Comstock's magazine 1118 - November 2018 - Page 48

n Mental Health “SHAMEFUL LEGACY OF NEGLECT” It was written in capital letters, a damning headline from the 2014-15 Sacramento County Grand Jury report that blasted the county’s failure to respond to the mental health crisis at hand. The report called out the county for its lack of action, flawed budget cuts and for abandoning vulnerable residents struggling with mental health issues. In 2009, the Crisis Stabilization Unit, the coun- ty’s primary point of service for psychiatric emer- gencies, was shut down by the Board of Supervisors as a budgetary decision — one of many “troubling decisions,” the grand jury noted. Five years later, the report found, suicide rates spiked, inmates in jail with mental illness doubled, and emergency departments became flooded with people in need of services and with nowhere else to turn. This isn’t just a local issue. The country on the whole is in the throes of a mental health crisis, with anxiety, depression, the opioid epidemic and rising suicide rates. But help has been hard to find due to a dearth of mental health professionals, and experts predict this problem will get exponentially worse. “The demand for mental health care is not de- creasing,” says Adrienne Shilton, director of gov- ernment affairs for the Steinberg Institute, a non- profit in Sacramento focused on advancing public policy and inspiring leadership on issues surround- ing mental health. “With longer wait times to see a psychiatrist, people’s conditions can deteriorate, which is more costly in the long run. We’re talking about people’s lives at stake here. If current trends continue, we see access issues continuing.” A GROWING PROBLEM A seminal 2017 report by the National Council for Behavioral Health estimates that “demand for psy- chiatry will outstrip supply by 15,600 psychiatrists, or 25 percent in 2025.” According to the council’s report, 55 percent of U.S. counties have no psychi- atrists and 77 percent have a shortage of practicing clinicians. The shortages are mirrored in Califor- nia, where 23 counties, mostly in rural Northern California, have fewer than one psychiatrist per 10,000 residents, and six counties have no psychia- 48 | November 2018 trist at all, according to a Sacramento Bee analysis of California Medical Board records. Sacramento County, by comparison, had 2.2 psychiatrists per 10,000 residents. Shilton attributes the shortage to several key factors, including not enough being done to recruit and train professional replacements as the ba- by-boom generation hits retirement age. In addition, she says, most licensed profession- als choose to work in urban hubs instead of rural areas, creating an unevenly distributed workforce. California also has struggled to recruit licensed professionals who reflect the state’s racial and eth- nic diversity, which may keep members from un- derrepresented groups from seeking help. Out of 333 active psychiatrists in the Sacramento area, 40 percent are white and only 5 percent are Latino, black or African American, according to a 2018 re- port from the Healthforce Center at UCSF. (Those who chose not to report their ethnicity made up the second-largest segment, at 29 percent.) In Sacramento County, the overall rate of men- tal health-related emergency department visits is 80 percent higher than the state rate, according to a 2016 study commissioned by the Sierra Health Foun- dation. Within the 15 ZIP codes predetermined to have the greatest levels of socioeconomic disparity, African Americans have the highest rates of mental health-related visits to the ER in nine — and more than 50 percent of the county rate in 13. Some Latinos and Filipinos who suffer from ma- jor depression don’t know they have it, says Dr. Ser- gio Aguilar-Gaxiola, director of the UC Davis Center for Reducing Health Disparities and co-chair of the California Future Health Workforce Commission’s Behavioral Health subcommittee. Many of them, he adds, can’t afford to skip work to see a therapist. Others confuse symptoms with physical ailments, which doctors might dismiss if they haven’t been trained to identify mental health issues. Aguilar-Gaxiola, a member of the Prep Médico Advisory Committee (a residential program for col- lege students interested in becoming physicians) helped create a program at UC Davis for Latino un- dergrad students. He advocates for recruitment in