KEY FINDING: MENTAL HEALTH Lack of knowledge and fear of stigma are key barriers to using mental health services.
Across the United States, about 40 percent of people with serious mental illness do not receive care despite the availability of effective treatment.9 Fear of public stigma remains one of the primary barriers to receiving care. Public stigma occurs when pervasive stereotypes about people with mental illness lead to prejudice. Subsequently, fear of public stigma may cause individuals to avoid seeking treatment, or to drop out of treatment to avoid being associated with negative stereotypes, such as the belief that people with mental illness are dangerous and unpredictable. Fear of stigma may also influence the beliefs and behaviors of friends, family members and care providers, which can pose further barriers to care for people experiencing mental illness. Stigma around mental illness is often more pronounced for recent immigrants, especially from those countries with more highly stigmatized views of mental illness.10
Stigma may lead to underreporting of mental health needs
Based on the weighted CalOptima population estimate, about 14 percent of members reported the need for mental health services in the past year. This number likely underrepresents the actual level of need, based on both national and local data. According to the National Institute of Mental Health (NIMH), each year approximately 19 percent of adults and 21 percent of youth ages 13–18 experience mental illness nationwide.11 12 Furthermore, 64 percent of CalOptima providers identified mental/behavioral health as one of the most important health problems facing Medi-Cal beneficiaries. This potential gap between the number of members reporting mental health needs and those who genuinely have a need may indicate a lack of knowledge about mental illness and its treatment. However, research suggests that the fear of stigma plays a larger role than knowledge in determining if individuals will report need and/or pursue treatment.13 Community leaders and members acknowledge the role that stigma plays in members’ willingness to admit to experiencing a mental health challenge. A key stakeholder described the situation: “Often times, people may be aware that they’re under stress … and the stress is compromising their health, but as far as reaching out for support and help, they may not go in the direction of mental health care because of the stigma of receiving mental health care.” CalOptima providers reported that upward of 50 percent of Medi-Cal recipients “rarely” or “never” access mental and behavioral health services when they are needed, further suggesting a substantial level of unmet need may exist among members.
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