A Snapshot of Mental Health and Access to Care Among Nonelderly Adults in California


The COVID-19 pandemic has coincided with worsening mental health throughout the nation, and California isn’t any exception. For this information notice, we analyzed information from the California Well being Interview Survey (CHIS), which asks noninstitutionalized adults detailed questions on psychological well being and substance use, to additional study the influence of the pandemic on psychological well being within the state.

The pandemic comes on the heels of an already worsening psychological well being and substance use disaster in California. As proven in Determine 1, a rising share of nonelderly adults have reported previous 12 months critical psychological misery over time in California, up from 9% in 2016 to fifteen% in 2020. Substance use points have additionally worsened – drug overdose deaths elevated over 40% from 2019 to 2020 in California.

Throughout the pandemic, critical psychological misery was extra pronounced amongst some communities, together with girls and low-income adults in California. As proven in Determine 2, girls in California (16%) have been extra possible than males (13%) to expertise critical psychological misery in 2020. Usually, women have extra usually reported poor psychological well being in comparison with their male counterparts each earlier than and in the course of the pandemic. In California, lower-income adults have been extra prone to expertise critical psychological misery (19% for incomes between 0 and 138% FPL; 17% for incomes between 139 and 249% FPL; and 15% for incomes between 250 and 399% FPL) than high-income adults (11%) in 2020 (Determine 2). A current survey of nonelderly grownup Californians who noticed a well being care supplier previously 12 months additionally discovered that low-income people have been extra possible than higher-income people to report worsening psychological well being in the course of the pandemic. Individually, in comparison with White adults in California (15%), some communities of shade – together with Asian (12%) and Black (11%) adults – have been much less prone to report experiencing critical psychological misery in 2020 (Determine 2). Critical psychological misery amongst Hispanic adults (15%) was much like White adults (Determine 2). Different KFF analyses discovered that, nationally, mental health and substance use concerns have been exacerbated amongst many individuals of shade all through the pandemic. Research has additionally proven that stigma – together with stereotypes and discrimination – round psychological well being issues is extra pronounced amongst communities of shade, maybe affecting self-reporting of psychological well being and entry to care. Moreover, a survey of adults in California discovered that amongst nonelderly people with psychological well being wants, folks of shade have been much less possible than White folks to obtain care.

In 2020, poor psychological well being outcomes amongst nonelderly adults different drastically throughout counties in California. As proven within the map under, the share of nonelderly adults with previous 12 months critical psychological misery ranged from 9% to twenty-eight% throughout counties in 2020; highest in some Central Valley counties (Colusa/Glenn/Tehama, 28.3%; Butte, 26.9%; Merced, 24.2%) and lowest in Bay Space counties (San Francisco, 9.1%; Marin, 9.5%; Contra Costa, 9.6%). The share of nonelderly adults who ever had ideas of suicide ranged from 8% to 34% throughout counties in 2020; highest in northern counties (Del Norte/Lassen/Modoc/Plumas/Sierra/Siskiyou, 34.3%; Butte, 29.7%; Mendocino, 29.2%) and lowest in some southern and jap counties (El Dorado, 8.1%; Imperial, 8.8%; Placer, 9.3%).

Practically nine in ten nonelderly adults in California have insurance coverage protection to assist them entry and canopy the price of well being care, together with psychological well being providers. In recent times and in response to the pandemic, the state has launched a number of coverage measures to extend entry to psychological well being and substance use providers; many of those efforts leverage insurance coverage protection by way of Medi-Cal (the state’s Medicaid program), which covers 20% of nonelderly adults, or non-public protection, which covers 67%.

Throughout insurance coverage varieties, giant shares of nonelderly adults reported poor psychological well being outcomes in 2020. Medi-Cal enrollees have been considerably extra possible than non-public insurance coverage enrollees to expertise previous 12 months critical psychological misery in 2020 (18% vs. 11%, respectively) (Determine 4), maybe reflecting Medi-Cal protection of many individuals with disabling well being situations together with critical psychological sickness and/or many low-income people who could also be extra prone to report poor mental health. Many nonelderly adults additionally reported ideas of suicide in 2020: 14% amongst Medi-Cal enrollees and 13% amongst non-public insurance coverage enrollees (information was not statistically completely different).

Many insured adults in California reported boundaries to look after psychological well being and substance use providers in 2020. Twenty 4 p.c of nonelderly adults in California reported needing assist for psychological well being or substance use points previously 12 months (Desk 1). Amongst nonelderly adults with psychological well being or substance use wants, the share who obtained therapy previously 12 months was related throughout plan kind (60% of Medi-Cal enrollees and 55% of personal insurance coverage enrollees) (Desk 1). Medi-Cal enrollees who obtained therapy reported the next common variety of visits to knowledgeable previously 12 months in comparison with their privately insured counterparts (18 visits vs. 11 visits).

