Reforming Mental Health Care

August 4, 2020

Across the country, millions of Americans are experiencing increased levels of anxiety and depression due to the health and economic uncertainties of the COVID-19 pandemic. Recent surveys show that pandemic-induced stress and anxiety has negatively affected 56 percent of Americans, and 40 percent have reported feeling symptoms of anxiety or depressive disorders. Only 11 percent of Americans reported feeling these same symptoms during the first half of 2019. The data for California is similarly alarming; nearly 45 percent of residents are reporting feelings of anxiety or depression, a significant increase from the estimated 17 percent of Californians experiencing mental, behavioral, or emotional disorders before the pandemic.

Experts predict the situation could become worse in the coming years. Deaths attributable to overdoses and suicides are expected to increase over the next decade due to the prolonged economic effects of COVID-19.

Accessing mental health care, which has long been a challenge in California, has been complicated by the pandemic. While mental health care professionals have largely switched to virtual platforms to connect with their patients, an estimated 22 percent of Californians lack the internet access needed to schedule and participate in online appointments. Low-income communities, the elderly, and those with severe mental illness are particularly disadvantaged by the digital divide. Connecting with patients via phone call, while possible, is a treatment of last resort for providers since it is often not covered by insurance. Even for those who do have internet access, attending virtual counseling and therapy sessions can be challenging; patients living in crowded or abusive households can struggle to find the privacy necessary to speak with mental health care professionals.

Many Californians were not receiving the mental health care they needed even before the pandemic. The California Health Care Foundation found that 63 percent of Californians with a mental illness and 68 percent of teenagers with depression did not receive mental health treatment between 2011 and 2015. Difficulties finding providers and high costs of care were cited as the most significant barriers to treatment. Qualified mental health professionals are in short supply in communities throughout the state; current trends show that by 2028, California could have 41 percent fewer psychiatrists and 11 percent fewer psychologists and therapists than it needs to treat those struggling with mental health. And finding providers covered by insurance is already problematic. In 2019, 48 percent of Californians with insurance reported having a difficult time finding mental health care providers that would accept their coverage. Similarly, 49 percent reported that they delayed or skipped mental health care because it was too expensive.  

Earlier this year, Governor Newsom called for an overhaul of the Mental Health Care Services Act to ensure that its resources reach the people who need it the most. Recognizing the pivotal role mental health care plays in mitigating the state’s homelessness crisis, Governor Newsom proposed reforming the Act to increase access to care for the state’s most vulnerable residents by focusing funding on at-risk youth and the homeless while expanding the services covered by the Act to include treatment for addiction. While these ambitious proposals have been placed on hold due to the significant budget cuts the state is facing due to COVID-19, the state’s Deputy Secretary for Behavioral Health, John Connolly, recently confirmed that mental health reform remains on the Administration’s policy agenda.

In its 2015 and 2016 reports on the Mental Health Services Act and our Chairman’s recent op-ed on the topic, the Little Hoover Commission pointed to key principles that should guide reform:

  • Oversight: Stronger statewide oversight of mental health care programs will ensure that counties are providing top-tier care to those in need. Lawmakers should expand and strengthen the oversight capabilities of the Mental Health Services Oversight and Accountability Commission (MHSOAC) by enabling it to annually review and approve county Prevention and Early Intervention plans just as it currently does for county plans to develop and test innovative mental health treatments.
  • Transparency: Greater transparency of mental health care funds and data is crucial to identify where funds are being spent, who is being helped, and where underserved communities are located in California. While the MHSOAC Transparency Suite offers information on county mental health expenditures and program outcomes, more information is needed to gain a better understanding about who is being served by county mental health programs.
  • Accountability: Lawmakers should strive to further clarify the roles and responsibilities of the state entities charged with enforcing the Mental Health Services Act so that voters can more easily hold the state accountable for program outcomes. Similarly, the state should broaden the authority of the MHSOAC to impose sanctions and withhold funding from counties with deficiencies in their spending plans.

While some progress has been made in the years since the Commission’s reports to improve the state’s mental health programs, more work must be done to ensure that all Californians have access to the mental health treatments and care they need now and in the years to come.  

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