles, spending limits, and maximum numbers of visits also limit access.
 
Right behind cost is stigma. Almost half of respondents needing but not receiving treatment (47%) cited stigma as a barrier. Many of them “did not feel comfortable talking with a professional about [their] personal problems,” or “were concerned about what would happen if someone found out [they] had a problem”. Minorities (Asians, Latinos and Blacks) were much less likely to receive treatment than whites. In addition, adults aged 65 and over and younger adults aged 18 to 24 had greater odds of having unmet mental health needs relative to middle-aged adults.
 
And there is a new challenge: A declining supply of mental health providers.
 
The California Healthcare Foundation released a report this spring that sounded the alarm. Forty-five percent of psychiatrists and 37% of psychologists are over age 60 years and are likely to retire or reduce their work hours within the next decade. And there is a limited pipeline of new providers to fill the emerging gap. Inadequate pay is a significant factor driving this, along with high debt loads. Salaries for mental health professions are lower relative to other occupations with similar education and training requirements. They have the same student loan debt, but less capacity to pay it off. The high cost of living in California completes the grim picture. The report notes that if current trends continue, California will have 50 percent fewer psychiatrists than needed and 28 percent fewer psychologists and other licensed mental health professionals than needed by 2028. And the demand for services is expected to keep rising.
 
What can be done? And how is Access Institute addressing these challenges?
 
The reports conclude that addressing these challenges requires coordinated policies and programs that lower the cost of treatment, increase mental health awareness, and reduce mental health stigma in all communities. Increasing investment in the education and training of mental health professionals was also cited as an urgent need.
 
For 15 years Access Institute has been a leader in all of the areas cited as critical in the reports. Our mission is focused on addressing the high cost of care (sliding-scale and pro-bono mental health treatment) problems related to access, particularly in marginalized communities (providing on-site treatment in elementary schools and at senior programs serving the Black and LGBT communities) and addressing stigma (public outreach, community events). Going forward, our greatest contribution may be the training we are providing to the next generation of mental health providers. To date, more than 125 psychologists, clinical social workers and marriage and family therapists have graduated from our programs. These young professionals have received the best psychodynamic and community-focused training, the kind of training designed to meet the needs of California’s diverse population. Our graduates will meet those needs for decades to come.
 
And beyond the intensive and formal training we give to mental health providers we are also training nurses, social workers, and other paraprofessionals in mental health assessment and trauma informed care. We provide these trainings at both of our partner agencies where we serve seniors in their communities. These trainings help to expand the impact of our work, creating positive ripple effects in the communities we serve.
 
We are also working on initiatives to address the underrepresentation of people of color, immigrants, and those from economically disadvantaged communities within the mental health professions. We are developing plans and outreach efforts to collaborate with professional organizations, training sites, and graduate schools to find innovative ways of addressing the needs of a more diverse community of providers.
 
And we will keep up the struggle. Access Institute was founded to address the gap in mental health care and training in the Bay Area and beyond, and as long as that gap remains we will continue to serve our community, to discover innovative treatment solutions, to fight stigma, and ensure access to mental health care for all.