Inland Region has Fewer Mental Health Professionals than Most Counties in the State
S. E. Williams
In the wake of last week’s mass shooting at a high school in Florida by a mentally troubled teenager, the nation has once again cried out for increased gun control while also focusing on funding mental health services to ensure they are available for those in need.
Nearly half of Americans recently polled believed failures to identify people with mental health issues was the primary cause of gun violence. They also stressed that if the country could only address issues related to mental health, such tragedies like the one that occurred in Florida last week would be deterred. However, data has shown otherwise.
A 2016 report by the American Psychiatric Association analyzed data from 235 gun-related mass killings and found only 22 percent of the perpetrators could be identified as mentally ill. In other words, in America, “mass shootings by people with serious mental illness represented only one percent of all gun homicides each year.”
Yet it is the ever-present threat posed by that one percent that strikes fear in the hearts and minds of Americans—especially when that one percent has unabated access to high-powered weapons and ammunition. In addition, gun violence experts agree that preventing sales to people determined “dangerous” by mental health professionals could help prevent mass shootings.
One in six adults suffers from mental illness and one in fourteen children has a serious emotional disturbance. Grappling with issues related to mental health has touched a large swath of American families, including many here in the inland region.
In recent years, although citizens have enjoyed substantially increased access to public and private insurance coverage for behavioral health services, increased health care insurance coverage has not resulted in increased care—many residents with mental health or substance abuse issues do not receive the treatment they need.
The important roles mental health professionals play in their clients’ ability to live healthy lives are well documented, but a report by the Healthforce Center at the University of California, San Francisco, titled “California’s Current and Future Behavioral Health Workforce,” recently highlighted that when ratios of behavioral healthcare professionals to population across the state of California are considered, “the lowest ratios persist in the Inland Empire and San Joaquin Valley.”
Until politicians can break the stranglehold the National Rifle Association has on their ability to pass any meaningful gun legislation, currently supported by a majority of Americans, the nation and the inland region’s best hope of mitigating risks associated with gun violence may lie in their ability to ensure a more meaningful and constructive approach to mental healthcare.
That effort, which began with increased access to healthcare coverage provided under the Affordable Care Act, must now extend to increased access to mental healthcare professionals—an area where California, especially the inland region, is far behind the curve.
The Inland Empire, like the rest of the state, in addition to needing more resources in this regard, also needs an adequate supply of behavioral health workers who reflect the demographic characteristics of their population. The report noted that African-Americans and Latinos are underrepresented among psychiatrists and psychologists relative to state and local populations and Latinos are underrepresented among counselors and clinical social workers as well.
The study also revealed that 45 percent of the state’s psychiatrists and 37 percent of psychologists are over 60 years of age and are likely to retire or reduce their work hours within the next decade.
The report stressed, “If current trends continue, California will have 41 percent fewer psychiatrists than needed and 11 percent fewer psychologists, licensed marriage and family therapists, licensed professional clinical counselors and licensed clinical social workers,” than required in the coming years.
Associate Professor of Health Policy at UCSF, and co-author of the report, Janet Coffman stressed the need to make investments to meet future demand in this regard. “Even though most of us are working longer than ever before,” she stressed. “When folks get into their 60s or their 70s, even if they don’t retire, they often reduce their work hours. So, we’re really in California needing to think, how can we substitute for these folks?”
She even pondered the possibility of a team approach to care where psychiatrists could operate as a coach and consultant to primary care doctors. Regardless of the stop-gap measures considered, Coffman stressed the need for increased psychiatrists in the state.
This report was in addition to information reported in 2017, which also stressed the lack of access to behavioral health providers, primary care physicians, and other health professionals, in addition to the devastating impact these shortages can have on residents’ health.
Last year, reports stressed the Inland Empire was one of the two largest and fastest-growing regions in the state whose ratio of primary care doctors was far below national standards. The Inland Empire had only 42 percent of the primary care doctors recommended by the Council on Graduate Medical Education.
In August 2017, the state’s Future Health Workforce Commission, comprised of leaders from across the health and education sectors, joined and began work on a blueprint to ensure California’s workforce is ready to meet the population’s current and future health needs. This 15-month effort represents the first time top statewide leaders have coordinated efforts to address this issue.
Janet Napolitano, President of the University of California and co-chair of the commission, said, “Now is the time to craft a blueprint that will help guide policymakers, healthcare educators, providers, and other state and community leaders in implementing a sustainable and forward-looking strategy that ensures all Californians have access to high-quality health care.”
The commission defined its charter as the need “to develop a master plan for California to heal the gap between the health landscape that exists today and one that works for future generations, while simultaneously creating thousands of jobs in the sector.”
The outcome of the commission’s research and recommendations will be released later this year. Hopefully, the final plan will promote solutions to address both current and projected future gaps in the healthcare workforce.
In the meantime, inland officials are not waiting for solutions. In 2016, University of California-Riverside School of Medicine welcomed its inaugural class of Internal Medicine residents and in July 2017 welcomed 61 new residents along with five new programs including Family Medicine, Emergency Medicine, OB/GYN, Transitional Year, and Neurology.
Last week, the San Bernardino County Board of Supervisors approved a Memoranda of Understanding with the Inland Empire Health Plan and Molina Healthcare of California Partner Plan, Inc. for the coordination of benefits with Medi-Cal Mental Health Managed Care Plans and Substance Use Disorder and Recovery Services for Medi-Cal eligible individuals. The Memoranda will remain in effect through December 31, 2020.
California’s Current and Future Behavioral Health Workforce report noted, “California had over 80,000 licensed behavioral health professionals in 2016, that were not distributed evenly across the state”. The report stressed that the state will need to make substantial investments to meet future demands for behavioral health professionals.
In addition, the report highlighted the need to improve the geographic distribution of the behavioral health workforce and training programs in behavioral health fields, as well the need to increase racial/ethnic diversity in alignment with the state’s changing demographics. At the same time, the report stressed the need to encourage a greater percentage of males into these professions.
As the nation continues to grapple with the urgent need to change laws in order to curtail repeated gun violence in the nation’s schools—whether random shootings in urban areas or mass shootings in rural communities—a renewed commitment to grapple with issues associated with mental health is a noble and necessary place to start.