Battling scope creep while reporting on unmet mental health needs in Santa Clara County

When I set out early this year to uncover gaps in mental health care services in Santa Clara County, I was utterly unprepared for just how deep the problems ran.

Every psychiatrist, every therapist, every policymaker and every advocate had a different story to tell, and each interview felt like it exposed a brand new problem in the way California delivers its mental health services. One day my focus was on the good ideas getting ensnared in a bureaucratic mess, the next day it was a workforce problem, long waiting lists and a dearth of clinics and practices willing to take new patients.

In retrospect, this probably shouldn’t have come as a surprise. There’s a well-documented gap between the number of people who meet the criteria for a behavioral health disorder and those who actually get services, and California has spent decades purposefully teasing out mental health from the rest of the health care system, treating it as a separate and — arguably — unequal set of services.

Scope creep was a real problem from day one, and each new report or study simply led to two or three more. There were rabbit holes within rabbit holes.

On the one hand, it was good to know that there was a story to be told, but it came with a number of challenges. Along with the risk of getting spread too thin, I had sources trying to convince me where the “real” problem lies. Was it low-income families on Medicaid who had it worse, or the commercially insured families who couldn’t pay out of pocket for psychiatrists who decline to deal with private insurers? Where along the continuum of mental health services, ranging from education and prevention all the way to hospitalization and crisis services, does the county fall short the most?

I got a different response from just about everyone.

A useful tool that kept me on track was relentlessly sticking to my original mission statement. It was abundantly clear, after reporting on education and local schools for three years, that students were not getting the mental health care they needed. I later found research that shows most mental illnesses show up by the age of 24, which only reaffirmed how important it was to focus specifically on children, adolescents and young adults.

Another strategy that helped focus the story was to find health care data (usually dry and lifeless) and find a specific local example of the real-life implications. “Penetration rates” for California’s Medicaid residents under the age of 21 are low, but what that actually means is that lower-income families, living in pockets of an otherwise affluent community, are not being reached by the county’s suite of mental health services. Mental health providers with deep ties to the community could turn those cold data points into real stories of families struggling with poverty and wary of any kind of government-run health care.

Data shows a loss of inpatient psychiatric beds in California going back to the 1990s, but behind those line graphs are families who had children in crisis and nowhere to take them — short of traveling to Sacramento or beyond. Some of those parents, upset and frustrated, felt so strongly about the lack of local services that they were willing to share their personal story on the record. I was fully prepared to use anonymous sources and pseudonyms, but it wasn’t necessary.

The method wasn’t just a way to tell a compelling story, it was a way of keeping the scope of the reporting project in check. In a situation where cuts must be made and bandwidth must be limited, substantiating the problem through a mix of data and personal accounts kept the series from turning into a sprawling mess.

One of the guiding principles throughout our week visiting USC Annenberg was that health care is inextricably tied to other elements of social services and social welfare, housing, culture and even the criminal justice system. While it’s a great mental exercise and something that could no doubt inform reporters on how to approach a health problem, I have no doubt that it added to the difficulty of keeping a sane scope.

While the depth and breadth of the unmet mental health needs in the community did pose a problem in trying to form a concise, cohesive narrative, it was counter-balanced by a huge advantage: People were desperate for help and more than ready to come forward with their story. Going into the project, I believed personal accounts of mental health crises and people willing to go on record with sharp criticism would be the hardest part of the story to nail down, and that anonymous sourcing was an inevitability.

It turns out that was the easiest part. Out of necessity, parents often rely on other parents for advice (particularly during crisis and emergency situations), creating a tight-knit community of people who feel very strongly about access to mental health services, and always seem to be poking and prodding health officials in public agencies and hospitals in the area. They were vital partners throughout my reporting project and were very forthcoming and willing to speak on the record and take photos.

By taking a conscious effort to carve out specific aspects of the story and setting them aside, I’m excited to dive into unexplored aspects of mental health care in Santa Clara County that didn’t quite fit into my earlier story. Providing access to quality mental health services for adolescents in the juvenile justice system (more than two-thirds of whom likely have a diagnosable psychiatric disorder) is plagued with challenges, for example, and stands on its own as an important reporting project worth pursuing. Privacy laws, particularly as it relates to school-based therapy and counseling services, is also a big concern that warrants more investigation.