An unsettling picture

Nearly 1 in 6 adults in California has a mental-health need, yet only half of those individuals get treatment. That is one significant finding among many in a recently released report from the California HealthCare Foundation (CHCF) examining how behavioral-health care gets delivered statewide.

The report, titled “Mental Health Care in California: Painting a Picture,” reveals that 1 in 20 adults has a serious mental illness—defined as a condition severe enough to impact normal daily activity—with an even higher rate among children (1 in 13).

Equally troubling is the rate of young people with mental-health needs not receiving treatment; nearly two-thirds of adolescents with mental-health needs don’t get help.

Other findings include:

• The prevalence of serious mental illness varies by income level and ethnicity. Rates of mental illness are higher among low-income individuals, Native Americans, African-Americans and multiracial individuals.

• California has a lower suicide rate than the national average, but incidences vary widely throughout the state. For instance, counties in the Northern and Sierra region have recorded double the state’s overall average number of suicides.

• Spending on mental-health care has changed dramatically over the past two decades, with less money spent on in-patient and residential care and more spent on outpatient care and prescription drugs.

The CHCF released a set of informational graphics titled “Mapping the Gaps: Mental Health in California” to accompany its study. These maps compare counties in terms of income levels, mental-illness rates and number of psychiatrists. According to this data, Butte County has relatively high rates of serious mental illness (5.1 percent) and poverty (20.9 percent) in the state context, falling roughly in the middle of the spectrum for number of psychiatric doctors.

Those numbers may be a bit misleading, said Anne Robin, director of the Butte County Department of Behavioral Health. She suggested the county’s rate of serious mental illness may rank so high because residents here are more likely to seek treatment than people in neighboring counties, due to the range of services available.

And though Butte County’s count of 8.6 psychiatrists per 100,000 residents is roughly average for the state, that figure includes psychiatrists who practice only part-time.

“We’re still considered a mental-health [care] shortage area [by the federal government],” Robin said. “It’s recognized statewide that there aren’t enough psychiatrists out there, and then to get them to come to the North State, we can’t compete with some of the pay ranges that they might have in urban areas.”

As a result, she said, the county’s Behavioral Health practitioners, rural clinics and private-practice psychiatrists all tend to have waiting lists for new patients, and the county has begun using telemedicine with psychiatrists from out of the area. There’s also a crunch for beds in the local inpatient psychiatric units—the county’s facility has 16 beds, while Enloe Medical Center’s 30 beds also accommodate patients from outside Butte County.

The need for mental-health services was also acknowledged by the 2013 Community Health Needs Assessment, conducted by Enloe in conjunction with Butte County Public Health, Feather River Hospital and Biggs-Gridley Memorial Hospital.

Deanna Reed, Enloe’s community-outreach coordinator, compiled the results of the countywide survey, which drew 1,322 respondents total. Around 1,200 answered the question asking how often they felt sad, blue or depressed. Thirty-six percent responded “sometimes,” 5 percent said “often,” and 1 percent “always.” (“Seldom” was the highest answer, at 49 percent, while 18 percent said “never.”)

Meanwhile, of the 1,100 who responded to the question about whether they’d ever considered suicide, 9 percent said yes. That may not seem like a large proportion, but if it holds true across the county (which has nearly a quarter of a million residents), that rate represents a large number of people.

Recognizing the symptoms of mental illness requires a trained eye, and in an area where psychiatrists are booked solid, primary-care doctors become the front line of behavioral health.

Dr. Scott Nichols, medical director of Enloe Behavioral Health, is working to expand his department’s reach to include not just the inpatient unit but also consultation on outpatient cases. His hope is primary-care physicians would refer complex cases to Enloe Behavioral Health, where psychiatrists could prioritize cases based on the severity of a patient’s condition.

“People get to this point where they can’t function,” Nichols said, emphasizing the importance of properly diagnosing such individuals, who often feel “a sense of hopelessness.”

“What I think would be really helpful in Butte County would be a place to make these diagnoses and get people to the right place,” he said.

The county, meanwhile, is bracing for an influx of new patients who will become eligible for Medi-Cal and private coverage under federal health-care reform legislation.

The challenge, Robin said, is “how [to] build up the entire community-provider network for psychotherapy, for substance-abuse disorder treatment, for all those things for all the levels of insurance that are going to be accessible to more people in the community. Frankly, it’s a little daunting.

“We’re going to hopefully be able to find more folks who are able to provide the treatment at the level [of coverage] the insurers are going to be willing to provide.”

Nichols, for one, is optimistic that will happen, thanks to the quality of psychotherapists and other professionals in the Chico area.

“I don’t think anybody in any county in the United States would say there are enough [mental-health providers],” he said. “[But] I do think that we have some great resources here. … The present and the future look promising.”