The mental health system isn’t working in California, study shows

The mental health care system isn’t working for millions of Californians, a survey conducted by the California Health Care Foundation revealed.

The purpose of the annual California Health Policy Survey conducted by the California Health Care Foundation and NORC at the University of Chicago is to gain a better understanding of Californian’s views and perspectives on the state's health care and medical system. Since 2019, the annual poll has focused on a variety of healthcare topics. 

This year, the survey revealed a list of public concerns. Large majorities say improvements are needed to treat people with serious mental illness and many people living in the state, low-income and not, cannot pay for doctor visits.

The California Health Care Foundation is an independent, nonprofit philanthropy that works and funds research and health initiatives to bring measurable, sustainable change to California’s complex healthcare system. 

The poll was conducted from September 18 through October 25, 2023, among a random representative sample of 3,431 adults aged 18 or older living in California. Interviews were administered in English, Spanish and Chinese. Most surveys were completed via the Internet, with a small proportion completing the survey by phone with NORC telephone interviewers.

According to CHCF, the survey was designed to achieve a sufficient number of interviews that would support an accurate representation of the California resident adult population. “We want to know whether the healthcare system is delivering high-quality care that's accessible to people and that they can afford. This survey is one of those efforts where we go out and hear from a wide range of people about what their experience is in the health care system,” Kristof Stremikis, director of CHCF’s Market Analysis and Insight team, told CALÓ News.

One of the key themes and findings from this year’s survey is that dissatisfaction with mental health care is high among Californians. Two out of three respondents told pollsters improvement is needed in the treatment of people with serious mental illness, with 42% saying “significant” improvement is necessary. In addition, more than half of Californians who tried to make an appointment said they have had trouble finding a mental health provider who takes their insurance, compared to only 14% who report difficulty finding providers who take their insurance for physical health care. More than half of Californians who tried to make an appointment reported waiting longer than they thought reasonable to see a mental health provider. 

The poll also showed the importance of state leaders in 2024 and the general elections when it comes to mental health. 81% of Californians think increasing access to mental health treatment should be an “extremely” or “very” important priority for state policymakers in 2024. 

“What all of these numbers show is that the mental health system is not working for the vast majority of people in the state,” Stremikis said. “We have serious access issues when it comes to the mental health care system here in California, and it needs to be an area that we prioritize moving forward.“

Since 2017, this was the first time the CHCF has asked about the impact of climate change and extreme weather on people's physical and mental health. This year’s poll asked Californians how worried they are about the effect of weather and environmental factors, such as extreme heat, floods, wildfires, and air quality, on their or their family member’s physical or mental health. 

More than half of Californians (53%) said they are “very” or “somewhat” worried about the health impacts of weather and environmental factors. Californians with low incomes (65%) are more likely to report being worried than those with higher incomes (50%). When it comes to Latinos, 61% of them are also more likely to be worried about environmental impacts than white Californians (44%). 

Language also plays an important role when it comes to environmental worries among Californians. “Latino Californians or Californians who preferred to take the survey in Spanish have higher environmental worries,” Stremikis said. The poll showed that those who speak Spanish (82%) are more likely to be worried than those who speak English (52%) or Chinese (51%).

In Los Angeles, the average cost of a primary care visit without insurance is $190, which is the cost of an office visit; any additional procedures, lab tests, or screenings would be an additional cost. 

The high cost of care also continues to be a major area of concern for Californians. According to the CHCF poll, more than half (53%) of Californians said they skipped or postponed care due to cost in the last year. For low-income people in the state, that number grows to 74%. “That is higher than we've ever seen in the 5 years of doing this survey,” Stremikis said. In addition, close to four out of 10 Californians (38%), and over half of Californians with low incomes (52%), report having medical debt.

The 72-page survey also has information on racial equity, behavioral health, the health workforce, artificial intelligence, hospitals, housing and homelessness, among other things. Stremikis said he hopes the survey results are used to create progressive legislation that betters the lives and health of Californians. “I hope the information and data presented here is useful to, you know, everyone here that is working to make our healthcare system work a little bit better,” he said.

Senator Susan Talamantes Eggman, chair of the Senate Committee on Health, said the findings found by the survey should remain a top state priority. “The CHCF poll also highlights a range of other issues that we will all need to focus on in this year’s health policy debates, from promoting racial equity in the health care system to building a health workforce that looks more like California,” Talamantes Eggman said.