Golden State Crisis:
Half of Californians Who Need Mental Health Services Are Not Getting Treatment
With ongoing national debate focusing heavily on the Affordable Care Act and
access to medical care for all Americans, the topic of mental health is getting
lost in the dialogue. Consider this: if a life-threatening virus outbreak were
to suddenly infect 20 percent of our population, the response from the medical
community and everyday citizens to mitigate the threat would be far-reaching
and immediate. So why is so little attention paid to mental health issues which
directly impact one in every five Americans?
In California, the incidence of mental health issues closely mirrors the national
experience. Nearly 1 in 6 adults has a mental health need in the state, and
approximately 1 in 20 suffers from a serious mental illness.1 The rate among
children is even higher: 1 in 13 suffers from a mental illness that limits
participation in daily activities. This translates to over one million adults
who live with serious mental illness, and almost half a million children with
serious mental health conditions.2 Even more alarming is the fact that about
half of adults and two-thirds of adolescents with mental health needs in California
do not get treatment.3
Research published within the mental health community has examined the reasons
why people avoid seeking help for mental health problems, showing there are
significant barriers.4 The most prevalent factor is social stigma: fear others
will view a person negatively if he or she seeks help. There is also the fear
of sharing one’s emotions with someone outside the family and friends
circle. Additionally, some cultural or ethnic backgrounds can be less open
to therapy and the notion of “seeking help” to feel better.
Commonly experienced mental health issues include anxiety, depression, bipolar
disorder, and post-traumatic stress disorder (PTSD).
An adult with mental illness has abnormal mental, behavioral or emotional
experiences which disrupt life’s activities; it could be a serious, moderate,
or mild functional impairment. Someone with a severe mental illness (SMI) experiences
substantial impairment on a daily basis and faces challenges in otherwise routine
Impact and Cost of Mental Illness on Communities
Untreated mental illness costs California businesses nearly $7.9 billion annually
in worker absenteeism and reduced productivity. A RAND Corporation study found
that people with depressive symptoms spend more days in bed than those with
disabilities, arthritis, back problems, lung problems, or gastrointestinal
disorders.5 Mental illness and mental health conditions are an important public
health issue; if left untreated, they can devastate families, dismantle a career,
end a marriage, or cause other serious difficulties. Mental illness can sometimes
lead to physical ailments and conditions, including high blood pressure, stroke,
or heart attack.6
California spends over $1 billion7 to treat 15 percent of the prison population
with documented mental illnesses,8 or roughly 33,000 inmates.9 That does not
include local corrections costs or the total expense to the criminal justice
Consider these statistics:
- Mood disorders, including major depression and bipolar disorder, are
the third most common cause of hospitalization in the U.S. for both youth
- Individuals living with serious mental illness face an increased risk
of having chronic medical conditions.
- Adults in the U.S. living with serious mental illness die on average 25
years earlier than others, largely due to treatable medical conditions.
- Over one-third (37 percent) of students (age 14-21+) with a mental health
condition, who are served by special needs educational programs, drop out
of school. In fact, students with mental illness comprise the highest dropout
- Suicide is the 10th leading cause of death in the U.S., the 3rd leading
cause of death for people aged 10–24, and the 2nd leading cause of death for
people aged 15–24.
- More than 90 percent of children who die by suicide have a mental health
- Each day an estimated 18-22 veterans die by suicide.11
Clearly, with debilitating mental illness rampant in our society, it is long
overdue that we as a nation increase the focus on de-stigmatizing the act of
getting help. Far from being a sign of weakness, seeking treatment is an act
of bravery. The California Association of Marriage and Family Therapists (CAMFT)
recognizes the gap in mental illness prevalence and the services available.
The association is doing its part to fill these unmet needs among California’s
residents and is shining a light on the issue so that those who are suffering
feel validated, not diminished, in their decision to seek treatment. Marriage
and Family Therapists (MFTs) are the most easily accessible mental health professionals
in the state, far outnumbering psychologists, counselors and psychiatrists.
MFTs are mental health professionals trained in psychotherapy with a wide range
of treatment modalities, and licensed to diagnose and treat moderate to severe
clinical problems including anxiety, depression, addictions, post-traumatic
stress disorder (PTSD), self-harm and other behavioral problems.12
It is critical that mental health problems in children and adults be identified
and treated to minimize consequences to their health, relationships, productivity
and to society. MFTs can fill that void. Here is how some of these mental health
issues may impact you or a loved one.
Adult women in California are more likely than men to experience serious mental
illness. The incidence in females increases according to age, from 2 percent
in women aged 18 to 20 to a peak of over 6 percent in the 35 to 44 age bracket.
Women are twice as likely to experience depression, with 12 percent of women
being affected versus 6 percent of men; this can take the form of bipolar disorder
or postpartum depression, among other psychopathologies. Women suffering from
depression often turn to alcohol abuse. And while much attention has been devoted
to post-traumatic stress disorder (PTSD) in male and female soldiers returning
home, the reality is that this condition presents twice as often in women than
men, unrelated to soldiering abroad. It can result from sexual violence, domestic
abuse or childhood trauma, among other causes. In people suffering from an
eating disorder, women account for 85 percent of bulimia and anorexia cases
and approximately 65 percent of binge eating disorders.13
Men are more likely to mask depression using unhealthy coping methods such
as drinking alcohol or abusing drugs. In fact, men are five times more likely
to abuse alcohol than women. With societal stigmas that equate mental illness
with diminished masculinity, men often have difficulty admitting to any prolonged
illness--mental or physical. The World Health Organization reports that prevalence
of alcohol dependence is more than twice as high in men than women, and they
are more than three times as likely to be diagnosed with antisocial personality
disorder.14 One in 20 men suffer from depression, with the highest incidence
in men aged 40 – 59.15 Fourteen percent of males experience anxiety disorder,
with approximately 75 percent of all suicides committed by men.
