Mental Health Service Gaps

Mental Health America shared key findings in their 2017 report of the state of mental health in America. Previous surveys conducted by the World Health Organization and policy researchers have noted there is a large sector of people with unmet mental health needs. As shown in the infographic below, 56% of Americans don’t have access to mental health services. In the state of Vermont which has the best access to services, 43% of adults with mental illness were not treated sufficiently. The survey reveals the rates of severe depression amongst youth have increased 2.6% between 2011 to 2014, yet 80% of the population did not receive sufficient treatment. This problem of inadequate access is exacerbated by the shortage of mental health professionals to provide services.

In the state of California, 2013 demographic study by California Health Foundation, shows higher rates of mental illness in areas of lower income and for Native American, multinational and African American populations. The distribution of spending on mental health care in the US has changed dramatically over the last 20 years, with inpatient and residential care spending decreasing, and outpatient care and prescription drug spending increasing.



Nearly 1 in 6 California adults has a mental health need. 1 in 20 has a serious mental illness which affects their daily activities.  The rate among children is even higher: 1 in 13 suffers from a mental illness that limits participation.  There is not enough data to understand individual disorders, statewide costs or quality of care.

In California, about 16% of the adult population — more than 4 million people — have mental health care needs. For those with disabling conditions who do not have private health insurance, publicly funded programs are their primary, if not only, source of mental health care.

Key findings in the California Health Foundation study are listed below:

  • Public spending on mental health services in California for Fiscal Year (FY) 2012–13 was estimated to be $7.76 billion, of which $3.34 billion was for Medi-Cal (California’s Medicaid program) beneficiaries. As the most populous state, California ranked first in the US for total spending on public mental health services but 15th for per capita spending in 2010.
  • For people with severe mental illness, the California public mental health system offers rehabilitative, recovery-focused care. However, many Medi-Cal beneficiaries and uninsured adults with less-severe mental health conditions face significant gaps in coverage and in access to services.
  • State laws shape California’s public mental health delivery structure, but nearly all financial and administrative responsibility for delivering these services rests on counties. This decentralization has resulted in wide variation in program operations, quality, and service availability.
  • As in many other states, funding for California’s public mental health system is “carved out,” or disconnected, from the rest of public health care system funding. As a result, people with mental health needs often must navigate two systems for care.

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Nga Cao is a 1st year MSW intern at the Painted Brain




Originally published in Painted Brain website:

“We who struggle with these disorders can lead full, happy, productive lives if we have the right resources.”

So said Elyn Saks, schizophrenia survivor, author, mental health advocate, MacArthur Fellow, and Law Professor at the USC Gould School of Law.

Holistic Mental Health Defined

According to the World Health Organization and the National Institute of Mental Health, access to the social determinants of health are far more important to mental health than access to health care alone. These social determinants include:

  1. affordable housing,
  2. reasonable access to educational opportunities
  3. reasonable access to job opportunities
  4. community inclusion — a feeling of acceptance within a larger peer group or community.

As crucial as quality mental health care is to recovery and daily management of symptoms, without these in place. what is otherwise high-quality mental health care will only go so far.

First, there is the social stigma.

Battling a mental illness is a challenge in itself. Then there is added social stigma, which in Psychology Today was defined as “characterized by prejudicial attitudes and discriminating behavior directed towards individuals with mental health problems as a result of the psychiatric label they have been given.

Then there is self-stigma

This is the most dangerous force in a person’s mental health recovery.

“Self-stigma causes the sufferer to consciously or subconsciously perceive themselves, or their illness in the prejudiced way society does.” This leads to loss of self-confidence, low-self esteem, poor self-efficacy, and self-isolation.

~Why Self-Stigma is the Most Dangerous Pitfall when Battling Mental Illness

Worst of all, it prevents the sufferer from seeking treatment or reaching out to others. It is not all too different (not to use an extreme example) in some ways to forced solitary confinement in prisons. In this case, it is self-imposed. It is common knowledge that extended social isolation can deteriorate a person’s mental health, even among those who do not have a diagnosis of mental illness.


The Vicious Cycle – Denial, Isolation, Loss


Too often, psychiatric hospitals, inpatient or outpatient clinics, assisted-living facilities, and many, many treatment centers meant to address problems like depression and suicide  fail to take into account the wider, social forces affecting a person’s mental health. Isolation is one of them.


Isolation is often a result of the brutal combination that comes out of the very distressing nature of mental illness itself with the added “lash” of self-stigma.


Isolation is the most pressing issue in young adults’ mental health.


People with mental illness have a harder time finding good jobs or safe housing. Out of almost 1500 respondents to one survey, HALF of them stated they would not socialize, work with, or have a family member marry someone with a mental illness.


A person who has just been discharged from a psychiatric hospital or released from the streets or jail needs more than a roof over their head. Meaningful activities, meaningful inclusion, and acceptance within a peer group or community, decent opportunities to get education and training; these are every bit as important as quality health care; and too often absent. Absent a path to reintegration, relapses become too common.


Self-stigma, social stigma, and isolation become a vicious cycle.

Meanwhile, the chances for jail recidivism, repeat hospitalizations, suicides, and the economic plus human toll of depression (on the individual and their families) only continues to mount, not decrease. Despite the rising numbers of people taking antidepressants and more attention given to mental health prevention, the core problem remains unsolved.

“Mental Illness is a Social Problem.

Art Brings People Together.

Change Begins with Simple Ideas.”

~Dave Leon, Founder and Executive Director, Painted Brain

The idea of infusing art, skills training, and peer-led art projects into mental health is for many in the mental health care profession, new unchartered territory, and that is about to change.

In fact, it is already changing. Art serves as an excellent addition, a compliment, to standard treatment programs. Art is being increasingly recognized (through academic studies and healthcare institutions) as a universal form of expression that can heal. Art is also a catalyst that brings people together, and art is a glue that builds community.

“There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life….We who struggle with these disorders can lead full, happy, productive lives if we have the right resources.” ~ Elyn Saks.