Exploring low-income Californians’ needs and preferences for behavioral health care

Nearly 70 years ago, world health leaders from 61 nations recognized that “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” They understood then, and we – as human beings – have always been acutely aware, that the mind and body are inextricably connected. Unfortunately, the American healthcare system has only recently begun to acknowledge this reality.

Historically, behavioral and primary care systems operated and were funded independently. Support for mental health and substance use treatment was largely unavailable for low-income patients, creating a significant unmet need due to coverage limitations and high out-of-pocket costs. Thankfully, we are now experiencing a major expansion of behavioral health benefits, especially for those newly enrolled in Medi-Cal under the Affordable Care Act. Although affordability has improved and demand for services is on the rise, provider shortages and siloed systems remain.

In order to inform the continued transformation and integration of behavioral healthcare, we solicited the views of low-income Californians to understand their preferences, aspirations, and concerns. We know that these low-income residents not only experience a higher prevalence of mental health and substance use challenges, many face additional language and cultural barriers that prevent them from seeking needed support and services. Their voices are critical to guide the field forward.

The Foundation commissioned this research to help fuel the evolving conversation about behavioral health and its implications for California’s safety net providers and patients. Building upon a series of surveys that began in 2011, this report reinforces the need to connect and simplify the systems that serve vulnerable patients. For example, its findings show us that patients prefer behavioral health services to be available in the same setting as their primary care, but many are not yet able to access services on-site. Throughout the report we see clear tensions that need to be addressed.

This research represents an important contribution to the broader dialogue taking place around health care generally, and behavioral health specifically. We look forward to continuing the discussion, and to our collective, ongoing work to improve the lives of all Californians.