The Blue Shield of California Foundation just released the results of a recent survey report by Langer Research Associates that highlights the behavioral health experiences, needs, and attitudes of Californians with low incomes. The main findings are that many Californians with lower incomes are not receiving needed behavioral health services, and that many prefer to receive behavior health services either from their primary care providers, or from a counselor located in the same facility as their primary care provider.
The Affordable Care Act (ACA) offers new insurance coverage that holds the potential to provide many people critical access to behavioral health services. The report cites a study that suggests that in California around 300,000 people will newly access mental health care, and 200,000 will newly access substance use disorder services through the ACA coverage expansions.
The report shows that, for Californians with low incomes, roughly three in ten felt a need to speak with a health care professional about behavioral health issues. In fact, Californians with incomes below $16,000 were most likely to say that they had a need for behavioral health services. However, only half of individuals who reported a need for these services actually received them. That share is simply too low.
At the same time, many respondents offered some clues about why they did not receive needed services, and what would make them more likely to use these often-stigmatized services. As you can see in the figure below, large majorities of this group felt that having access to both mental health and substance use disorder (SUD) services at their primary care facility was very important. Yet, half or fewer said that these services were available in that location. The same pattern was true for team-based care that included behavioral health services, referrals to social services, and health navigators.
The survey findings suggest that having co-located physical and behavioral health care providers increases access to behavioral health services. Importantly, among those who said that they needed behavioral health services but did not receive them, 6 in 10 said that they did not know whom to speak to about it. Yet, individuals who said that a counselor was located within their primary care facilities were two times as likely as other respondents to have spoken with a provider about behavioral health issues.
Of those who said that they needed to talk to a health care provider about behavioral health issues in the previous year, 6 in 10 of those who had on-site counseling available received the service, while the share was around one third for those who did not have that option.
These results suggest that the competency of primary care practitioners in sensitively engaging their patients about behavioral health needs can have a considerable impact on access to behavioral health services for people with lower incomes. Moreover, having integrated care teams can effectively link individuals to the right professionals at the right time, and California’s health policies and coverage programs should prioritize these models to improve the health and wellbeing of people with low incomes.