Community engagement drives effort to make mental health care more equitable in one California county

A patient’s experience with the health care system often begins well before they see a provider.

The way they’re greeted in the lobby can make a big impression. Similarly, signage in their language or the ease of interpretation services can make someone feel seen, respected, and understood.

“When these things aren’t happening, it translates to people not wanting to come a second time,” said Dr. Sergio Aguilar-Gaxiola, a leading international researcher of mental health access challenges for immigrants and communities of color.

That return visit is especially important for patients seeking mental health care, which often requires ongoing visits to deliver benefits, he added.

Aguilar-Gaxiola, a professor of clinical medicine and the founding director of the Center for Reducing Health Disparities at UC Davis Health, described these and other takeaways from his team’s innovative effort to increase equity and access in mental health care in California’s Solano County in a recent Center for Health Journalism Health Matters webinar. That community-focused model has garnered attention from county and state leaders as a potential roadmap for addressing similar mental health disparities throughout the state and beyond. 

Narrowing the mental health gap

For more than seven years, Aguilar-Gaxiola and his team have been working to advance health equity for historically underserved populations in Solano County, a region that lie between San Francisco and Sacramento. When community leaders there approached the UC Davis team and asked for their help in addressing persistent mental health disparities, Aguilar-Gaxiola jumped at the opportunity, he said.

The collaboration, which began in 2016, used Mental Health Services Act innovation project funding, which uses taxes on wealthy Californians to transform behavioral health services. The project focused on three groups facing mental health access challenges in the county: Filipino Americans, Latinos, and LGBTQ+ clients. 

The team worked closely with community organizations, such as Fighting Back Partnership, Solano Pride Center, and Rio Vista Care to assess the community’s needs. Through hundreds of interviews, meetings and focus groups and trainings, they gauged the community’s strengths and needs and used that information to improve mental health delivery with a focus on sustainability.

They invited dozens of community members to train in Culturally and Linguistically Appropriate Services, a national standard aimed at reducing health inequities.  The diverse participants included individuals from the community as well as county employees, and representatives from social services, schools, churches, law enforcement and housing organizations. 

“By design, we made it very, very interactive,” he said. “It was very important for them to have fun as well.”

The trainings led to specific action plans, such as hosting community mental health workshops, ensuring clinics are culturally inclusive and creating training for front-desk reception staff. To keep the effort ongoing, the changes were incorporated into organizational policies and hiring practices.

Lessons learned   

The effort led to increases in the volume of calls to a mental health access line — 29% overall — and was especially high among LGBTQ+, he said, with a 309% increase in calls. The overall number of users grew from about 1600 per year to more than 2000 annually after the project.

After the intervention, these three communities were also less likely to enter the mental health system through a crisis, he said. Instead, they were increasingly using outpatient services, which also led to cost savings. Specifically, those figures declined 15% for Filipino Americans, and 8% each for Latinos and LGBTQ+ clients. 

Throughout, the group learned about the importance of listening attentively to a broad group of community partners, stakeholders, and people in need of mental health services. They also noted the importance of using local data on health outcomes. Information that’s not available can be a key part of the story.

“Look for the gaps,” he advised.

Much of Aguilar-Gaxiola’s previous population health work focused on deficits, symptoms, and disorders, he noted. This project emphasized the community’s strengths, assets and resilience and used them to strengthen equity.

Perhaps more than anything, the project underscored the importance of building trust. That can be achieved through working closely with community health workers, recruiting broadly for focus groups and allocating ample time to build relationships, he said. It also involves understanding a group’s key concerns and hesitations. For example, hosting a meeting at or near a police station wouldn’t be a good choice for undocumented community members.

Solano County will become a mentor to much larger counties interested in improving mental health equity from Los Angeles County to Marin County, he said. These counties will address topics such as the effects of COVID-19 on mental health and the implications of trauma on marginalized communities. They may also explore how to use digital solutions such as telehealth in areas with mental health provider shortages. 

Throughout his career, Aguilar-Gaxiola has wondered whether it was possible to advance health equity in underserved populations through community engaged approaches. Now, he’s very clear on the answer. 

“Yes, absolutely yes,” he said. “Mental health equity can be advanced as we have documented with this particular project.”

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Watch the full presentation here: