PPIC Logo Independent, objective, nonpartisan research
Blog Post · October 2, 2023

Low-income and Undocumented Californians Struggle with Mental Health

photo - Man in a counseling session

While mental health needs are on the rise for all Californians, low-income adults continue to experience distress at higher rates than middle and high-income adults. In 2021, nearly 20% of low-income adults reported serious psychological distress in California, in contrast to about 14% of higher-income adults. For California’s low-income undocumented adults, finding help to address trauma can also mean working around barriers to care.

State leaders are prioritizing health care equity through efforts that include expanding Medi-Cal to all low-income residents, regardless of age or immigration status. This policy will take effect in January 2024, and it will offer comprehensive coverage, including for mental health services, to the largest demographic of uninsured residents—all adults aged 26 to 49.

Undocumented immigrants have experienced high rates of trauma, according to experts we interviewed in Los Angeles County. This trauma may be related to domestic violence, the migration experience, and war in home countries. Community health centers—clinics that many immigrants, including many undocumented, identify as their usual source of care—are responding to the growing need for mental health services among undocumented patients. For example, one clinic in LA County grounds their care in psychoeducation—teaching patients about their mental health issues and providing information and resources to treat their issues. Another clinic in LA is providing application assistance to safety net programs because struggling patients are forgoing safety net benefits that would improve their well-being and reduce stress.

While community health centers are a critical source of care, their efforts are met with certain challenges. At some clinics in an upcoming PPIC study, the wait time to receive mental health services is about two to three months. Clinics may struggle to recruit bilingual and multilingual social workers with sufficient fluency to conduct therapy in the patient’s native language.

It can also be difficult to convince patients to sign up for the mental health services they need, due to stigma, lack of health care coverage, and misinformation related to these services. In 2021, about 15.3% of low-income noncitizens experienced severe psychological distress but only 8.2% saw a mental health provider in California. Low-income patients who are citizens experienced distress at rates similar to their rates of seeing a mental health provider.

Access to mental health services is further complicated by a lack of providers in parts of the state. Also, immigrants with limited English proficiency may have worse experiences trying to schedule mental health visits.

California has taken great steps in recent years to close health equity gaps and improve access, including funding a system to transform how Medi-Cal delivers payments to primary care clinics. By learning from community health centers that already work with undocumented patients and providing additional resources—such as for hiring more bi- or multilingual staff—policymakers and advocates can strengthen policy and advocacy efforts to prepare for increased enrollment with January’s Medi-Cal expansion. Stay tuned for our upcoming report on this topic and other insights into the health needs of low-income adults around the state and the role of California’s community health centers.


community health centers Health & Safety Net Immigrants in California Medi-Cal mental health Population Poverty & Inequality undocumented immigrants