Sacramento County aims mental health effort at hard-to-reach groups The Sacramento Bee
February 13, 2012
Psychologists across the country have grappled for years with a
thorny problem: While every demographic group has mental health
problems, certain groups tend not to seek treatment.
Now, Sacramento County is using an infusion of state cash to try
to close that gap locally.
The county Department of Health and Human Services has contracted
community agencies across the county – one for each of eight
specific ethnic or age groups – to evaluate what mental health
services those groups need and what obstacles block them from
In the next 30 months, those agencies will use the evaluation
results to try to build programs that better meet those needs.
The initiative also includes a “warm line,” a phone number
established several months ago that people can call when they
need support or information but aren’t necessarily in crisis.
While the immediate goal is to get more residents the treatment
they need, the county ultimately aims to reduce the number who
attempt or commit suicide.
“We really want to provide choices for people, so that they will
feel comfortable accessing our services in the way that they feel
is appropriate for them, their family and their community,” said
Jo Ann Johnson, cultural competence and ethnic services manager
for the county’s behavioral health services.
The initiative will cost $1.6 million this fiscal year and a
similar amount in years to come, all from the state Mental Health
Services Act. California voters approved the law in 2004 to
enhance services through a 1 percent tax on personal income over
The Sacramento effort targets groups that data show tend not to
either seek or stick with treatment: Latinos; Hmong, Vietnamese
and Cantonese speakers; Slavic and Russian-speaking residents;
youths transitioning from adolescence to early adulthood; older
adults; African Americans; American Indians; and college-age
The county offers outpatient counseling and inpatient care for
residents who have major psychological disorders, such as
schizophrenia or severe depression, and have Medi-Cal or no
In 2009, only about 6.4 percent of the residents eligible for
Medi-Cal used the county’s mental health services.
That percentage plummeted to 3.9 for Hispanics, 3.5 for Asians,
and 3.4 for people age 60 and older. County officials suspect
many more needed help but didn’t seek it.
The local rates of mental health care for Asians, Indians,
blacks, whites, and seniors fall well below the average for other
large California counties.
Suicide rates themselves aren’t the reason for the new county
program. Data from the National Institutes of Mental Health
indicate that suicide is substantially less frequent among
blacks, Latinos and Asians – around 5 or 6 suicides per 100,000
people – than among whites, whose rate is over 13.
American Indians and Alaska natives have the highest rates of
all, at more than 14 suicides per 100,000.
Sacramento County is targeting suicide prevention, Johnson said,
because in planning sessions for how to spend state MHSA dollars,
community members ranked it as a major concern.
County officials believe the disparities in care stem from the
fact that, in mental health services, one size does not fit all.
“The mental health system historically has been developed on a
European model of treatment,” Johnson said. “We find that that
model doesn’t always work well with cultural, racial and ethic
groups, because of differences in beliefs and experiences.”
African Americans, for instance, tend to cycle in and out of
treatment quickly, which Johnson believes is because the services
don’t satisfy them.
So in the African American community, the county’s contractors
are working to launch a program of “kitchen table talks,” where
family members and neighbors gather to eat and talk with a
counselor about issues of concern.
“For some groups, that’s much more natural and comfortable than
coming to your local mental health agency,” said Johnson.
There are other cultural barriers. For example, whereas U.S.
clinicians naturally focus counseling on the individual, people
who come from more collectivist cultures may need treatment that
involves the patient’s family and community, said Nolan Zane, a
psychologist and chair of Asian American Studies at Davis.
Research has consistently shown that Asian Americans “drastically
underutilize” mental health services, he added. Negative views of
mental illness are prevalent in many Asian cultures, both in Asia
and the United States, and that can make it feel shameful for
people to admit they’re distressed and need help, Zane said.
Also, mental illness may look different in people from different
cultures, said Zane.
While Western medicine tends to see mental and physical disorders
separately, East Asian cultures view health holistically. So
people from those cultures tend to express their psychological
problems more through physical symptoms such as pain and fatigue,
Those variations may make it harder to spot mental illness in
certain groups of people, he added. And even if they get into
treatment, cultural divides could make them feel that
Western-style counseling isn’t helping them.
If a patient complains of a headache and the doctor responds, “Do
you think the headache is due to the fight you had with your
husband?” Zane explained, “That’s a reason why they may leave
treatment early or politely stop coming.”