58 million Americans affected by mental illness
Healthcare in America has traditionally sidelined mental health and substance use disorder treatment. According to a 2021 report by the National Institute for Mental Health (NIMH), almost 58 million Americans (almost 23% of the population) suffered from Any Mental Illness (AMI). Any Mental Illness is defined by the NIMH as “a mental, behavioral, or emotional disorder,” that can range from very mild to very severe. Barely 50% of this large group of people received mental health care.
Data gathered by the CDC in 2021 showed that there were 48,183 deaths by suicide during that year, twice the number of homicides in the same period. People of color and immigrants are disproportionately affected by mental health challenges and are least likely to receive care.
Medi-Cal introduces changes
Healthcare policymakers and providers in some states, like Medi-Cal, California’s Medicaid program, have introduced significant changes to address this inequity. At an Ethnic Media Services briefing on May 16, DHCS leaders and community health care providers shared how Medi-Cal is helping Californians needing mental health and substance use disorder treatment lead healthier lives.
Medi-Cal provides healthcare services for over 15 million Californians, a third of the population, and falls under the governance of the Department of Health Care Services (DHCS).
Paula Wilhelm, the interim deputy director for behavioral health for the California DHCS was clear about the reasons to introduce more mental health care in Medi-Cal. “As a department, we know that mental health is just as important as physical health and all of our health outcomes are intertwined,” she said, adding, “A member may use alcohol or drugs to cope with their mental health needs. They may have medical problems. They may face challenges meeting basic food and housing needs.” All these serve as impediments to seeking and receiving mental health support.
According to Wilhelm, DHCS works with managed care plans and county behavioral health agencies that provide a wide range of behavioral health services, including prevention and wellness with the help of community health workers. These services include screening and assessment of mental health and substance use needs, an array of outpatient and community-based treatment services, including individual group and family therapy, and more intensive treatment services like crisis care, residential treatment, or inpatient. They also cover mental health and substance use medications.
Behavioral Health Services Act
The newly updated Behavioral Health Services Act, which the California voters passed, is designed to include changes that underline the importance of care beyond the physical realm. “This effort is really going to reorganize and transform the way we plan, finance and deliver our publicly funded behavioral health services to better support our populations living with the most significant mental health and substance use needs,” shared Wilhelm.
Some of these updates include
- Reforming behavioral health care funding so that we’re equitably funding treatment for those with substance use disorders and prioritizing care for those with the most serious conditions.
- Expanding services, including prevention and early intervention services and making new investments in housing and the behavioral health care workforce.
- Continuing to focus on outcomes, accountability, and health equity by supporting culturally responsive services and community-defined practices and developing a behavioral health workforce that reflects the diverse communities we serve in California to provide culturally and linguistically appropriate care.
- 24/7 access helplines for members
Significant strides in juvenile care include the Governor’s master plan for kids’ mental health announced in 2022, featuring a 4 billion dollar investment in the Beaver Health Initiative for children and youth, to treat emerging and existing conditions.
Children need early intervention
Autumn Boylan, Deputy Director of the Office of Strategic Partnerships at DHCS shared some disturbing numbers – half of all lifetime cases of diagnosable mental illnesses emerge for young people by the age of 14 and 75% of lifetime diagnosable mental illnesses begin by age 24. She reiterated the importance of providing preventative services and intervention early in the lives of children.
Boylan added that “in California specifically, almost 300,000 or 284,000 youth are coping with major depression and 66% of those young people do not get treatment access in the way that they should or timely access to care.” While the Covid-19 pandemic was a factor, it was not the sole cause. Boylan said that an emerging youth mental health crisis was rooted in 24/7 access to information and social in the palm of their hands through their phones, “They engage in interactions, healthy and unhealthy. They are bombarded with information about the world around them including climate change and the political world, including school shootings are contributing to the stressors that young people today face.”
Youth initiatives
Additional children and youth behavioral health initiatives include,
- Strengthening the network of support for our young people where they spend most of their time.
- Working very closely with our county offices of education, school districts and schools throughout the state to strengthen the network of care and supports that available in school settings, both at the K through 12 as well as the California Community Colleges, University of California, and California State University Systems to help people deal with the stressors of school.
- Making available more school counselors, school psychologists, and reimbursable health services
- Implementing well-being and mindfulness programs to ensure school environments is focus on mental well-being and emotional health.
- Focusing on community-based services by investing in evidence-based interventions and strategies and community-defined practices known to be of benefit and achieve better outcomes for our young people of color in low income populations.
Community advocacy
Jennifer Oliphant, Director of the Two Feathers Native American Family Services shared information on the Peer specialist service streams her organization provides. The also have cultural and outreach departments, a facility for community gathering activities and ceremonies, and provide youth services including employment support.
Oliphant said that the Medi-Cal Expanded Services Act provided a “sustainable funding stream which we use along with our regular grant funding and allowed us to expand and include more youth programs because mental health services are now covered.”
She urged the DCHS to involve BIPOC communities more and think out of the box to overhaul how these services are delivered to them
Tricia Nyugen, CEO of Southland Integrated Services, Inc., described her nonprofit as a one-stop shop for all community services including health care. Her organization provides comprehensive health, mental health, social, transportation, and other supportive services to low-income residents in Orange County, CA. The biggest challenge facing healthcare providers is finding bilingual health providers she said. Nyugen urged the media “to tell people that these services are available, address stigma in communities, make resources more available and raise awareness all year long,” and not just during mental health awareness month.
Photo by Devin Avery on Unsplash
