​"Navigating the multiple systems of care to receive mental health services is complex and can be daunting"​

D. Imelda Padilla-Frausto, is a researcher at the Center and lead author of a new policy brief on lack of treatment among young children who need mental health care. In this brief interview, Padilla-Frausto discusses what barriers keep children from getting mental health care and why having insurance hasn't helped, how coordinated care could increase the number of children treated and what can be done to better to ensure mental health care for children.

Q: Although 95 percent of children in need of mental health care have health insurance, most don’t receive help. What may be some barriers preventing parents of insured children from accessing services?

​There are many barriers, and some are related to whether a family has private or public health care coverage.

For people with private insurance, studies have discussed the lack of health care coverage for mental health problems. This places a huge financial burden on families to pay out of pocket. For those in public health care, reports suggest that navigating the multiple systems of care to receive mental health services is complex and can be daunting, which deters and delays families and children from receiving timely care. And some people may not know whether their coverage includes mental health care or not.

About 15 percent of Californians live in areas where there is a shortage of mental health professionals. These shortages result in long wait times or long commutes to be seen and treated which may discourage or prevent parents from seeking services for their children.

And while most of these children with mental health needs have a usual source of care, there could be a lack of mental health screening taking place at well-child or sick-child visits, and there may be a lack of mental health training among physicians to identify mental health problems. On the other hand, physicians may be screening for and identifying mental health problems among children but facing barriers in getting their young patients timely care due to a shortage of mental health professionals and long waiting lists or there may be a lack of coverage by health plans.

Finally, stigma may also be a contributing factor to seeking mental health treatment.

Q: Your study hints at a lack of coordination between medical professionals -- does there need to be a one-stop health care group where a child can go for physical and mental care?

​Yes, I do believe it would be beneficial to have something like a medical home where coordinated and integrated care is provided. This may increase the number of children being treated. For example, one report found that a higher percentage of children received mental health care under a Kaiser health plan, compared to other health plans, because Kaiser’s mental health services were under one coordinated system, making it easier on families.

Integrated and coordinated care where mental health professionals are embedded in medical settings could address some of these issues. Lack of coverage by health plans could be addressed with better implementation of mental health parity laws.

Q: What can we do better to ensure that children are getting the mental health care they need?

​​Right now, we’re focused more on the treatment of mental health disorders – we’re coming in after the fact. Treatment is important, but intervening early should become a focus as well. To safeguard children’s mental well-being, a public health approach is needed to promote well-being and prevent mental health problems before they happen.

Read the policy brief: Three Out of Four Children with Mental Health Needs in California Do Not Receive Treatment Despite Having Health Care Coverage

​D. Imelda Padillo-Frausto is a graduate student researcher at the Center. Her recent study found that 772,000 California seniors are struggling to make ends meet. In this brief interview, Padilla-Frausto discusses how changes to a household can make it more vulnerable, the hardest-hit among the hidden poor, and the importance of supplementing Social Security.

Q: Your study makes a distinction between different types of households, like grandparents raising grandchildren and older adults housing adult children. Why are these particular families important?

​Economic status is very much affected by how ― and with whom ― people live. In California, about two-thirds of older adults are either single elders living alone or older couples living by themselves. The remaining one-third live in other types of arrangements.

Those other arrangements include grandparents raising grandchildren and older adults housing adult children. We focused on these two groups because they are particularly vulnerable. These are seniors who are struggling with additional household costs and financial responsibility. As our study reveals, grandparents raising grandchildren are disproportionally affected by economic insecurity.

Q: Your study shows the number of California women age 65 and older (286,000) in the "hidden poor" group is more than double that of men in that age range (106,000). Why is that?

​In general, women live longer than men but earn less over their lifetimes. According to the National Partnership for Women and Children, the average lifespan is 82 for women and 77 for men. Historically, the earning power of women has been much lower than that of men, so women have less savings and Social Security benefits than men. Combined, those play a big role in why the number of women in this group of "hidden poor" is so much greater than men.

Q: Doesn't Social Security bridge the gap between poverty and a decent standard of living?

​Many more of the "hidden poor" would be beneath the federal poverty level without Social Security. However, the benefit doesn't stretch as far because the cost of housing and health care keep rising. Social Security accounts for 64 percent of low- and middle-income seniors' family income, according to the AARP, and the average annual benefit in California was under $15,000. According to the Elder Index, that wouldn't even cover annual rent in the least expensive county in California (Kern at $18,781.)

D. Imelda Padilla-Frausto is a Center research scientist and co-author of a fact sheet on rent burden shouldered by low-income seniors in California. In this brief interview, Padilla-Frausto discusses the concept of rent burden and poverty, regional rent and senior budgets, and the image of “worry-free” retirement living.

Q: Your study says that more than three-quarters of low-income senior renters are rent burdened (pay 30 percent or more of their income on rent). How did this happen?

​Many low-income older Californians live on a fixed income year after year. But rental housing costs in California rise dramatically every year, creating an ever-growing gap between older adults’ income and rental housing costs. As this gap widens, more adults become rent burdened. Housing tends to be the biggest expense in older adults’ budget as documented by the California Elder Economic Security ™ Index (Elder Index), and low-income, older Californian renters are the most vulnerable.

In fact, California ranks third in the nation for having one of the largest gaps between renters’ wages and the cost of rental housing. This large gap is for wage earners so we can assume it is much worse for those on fixed-incomes like older adults.

Q: How can the rent burden for seniors be higher in Sacramento than in San Francisco? And what can be done about it?

​This difference is most likely due to rent-control policies that exist in San Francisco but not in Sacramento. For this data, rent burden is calculated using current spending on rent. So, while the cost to a new renter for a one-bedroom apartment in San Francisco is more than twice that for a comparable unit in Sacramento, the long tenure of older renters in San Francisco’s rent-controlled units likely reduces the actual rents paid by most seniors.

There are a few things that can be done to decrease the number of rent-burdened older adults, such as adopting more local rent-control policies for older adults in particular and building more affordable housing for seniors. Another unique approach would be to subsidize low-income older renters like the pilot project in Santa Monica called Preserve Our Diversity. This program provides rental assistance to their long-term residents over the age of 65 who would otherwise be displaced from the city due to their inability to pay their rent. The Santa Monica Housing Council used the Elder Index for Los Angeles City to identify the income an older adult needs to pay for basic living expenses.

Q: There's a general image that older adults retire and live comfortably in senior communities. What is the reality?

​For some fortunate older adults, this may be true, but for many older adults, the happily-ever-after ending of the “golden years” is complete fiction. Recent data from the Elder Index shows over one-quarter of older adults do not have enough income to cover basic living expenses, and there are particular groups of older adults who are disproportionally impacted.

For instance, older renters fare the worst compared to those who own their homes, regardless if they have a mortgage or not. Older Latinos, blacks and Asians are more likely to be economically insecure than their white counterparts. Older women are more likely to have less income to meet their basic living expenses than older men, but there is still one-quarter of older men who are economically insecure. Similarly, older Californians age 75 and over tend to be more vulnerable to economic insecurity than those age 65 through 74, but still one-quarter of the younger age group face economic challenges.