Mental health services lacking in poorer areas, study says

kcarlson@modbee.comJuly 20, 2013 

20081105 Teen suicide

Val B. Mina/The Sacramento Bee


    alternate textKen Carlson
    Title: Staff writer
    Coverage areas: County government, health and medicine, air quality, the environment and public pension systems
    Bio: Ken Carlson has worked 13 years for The Bee, covering local government agencies in Stanislaus and San Joaquin counties. His in-depth reporting has focused on access to health care and public employee pensions.
    Recent stories written by Ken

Mental illness is more prevalent in poverty-stricken counties in California, according to a newly released study.

And those counties often are short on psychiatrists needed to diagnose and treat mental disorders. The California Healthcare Foundation study paints a picture of mental illness across the state and an uneven system of psychiatric care.

In Stanislaus County, where 20 percent of residents live in poverty, about 5 percent of adults have serious mental illness and there are 6.6 psychiatrists per 100,000 people. In the Bay Area, far more affluent Santa Clara County has a 3 percent adult mental illness rate and almost four times the number of psychiatrists per capita.

In Merced County, serious mental disorders affect 5 percent of adults and the county has only 2.3 psychiatrists per 100,000 residents. San Joaquin has a 4.7 percent adult mental illness rate and 7.6 psychiatrists per 100,000.

A serious mental illness, a categorization for adults age 18 and older, is "any mental illness that results in substantial impairment when carrying out major life activities," according to the health care foundation.

People who live in poverty are more vulnerable to mental disorders, and those who are disabled by depression or other disorders often move to less affluent counties for the lower cost of living, said Neal Adams, a study author and deputy director of the California Institute for Mental Health.

Adams said mental health professionals gravitate to urban areas "because of the nature of people who are attracted to psychiatry. We have seen smaller counties offering higher salaries to lure psychiatrists, and it has worked to some extent."

Joyce Plis, a leader with the National Alliance on Mental Illness in Stanislaus County, said a psychiatrist who did excellent work treating her adult son moved to Palm Springs. "He wanted a better school for his children and less crime and a nice neighborhood," Plis said.

In California, counties shoulder most of the responsibility for providing mental health services for low-income residents, and there is variance in access and service levels, the study said.

Twenty-five counties have no inpatient psychiatric facilities. Stanislaus has a 67-bed behavioral health center for adults on Claus Road in Modesto, but no facilities for children. The spending per client in this county was less than the state average of $4,856 in 2011, the study said.

"We found a big variation among counties in terms of the average number of people getting services and the average amounts spent on clients," said Sandra Shewry, director of state health policy for the health care foundation.

In other key findings, the report said:

• Almost half of adults and two-thirds of adolescents with mental conditions did not get the treatment they needed.

• California's suicide rate of 10.3 per 100,000 population was lower than the national rate from 2008 to 2010.

• The San Joaquin Valley's suicide rate was 9.1 per 100,000 residents, lower than the statewide rate.

Adams described the study as a mental health almanac to provide comprehensive information for policymakers.

He suggested the abundant number of marriage and family therapists in California could be used to fill gaps in care. Those therapists are able to provide certain services but are unable to bill the Medicare program or Medi-Cal.

"Geographic disparities are a real concern," Adams said. "Obviously, we have a ways to go to make sure Californians have equal access to mental health services."

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Bee staff writer Ken Carlson can be reached at or (209) 578-2321.

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