Fear grips San Luis Obispo County mental health professional Tom Buckley when he takes stock of the available local resources for young people.
“Kids are still depressed and isolated after the pandemic,” he said. “This is going to get worse. We are at the eye of the storm right now, and I’m terrified for what this next generation is going to have to deal with.”
Buckley is the executive director of Aspire Counseling Services’ SLO chapter—an organization that provides intensive outpatient care. He’s set to complete four years of his two-decade social services career with Aspire, but 2023 is proving to be the most daunting one yet.
“More clients have died from self-harm, suicide, and from overdoses than I have seen in my entire career of almost 20 years this year,” Buckley said. “Things are getting more and more dire.”
SLO County’s youth, especially its teenagers, must evade gaps in services if they seek mental health care. According to Buckley, the majority of those kids are covered by their parents’ insurance plans that don’t make the cut for many county services.
He explained that the county’s current mental health services priority primarily caters to those covered by Medi-Cal—the low-cost health care coverage for eligible California residents with limited income. Beyond that, several services are available for wealthier customers who can pay out of pocket and access resources that don’t take insurance. Such financial extremes in coverage leave a large swathe of community members in the lurch.
“The biggest barrier in SLO County is the lack of insurance-based resources,” Buckley said. “Then there are kids who don’t have a lot of money. Their parents are working-class people. The county services aren’t available to them because they don’t qualify for Medi-Cal. But they don’t have the cash to go find the other higher end services either. So, they literally have nothing.”
People are matched with different resources based on the level of care they need. Someone at risk of hurting themselves would be admitted to a hospital, which is the highest level of care. An individual trying to improve their mental health or recover from substance abuse needs to go into residential treatment—the second level of care—if they’re not safe at home, Buckley explained. Youth residential care is nonexistent in SLO County.
As an intensive outpatient service, Aspire caters to people who need a higher level of service but are able to stay at home. They can receive clinical services five days a week up to six hours daily that include psychiatric, therapeutic, and group counseling care. But its short-term nature compels organizers to frequently debate with insurance companies.
“We’re battling insurance just to get these clients five, six, 10 days of service” Buckley said. “Every time they run out of days, we have to call back to the insurance company and argue with them why their clients need medical necessity.”
For the past three years, Buckley has been actively searching for outpatient therapists in SLO County. They’re needed as the next step of care once Aspire’s patients leave the intensive programs. Insurance companies claim to send him a list of outpatient providers like weekly therapists, but Buckley and his team have hit a wall.
“We can’t find any outpatient therapist from this area that accepts insurance and are currently accepting new clients,” he said. “I mean, zero.”
He’s keen for a deeper collaboration between the county, nonprofits, and private resource groups. Such an effort would open hospital space and reduce suicide attempts, DUIs, emergency room crowding, and the strain on first responders, according to him.
“Before the wheels fall off the bus, the county can actually save a lot of money and their resources,” Buckley said. “They can be distributed where they need to be instead of having paramedics and fire responding to mental health emergencies that they’re not trained for and have nowhere to bring those folks.”
Aspire and the county do already work together in some ways, such as Aspire’s work as a pretrial diversion provider, which requires partnering with county Drug and Alcohol Services. But Aspire’s most frequent collaborations are with private organizations in local schools and nonprofits. They aim to address the lack of services for kids in the county with help from the suicide awareness group Knowing You Matter, the Family Care Network, Transitions-Mental Health Association, Hospice of SLO County, and mental health awareness events in different school districts.
Frank Warren, the county Behavioral Health Department’s deputy director, confirmed that the county’s mandate is for people with Medi-Cal who require higher levels of care.
According to data he provided, the county receives an average of 35 crisis calls every month from kids under 18 years old. Ninety-seven percent of those kids are transported out of the county to receive the care that’s missing locally. It’s an issue the 2021-22 SLO County civil grand jury raised in its investigation of county-provided mental health services.
