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Improving Equity in Mental Health Services

Daniel Tan December 12, 2019
photo - Doctor Comforting Depressed Patient

California has seen historic declines in the number of residents without health coverage—since 2014, the state’s uninsured rate has decreased from 17.3% to 10.3% percent among adults  younger than 65. Expansions in the Medi-Cal program account for most of this expanded coverage; since 2014 enrollment in Medi-Cal has increased more than 50% and now provides coverage to nearly one-third of Californians. However, many challenges remain to ensure that coverage translates into access, particularly in the area of mental health.

Over one million Californians use the state’s public mental health system, which includes services provided through Medi-Cal managed care plans and county mental health plans. For many patients, the system is difficult to navigate. The fragmented delivery system is part of the issue, but there are also concerns that mental health providers are unable to meet the needs of California’s diverse communities—and those needs are notable. In a recent survey, 11.2% of Latinos were identified as likely to have experienced serious psychological distress during the past year.

The disparities in access for underrepresented communities may be reflected by current utilization patterns of county mental health services. Among adult Medi-Cal enrollees, fewer Latinos and Asian/Pacific Islanders use these services than African Americans and whites.

figure - Use of County Mental Health Services Varies Widely by Race

These disparities are similar nationwide—and are likely to be related to a variety of factors. One possibility is the higher share of Latinos and Asian Americans/Pacific Islanders who may experience language barriers, compared to African Americans and whites.

A primary vehicle for reducing these disparities are Cultural Competence Plans, which are intended to guide county mental health plans in meeting the cultural competence and linguistic requirements already mandated by law. Recent legislation seeking to codify these requirements for county mental health plans did not make it past the governor’s desk. But its advancement through the legislature signals growing recognition of the need for communities of color to have access to culturally and linguistically appropriate mental health services. As California’s population becomes more diverse, culturally competent care will become even more important in the coming years.

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