Mental health crisis in rural California

Special to The Sacramento Bee

One of the greatest challenges facing California is mental health care. We see it in the number of unhoused people suffering from mental illness. We see it in the abnormally high behavioral health worker vacancy rates. And we see it in the rising levels of depression and anxiety since the onset of the COVID-19 pandemic.

Consequently, the demand for robust behavioral health treatment is at an all-time high.

In rural California, where behavioral health provider availability already ranges from limited to nonexistent across large expanses of geography, the care crisis is particularly challenging. To ensure everyone in California has access to care, we need to invest in the behavioral health workforce, infrastructure and systems of the state’s rural communities.

Across rural areas, health care and behavioral health care facilities are often limited in number. This is due in part to financing restrictions that have diminished the ability of rural local governments to invest in providing the full continuum of treatment services.

Additionally, some rural areas have no community-based organizations to assist in providing behavioral health services. My county, Inyo, has a federally qualified health care center and an Indian Health Service provider in the town of Bishop. The rest of the county’s 10,000 square miles are underserved or completely unserved by a qualified health center or community-based organization.

High job vacancy rates among rural mental health care providers add to this access disparity. As of fiscal 2021, 33 rural California counties were designated as having mental health professional shortage areas.

With little behavioral health infrastructure and housing availability, the capacity to build the workforce in rural areas is limited.

This is exacerbated by high burnout and turnover rates among the small number of county behavioral health employees who are tasked with providing 24-hour crisis response on top of direct services to severely mentally ill people. In rural counties, these cases are complicated by significantly constrained placement options, sometimes requiring county staff to transport people in crisis across several hundred miles for stabilization.

To address these gaps, the Rural County Representatives of California, a coalition representing 39 rural counties, is partnering with other organizations to identify health access and behavioral health needs in underserved rural areas. One such partnership is with the County Medical Services Program, a crucial provider of health care and behavioral health care coverage to low-income adults regardless of immigration status across 35 primarily rural California counties.

To be successful in addressing these identified, state support is essential. Recent state initiatives in this area could be more effective by recognizing the recruitment and retention challenges faced by county mental health programs that struggle to provide an adequate baseline level of service.

Addressing the mental health crisis in rural communities requires strategies such as loan forgiveness programs to build the necessary behavioral health infrastructure and workforce. Targeting such investments to underserved communities can help ensure that we serve the health care needs of vulnerable people in rural communities where the need is dire.

Matt Kingsley is an Inyo County supervisor and delegate to the Rural County Representatives of California.