As mental health needs increase for all Californians, low-income adults continue to experience distress at higher rates than middle- and high-income adults. In 2021, nearly 20% of low-income adults reported serious psychological distress in California, compared to about 14% of higher-income adults. For low-income undocumented adults in California, finding help to cope with trauma can also mean working around barriers to care.
State leaders are prioritizing health care equity through efforts including expanding Medi-Cal to all low-income residents, regardless of age or immigration status. This policy will take effect in January 2024 and will provide comprehensive coverage, including for mental health services, to the largest demographic of uninsured residents, all adults ages 26 to 49.
Undocumented immigrants have experienced high rates of trauma, according to experts we interviewed in Los Angeles County. This trauma can be linked to domestic violence, migration experience and war in countries of origin. Community health centers—clinics that many immigrants, including many undocumented immigrants, identify as their usual source of care– address the growing need for mental health services among undocumented patients. For example, a clinic in Los Angeles County bases its care on psychoeducation: it teaches patients about their mental health problems and provides them with information and resources to treat their problems. Another Los Angeles clinic provides application assistance for safety net programs as struggling patients forgo safety net benefits that would improve their well-being and reduce stress.
Although community health centers are an essential source of care, their efforts face certain challenges. In some clinics of a next PPIC study, the wait time to receive mental health services is approximately two to three months. Clinics may struggle to recruit bilingual and multilingual social workers proficient enough to conduct therapy in the patient’s native language.
It can also be difficult to convince patients to sign up for the mental health services they need, due to stigma, lack of medical coverage, and misinformation related to these services. In 2021, approximately 15.3% of low-income noncitizens experienced serious psychological distress, but only 8.2% saw a mental health provider in California. Low-income patients who are citizens experienced distress at rates similar to those they experienced when seeing a mental health provider.
Access to mental health services is further complicated by lack of providers in some parts of the state. Additionally, immigrants with limited English proficiency may have worst experiences trying to schedule mental health visits.
California has taken big steps in recent years to close health equity gaps and improve access, including fund a system to transform how Medi-Cal makes payments to primary care clinics. By learning from community health centers that already work with undocumented patients and providing additional resources, such as to hire more bilingual or multilingual staff, policymakers and advocates can strengthen policy and advocacy efforts to prepare for a increased enrollment with January Medi-Cal expansion. Stay tuned to our upcoming report on this topic and other information on the health needs of low-income adults statewide and the role of California’s community health centers.
