Link to full article in Medium
California’s kids are in crisis, and the issue isn’t getting the attention it deserves. It’s a crisis of too many and too few: too many kids with mental health problems, and too few resources to address them.
Up to 20 percent of children on Medi-Cal need mental health services¹, but only three percent receive them. So many kids need a psychiatrist but the 1,150 in the state² can offer appointments on average about once a year to new patients.³ There are 528 psychiatric beds needed in the Bay Area but only 137 are available.⁴
The California Little Hoover Commission has found that despite a massive increase in funding starting in 2004 and good policy intention, the state can’t quantitatively validate spending, is weak on oversight of expenditures and implementation, and shows poor transparency and fiscal accountability.
How did California end up here? The core of the problem is the dangerous myth that mental health problems are self-inflicted, and cures are secured by mental resolve. More broadly, our society stigmatizes mental health problems in ways that interfere with seeking help, making mental healthcare challenging at preventive, diagnostic and treatment levels alike.
It’s a confounding problem which does not lend itself to simple solutions. But if you look carefully, there are reasons for optimism. In San Francisco, the mayor and Board of Supervisors have dueling proposals around aspirational reform goals. In Oakland and Alameda, plans are afoot to launch a ballot proposition in support of pediatric mental health. At the state level, Governor Gavin Newsom has formed a homelessness task force and appointed a nationally renowned psychiatrist and neuroscientist to lead the state’s work on mental health.
The public officials behind these efforts understand that the most effective solutions will be holistic. They will involve collective action including a significant investment of public funding, new care delivery models, a dramatic increase in access and far more demanding accountability to enforce positive outcomes.
The first place to start is at the front door: access to care. As it stands today, getting a phone call answered or a referral delivered are seen as accomplishments by patients and their families. Once in this dysfunctional world, the care delivery model is from the last century and fails to integrate care by ignoring optimal staffing models or insufficiently utilizing technology to simplify data collection. Improved tools for detection would improve care delivery through deeper patient engagement.
More broadly, our funding and accountability models need an upgrade. For example, reimbursement levels trail primary care by 30 percent. We can’t expect to attract high-quality pediatric mental health providers — psychiatrists, psychologists, social workers and trained community workers — if we don’t increase the level of reimbursement to a level equivalent to primary care for physical ailments.
Further, we need to educate leaders in government at all levels of the scale of mental health needs among their children, especially homeless and undocumented children. This awareness must be tied to concrete funding sources and lines of accountability for each party. No more passing the buck between the state, cities and counties.
Last, we should modernize our care delivery models to address the new risks of social media addiction, cyber-bullying, opioid addiction and suicide. Part of the response to these mental health risks can include working with reform-minded community organizations like churches, community groups, sports leagues and local businesses.
The bottom line is this: children are the only segment of our population with an increasing prevalence of mental illness. And while effective treatments exist, some 65 percent of kids still suffer without care. Now is the time for California to chart a new path on mental health care. What we’re missing is a plan that aggressively addresses the impediments to care in a holistic way. As a starting point, let’s agree that the scale and urgency to act on reforms needs to match the moment. Timid half steps or fine-minded inside baseball moves won’t cut it. The leader who has committed to and now owns this challenge is Governor Newsom. Let’s help him get this important work done.