“The county has no services available to treat juveniles who experience acute mental health issues and are detained under … the juvenile equivalent of a 5150 hold,” the grand jury report read, referring to the code for an adult mental health crisis involuntary hold. “As a result, all youths in SLO County experiencing serious mental health issues are transported to facilities in Los Angeles, Sacramento, and other distant locations, away from family, school, church, and their other support networks.”
The county’s improvements on its own system center on reducing the hold time for kids. In fiscal year 2021-22, the county issued holds on 56 percent of youth crisis calls. That dropped to 51 percent in 2022-23. Warren said they’re continually working on bringing it down further.
Apart from a service provider shortage, the process of getting care under private insurance coverage is difficult in SLO County, he said.
“We don’t have major health care provider systems like Kaiser,” Warren said. “We get a lot of students who come over here to go to school here, and they have Kaiser insurance, but they can only be seen in the Kaiser system.”
Money is the biggest roadblock preventing SLO County from reforming its service system.
Finding a funding source that pays staff and supports services is a constant struggle. The county Behavioral Health Department is always looking for more grants to apply for. Some grants and awards come through the Mental Health Services Act that’s funded by a 1 percent income tax on personal annual incomes above $1 million.
Warren told New Times that more than $1.5 million from the act is allotted for a countywide round-the-clock mobile crisis service called the Mental Health Evaluation Team. But the act might be poised for change.
“The Mental Health Services Act right now is being threatened by a reform,” Warren said. “It’s a proposition that will go to the voters in March, which will move a third of its funding over to housing programs only.”
Beyond the Mental Health Services Act, other funding streams from the state help pay for mobile crisis services for SLO County’s youth.
A grant from the state’s Health Facilities Finance Authority worth $270,000 over five years until 2026 pays for a mobile crisis team for youth in schools and hospitals. Another state grant of $236,000 over three years until 2026 funds vehicles, dispatch services, and a few personnel. In fiscal year 2022-23, 606 people 21 years old and under received mental health evaluations from the mobile crisis response team.
But making a case to receive funding is tough. Both Warren and Aspire’s Buckley told New Times they’ve faced a perception that SLO County contains “the happiest city in America” when they advocate for more robust services.
“You have to constantly prove that you have need when you’re competing for dollars,” Warren said. “But even if we get dollars, it’s very expensive here.”
Steady communication between the county and its partners aims to address the need for residential treatment services. It’s resulted in a youth gap analysis that will be released soon.
A partnership among Transitions-Mental Health Association, the county Behavioral Health Department, other community groups and hospitals, the analysis acknowledges that the Board of Supervisors identifies the service gaps as a crisis while developing priorities for next year.
“We are working on a strategic plan for Behavioral Health, which will also focus on some of these issues around both workforce and insurance,” Warren said. “That’s coming out in January.” Δ
Reach Staff Writer Bulbul Rajagopal at brajagopal@newtimesslo.com.
This article appears in Nov 30 – Dec 10, 2023.
“The Mental Health Services Act right now is being threatened by a reform,” Warren said. “It’s a proposition that will go to the voters in March, which will move a third of its funding over to housing programs only.” – Local government’s have made it increasingly difficult for developers to provide much needed housing across the past few decades. They will instead point to affordable housing funds as the solution, when really these funds simply subsidize the demand and don’t truly provide the large amount of new construction needed to bridge the housing gap. In this case, these efforts to increase housing subsidies are coming at the very real cost of mental health treatment in the state. If local governments would make real efforts to allow for a variety of housing projects to be permitted, we wouldn’t have to try and tear apart our other social service funding sources.
Get off social media.
I 100% agree with Mr. Chomo’s comment and will add to it…force the social media companies and/or their parent companies to start funding the mental health disaster they have created. We are only just beginning to see the damage that has and will be inflicted on the youth using social media. As adults we can reflect and limit our usage but to the social media companies the youth are the new addicts.