In California, is quality mental health care reaching the kids and young adults who need it most?

Despite recent legislative changes that aim to expand access to mental health services, both nationally and at the state level in California, people in need of care are frequently finding themselves lost in a troubled system. What services are available vary widely by county. Even if you have health coverage, it can be difficult to find a mental health care provider that accepts your insurance. In the case of an acute mental health crisis, hospital beds are few and hard to come by. 

The dysfunction takes on new dimensions when you look at youth and young adults. About half of the kids in California are covered by Medi-Cal, and the state’s Medicaid reimbursement rates for providers are some of the lowest in the country. Advocates say that families looking for mental health care for their kids are ending up on waiting lists, and when they do get care, they may not continue seeking it out if it’s of low quality. Youth in need of mental health services are entering the juvenile justice system because their families run out of options that don’t involve law enforcement.

Youth in the child welfare system who are transitioning to adulthood frequently experience mental health issues and have histories of neglect or abuse, but they often have no one to turn to for help. What happens if they’re not getting the help they need, and in the meantime their housing situation is unstable? Young people enrolled in college who are struggling with their mental health might turn to a campus health center, but what if the health center lacks enough resources to meet the demand?   

My plan for my 2016 California Fellowship project is to look at the state of mental health care for three different subgroups of youth and young adults in California — community college students, older foster youth, and youth in the juvenile justice system — as a way of illuminating broader issues with our mental health care system, as well as how the system can be strengthened. 

With regard to community college students, I’m interested in finding out whether California community colleges have adequate resources (in terms of funding) to provide quality mental health care through campus health centers, especially in comparison to the funding provided to schools in the University of California system. This story grew out of a project that my news organization, New America Media, did at Pierce Community College in Los Angeles; over the past year we worked with a cohort of student journalists there to tell stories about young people dealing with depression, as a way of breaking the silence. Community colleges serve all students — diverse populations of individuals dealing with all different kinds of life circumstances. I want to investigate whether those schools are getting the resources they need to effectively serve the emotional health of this population. 

For youth in the child welfare system — specifically older foster youth — I want to find out what access to mental health care looks like in light of the lack of foster placements for older youth who often have mental health needs and, now, the phasing out of group homes in California with the implementation of Assembly Bill 403. Over the past few months, I worked on a storytelling project with a group of youth in the system who have dealt with unstable housing situations because of gaps in the safety net. I’d like to shift my focus to their access to mental health services, because there’s a disproportionate need for them among youth in this population, especially as they’re emancipating.

There’s been a positive development around the providing of mental health care to youth in the juvenile justice system; some advocates hope that the change could result in fewer kids ending up in detention and ultimately the prison system. California’s Department of Health Care Services recently acknowledged that Pathways to Mental Health Services (also known as “Katie A.” benefits), which refer to certain types of community-based mental health treatment, must be extended to all Medicaid-eligible youth in California, not just kids in the child welfare system, as had been the case previously. But I’m interested in finding out what exactly this will mean for kids in the justice system, who are disproportionately in need of mental health treatment (the San Francisco-based Young Minds Advocacy Project estimates that 70 percent of them need such services; around 4,500 will be newly eligible for community-based treatment as a result of the DHCS decision in November).

For those youth who aren’t getting the help they need, where exactly is the system breaking down? If improvements are on the horizon, what will it take for them to be effective and to make a real difference in the lives of individuals? I hope to be able to contribute something to this conversation and the search for solutions.

[Photo by Jesse Millan via Flickr.]