Many Medi-Cal (40%) and personal insurance coverage (45%) enrollees with psychological well being or substance use wants didn’t obtain therapy. Giant shares of insured adults who didn’t obtain therapy cited issues about prices (54% of Medi-Cal enrollees and 49% of personal insurance coverage enrollees) and difficulties scheduling an appointment (30% of Medi-Cal enrollees and 20% of personal insurance coverage enrollees) as boundaries. With the pandemic and accompanying financial recession, many adults have confronted financial hardship and have had issue paying for standard bills. This can be linked to the excessive shares of adults citing issues over prices as a barrier for accessing psychological well being or substance use therapy – even for Medi-Cal enrollees, who’ve very low or no out-of-pocket prices for these providers. Scheduling difficulties as a barrier to accessing psychological well being or substance use providers might mirror an inadequate availability of suppliers.

All Nonelderly Adults Medi-Cal Enrollees Personal Insurance coverage Enrollees
Share of Nonelderly Adults with Psychological Well being or Substance Use Wants 24.3% 23.2% 23.8%
   Share that Acquired Therapy 53.8% 59.6% 54.8%

Common Variety of Visits to a Skilled

13 18* 11*
   Share that Did Not Obtain Therapy 46.2% 40.4% 45.2%

Did Not Obtain Care On account of Issues About Prices^

57.2% 53.9% 49.1%

Did Not Obtain Care On account of Issue Scheduling an Appointment^

23.0% 30.2% 19.9%
*Signifies statistically vital distinction between Medi-Cal and personal insurance coverage enrollees.
^Respondents have been in a position to choose from a number of causes relating to not accessing wanted psychological well being or substance use providers.
NOTES: Nonelderly adults refers to adults ages 18 to 64. Medi-Cal enrollees refers to enrollees with solely Medi-Cal protection for the previous 12 months. Personal insurance coverage enrollees refers to enrollees with solely non-public insurance coverage (by way of employer plans or privately bought) for the previous 12 months.
SOURCE: KFF evaluation of California Well being Interview Survey (CHIS) Grownup Information Information, 2020.

 The pandemic highlights points with accessing psychological well being and substance use care throughout California. California continues to face shortages of psychological well being suppliers. In gentle of pandemic-related precautions and restrictions, accessing providers for well being care, together with psychological well being or substance use care, has been difficult nationally. In response, measures, together with the short-term public well being emergency, have allowed many suppliers to supply care by way of telehealth. Throughout the state of California, entry to psychological well being care can even differ drastically. Particularly, for Medi-Cal enrollees, entry can differ extensively from county to county and navigating care could be significantly difficult for enrollees with co-occurring critical psychological well being and bodily well being wants.

In response to psychological well being and substance use wants in California in the course of the pandemic, a number of coverage actions have been taken to extend and standardize entry to care. Senate Bill 855 addresses gaps in present psychological well being parity legal guidelines by requiring insurers to broaden protection to a broader vary of psychological well being and substance use problems (aside from Medi-Cal). Assembly Bill 2265 will permit for funds from the Mental Health Services Act, sometimes reserved for psychological well being providers solely, for use for substance use providers as properly amongst folks with co-occurring psychological well being and substance use points. Moreover, by way of Senate Bill 803, Medi-Cal psychological well being and substance use providers will broaden to incorporate peer support specialists. In California’s current state price range proposal, funds have been allotted for dyadic care – permitting for behavioral well being providers for fogeys to be integrated into pediatric well being care visits amongst Medi-Cal beneficiaries. California’s renewal functions for Section 1115 and 1915(b) waivers, generally known as California Advancing and Innovating Medi-Cal (CalAIM), have been additionally lately permitted. CalAIM builds on the state’s Medi-Cal 2020 Entire Particular person Care pilot program to coordinate and combine bodily well being, behavioral well being, and social providers for Medicaid enrollees with complicated wants. Along with transitioning these providers to the state’s managed care system, CalAIM contains behavioral health initiatives to deal with the division of providers between county-level psychological well being plans and managed care plans, and to standardize entry to providers for enrollees with critical psychological well being wants. Personal insurers have additionally taken steps to deal with psychological well being and substance use care. Nationally, some plans expanded coverage to incorporate psychological well being or substance use providers accessed by way of telehealth and plenty of employer sponsored plans made modifications resembling waiving or lowering cost-sharing and growing protection for out-of-network providers. Individually, California has taken steps to fund the statewide launch of 988, a psychological well being disaster hotline.

Wanting forward, additional analysis on entry to care and utilization of psychological well being providers will likely be informative as state policymakers, directors, and well being care suppliers proceed to debate the right way to tackle psychological well being and substance use wants amongst Californians.

This work was supported partly by Nicely Being Belief. We worth our funders. KFF maintains full editorial management over all of its coverage evaluation, polling, and journalism actions.

This evaluation makes use of the 2020 California Well being Interview Survey (CHIS) Grownup Information Information, which surveys noninstitutionalized people. We narrowed our evaluation to nonelderly adults, ages 18 to 64. In 2019, CHIS carried out a redesign of the survey. The redesign affected illustration of various teams within the pattern body. Due to this fact, some demographic degree information should not reported on this evaluation; for instance, demographic breakouts by kind of insurance coverage is excluded.

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