Senators discussed mental health and substance abuse challenges during a joint meeting between the Select Committee on Mental Health and Addiction and the Select Committee on California’s Mental Health last week. They noted that making progress on addressing these issues cannot be done without a strong healthcare workforce.
Dr. Janet Coffman, co-associate director at the University of California at San Francisco (UCSF) Institute for Health Policy Studies, spoke about workforce development in the mental health sector.
“Demand for behavioral health services grew during the 2010s and accelerated during the COVID-19 pandemic—particularly among young people. Demand is increasing and Californians had big challenges in accessing behavioral health before the pandemic, and I think it’s fair to say those challenges have become greater.”
— Coffman
Many Californians have unmet behavioral healthcare needs, and while there is a shortage of providers throughout the state, the Inland Empire and Central Valley regions are experiencing the greatest shortages, according to Coffman. To help address the issue, UCSF is focused on a workforce pipeline program called Community Health Advanced by Next Generation Efforts in San Francisco (CHANGE SF).
“You can’t be what you can’t see, and many of our young people—particularly people of low-income, marginalized communities—don’t have a lot of experience with behavioral health professionals,” Coffman said.
The CHANGE SF program provides paid workplace learning and mentoring for youth ages 13 to 24.
“Those participants have gotten multiple opportunities to learn about mental health, be mentored by faculty, have enough exposure to different career paths, and three of them thus far have been hired by UCSF after completing the program,” Coffman said.
Coffman said the paid workplace learning aspect of the program is crucial for lower-income communities. While youth have exposure to healthcare mentoring and positions like clinical research coordinators, she thinks the program can be scaled up.
Robert McCarron, director of the University of California at Irvine (UCI) Train New Trainers Primary Care Psychiatry Fellowship, noted that maternal mental health is the leading cause of pregnancy-related deaths in the country, while opioids are the number one cause of accidental deaths in the country.
“One out of three of us in this room will suffer from a substance use disorder—crippling alcoholism, for example, (or) meth dependency. One out of five currently have a psychiatric disorder and, in our lifetime, half of us will struggle with a psychiatric disorder.”
— McCarron
The staggering statistics that show a massive need for medical assistance can also leave patients suffering for months due to referrals and a lack of providers. McCarron said about 70 percent of behavioral healthcare is not delivered by psychologists, social workers, or psychiatrists.
“It’s delivered by primary care providers and emergency medical doctors, and here’s the problem with that: many of them didn’t get the training for that,” McCarron said.
UCI is on the cutting edge of innovation, however, and is creating fellowships that provide behavioral healthcare training. The goal of the fellowships is to allow healthcare workers to improve their skills, while learning how to train other clinicians. A couple different programs accomplishing this work over the past several years include the Pediatric Care Fellowship and Primary Care Training in Addiction Medicine.
“In a nutshell, what we do is provide targeted training during non-clinic hours, so these folks are still working and seeing patients in the busy primary care setting,” McCarron said. “We’re telling them about common psychiatric issues with a focus on three things.”
The three primary focuses are prevention, how to quickly diagnose an issue, and how to partner with a patient for treatment. McCarron said those who have graduated from these UCI programs are more likely to diagnose depression early—in comparison to those who didn’t go through the program—and graduates are prescribing lesser amounts of opioids to patients. McCarron hopes these programs will grow, and that career-long training won’t stop.
Brett J. Feldman, director and co-founder of University of Southern California (USC) Street Medicine, discussed street medicine achievements. He defined street medicine as the direct delivery of healthcare for unhoused people. Feldman has been practicing street medicine since 2007, and understands how those who are unsheltered experience major barriers when seeking healthcare.
Feldman’s team is made up of doctors, physician’s assistants, nurses, physicians, social workers, and community health workers with lived experiences around homelessness. The street medicine team can dispense medications, draw labs, and administer EKGs and ultrasounds.
“At USC we’ve had very good results from doing it this way. For example, we can decrease hospitalization by 70 percent.”
— Feldman
Feldman hopes efforts during the 2024 legislative session will make it possible for anyone who wishes to deliver street medicine to be able to do so without having to undergo bureaucratic interference.
The California Firefighter Behavioral Health Task Force was formed in 2016, when the leading cause of death for firefighters was suicide.
“That was a wakeup moment for us—and a wakeup moment for me—and that’s why I, along with my colleagues, got involved in the California Task Force on Behavioral Health,” said Dave Gillotte, co-chair of the task force and president of Los Angeles County Firefighters Local 1014.
The formation of the task force has helped break access stigmas related to behavioral health services. It has a peer support team, as the county has over 150 trained peer supporters to aid firefighters experiencing mental health challenges. Gillotte noted that healthcare workforce shortages remain a huge barrier to care, but there are ways to increase the number of practicing clinicians.
“In my opinion, humbly—we have a health insurance plan that we run for firefighters—and we’re offering (it) to the clinicians that are taking our training program. It’s three hours of (continuing education)—and they’re actually coming out and riding along with us to become culturally competent for my fire workforce, so they know how to talk to and counsel my firefighters,” Gillotte said. “We’re offering them better than table rates. We’re offering them worker’s comp, and we’re paying them in 30 days. And let me tell you what happens: you have a long line of clinicians that want to treat firefighters.”
Gillotte said the suicide rates among firefighters have been dramatically reduced through these initiatives, and they impact those outside the department as well.
“Relating to the people we treat in the streets, if we were to have programs like you’re hearing [about] today that mirror what we’re doing for our firefighters, you can see a dramatic reduction in the behavioral health issues in the street, and probably related costs associated with it,” Gillotte said.
Those who want to learn more about mental health initiatives in California can register for the 2024 Northern California State of Reform Health Policy Conference, which will be held on April 16 at the SAFE Credit Union Convention Center.