Children and Adolescents
Depression is one of the most prevalent mental health disorders among adolescents.16
Between 2005 and 2009, approximately 8 percent of teens in California reported
that they had experienced an episode of major depression in the previous year.
The rate for California adults during that same period was 6 percent.
Early childhood trauma generally refers to the traumatic experiences that
occur to children aged 0–6. The most common traumatic stressors for young
children include accidents, physical trauma, abuse, neglect, and exposure to
domestic and community violence. Young children are exposed to traumatic stressors
at rates similar to those of older children. In one study of children aged
2–5, more than half (52.5 percent) had experienced a severe stressor
in their lifetime.17
Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ)
Members of the lesbian, gay, bisexual, transgender, queer and questioning
(LGBTQ) community may experience more mental health challenges than other people,
as a result of prejudice and societal biases. LGBTQ individuals are almost
three times more likely than others to suffer a mental health condition such
as major depression or generalized anxiety disorder. They may also experience
substance abuse, post-traumatic stress disorder and thoughts of suicide more
readily than others. In fact, LGBTQ youth are four times more likely--and questioning
youth are three times more likely--to attempt suicide, experience suicidal
thoughts or engage in self-harm than straight people. Between 38 and 65 percent
of transgender individuals have thoughts of suicide, and for LGBTQ youth between
ages 10 and 24, suicide is one of the leading causes of death. An estimated
20 to 30 percent of LGBTQ people abuse substances, compared to about 9 percent
of the general population.18
Fortunately, all of these issues can be successfully treated by MFTs. It is
time to end the stigma of pursuing treatment for mental health conditions.
According to the American Association for Marriage and Family Therapy (AAMFT),
numerous research studies validate the effectiveness of marriage and family
therapy in treating the full range of mental and emotional disorders.19 Clients
- Surveys show that almost 90 percent of clients report an improvement in
their emotional health after treatment.
- Nearly two-thirds report an improvement in their overall physical health.
- Over 98 percent of clients of marriage and family therapists report therapy
services as good or excellent.
- When a child is the patient, parents acknowledge that their child’s
behavior improved in nearly 74 percent of cases; their ability to get along
with other children significantly improved; and their academic performance
in school was heightened.
With thousands of MFTs in California providing a wide array of treatment modalities, there is no longer a reason to delay seeking help. Finding a qualified MFT is as easy as visiting www.counselingcalifornia.com. Nearly 8,000 MFTs on this site are available to provide relief and promote healthy, happy and productive lives.
1 California Healthcare Foundation’s Mental Health Care in California:
Painting a Picture July 2013
2 National Alliance on Mental Illness State Advocacy 2010: California Fact Sheet
3 California Healthcare Foundation’s Mental Health Care in California:
Painting a Picture July 2013
4 David L. Vogel, Stephen R. Wester, and Lisa M. Larson, “Avoidance of
Counseling: Psychological Factors That Inhibit Seeking Help,” Journal
Counseling & Development Fall 2007, Volume 85
5 “Making Employee Mental Health Your Business,” Screening for Mental
Health, Inc. August 26, 2014 (https://mentalhealthscreening.org/blog/making-employee-mental-health-your-business:accessed
April 20, 2016), para. 5.
6 “Anxiety and Physical Illness,” Harvard Health Publications, Harvard
Medical School, July 2008 (http://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness:
accessed April 30, 2016), paras 2, 4, 11, 12.
7 “California Prison Healthcare Costs Soar Under Federal Receiver,” Prison
Legal News, October 2014 (https://www.prisonlegalnews.org/news/2014/oct/10/california-prison-healthcare-costs-soar-under-federal-receiver/: accessed February 4, 2016), para. 8.
8 “How many individuals with serious mental illness are in jails and prisons?” Treatment
Advocacy Center, November 2014 (http://www.treatmentadvocacycenter.org/problem/consequences-of-non-treatment/2580: accessed February 4, 2016), para 1.
9 “Mental Illness in California Prisons,” New York Times, April 10,
accessed February 2, 2016), para. 1.
10 Martha L. Thurlow, Mary F. Sinclair, and David R. Johnson, “Students
with Disabilities who Drop Out of School—Implications for Policy and Practice,” NCSET,
June 2002 (http://www.ncset.org/publications/viewdesc.asp?id=425 : accessed February
6, 2016), para. 7.
11 “Mental Health by the Numbers,” National Alliance on Mental Illness
(https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers : accessed February
4, 2016), para. 4.
13 Everyday Health
14 “Gender and women’s mental health,” World Health Organization,
(http://www.who.int/mental_health/prevention/genderwomen/en/ : accessed February
20, 2016), para.12.
15 “Suicide and silence: why depressed men are dying for somebody to talk
to,” The Guardian August 15, 2014 (https://www.theguardian.com/society/2014/aug/15/suicide-silence-depressed-men: accessed February 20, 2016), para.
16 Mental Health, United States, 2010, HHS Publication No. (SMA) 12-4681 (Rockville,
MD: Substance Abuse and Mental Health Services Administration, 2012)
17 Egger, H., & Angold, A. (2004). Stressful life events and PTSD in preschool
children. Paper presented at the annual meeting of the American Academy of Child & Adolescent
18 “LGBTQ,” National Alliance on Mental Illness (https://www.nami.org/Find-Support/LGBTQ: accessed March 6, 2016), para. 2-14.