David Grant is the director of the California Health Interview Survey (CHIS) and the lead author of a new report on mental health in California. In this brief interview, he discusses why so few Californians seem to be taking advantage of mental health services, which demographic groups suffer an especially heavy mental health burden, and how CHIS data can help monitor mental health service provision in the future.
Q: Although mental health treatment is mandated in insurance coverage programs, very few Californians with mental health needs seem to be taking advantage of these services. Why?
Legislation enforcing parity in physical and mental health treatment is still quite new and certainly a positive step in expanding the availability of mental health services to those seeking treatment. For a number of reasons, however, many with mental health needs will not seek treatment. Stigma associated with mental health remains a powerful barrier to seeking treatment. Our data and analysis helps to identify some of the populations with mental health needs who often do not seek care; this information can be used to aid in the development of focused outreach programs.
Q: The report reveals great disparities among those with mental health needs. Can you describe the gaps that surprised you the most?
We did find a lot of mental health disparities and it underscores the need for the kind of data that CHIS provides on mental health in California—data that can readily assess and explore health disparities among California’s diverse population. Some of the most striking disparities concern family types, with unmarried adults, especially those with children, having much higher rates of mental health needs. Sexual minorities also had much higher mental health needs than heterosexuals. While there are differences among racial/ethnic groups, there are also differences within groups. For example, native-born Latinos had nearly double the rate of mental health needs of Latinos born outside of the U.S. Finally, I was also struck by the size of the gap in chronic illnesses between those with and without mental health needs. When these estimates were adjusted to control for differences in age, income, gender, and education, the gap sometimes increased. This suggests that disease onset is occurring earlier in the lifecycle for adults with mental health disorders, or despite the presence of what we often think of as protective factors, such as income and education.
Q: How are structural changes in how state mental health programs and oversight are provided likely to affect the provision of services, especially for low-income Californians?
There is a lot of change going on in mental health service delivery right now as most functions of the Department of Mental Health are being transferred to the Department of Health Care Services. Add the state’s fiscal crisis and the implementation of healthcare reform on top of this and the future is quite murky. Our data clearly show that low-income adults have significantly higher mental health needs and that the uninsured have the highest rates of unmet need. The expansion of health insurance coverage through healthcare reform should increase the proportion of adults with mental health needs who receive care, thereby reducing unmet needs. Given the uncertainty, it is important that we continue to track mental health needs, service use, comorbidities and unmet needs going forward. In that regard, the CHIS 2007 data and findings from this report provide an important benchmark to assess how well California meets the mental health needs of adults moving forward. R
Read the report: Adult Mental Health Needs in California