About a year and a half ago, Long Beach resident Dawne Iannaci began the process of searching for a therapist.
“I really needed help, and I was not doing well at all,” Iannaci, 55, said. “I have some chronic illnesses that I deal with, and my thoughts weren’t OK.”
After securing a referral from her primary care doctor, Iannaci—a nurse who was on disability due to a recent hip surgery and has Medi-Cal insurance, the state’s health coverage program for low-income Californians—was told that she just had to submit a financial form and she would be contacted within a week.
Instead, Iannaci received no response. When she was eventually able to secure an introductory appointment, the therapist didn’t contact her again for over a month.
Iannaci tried restarting the process, but her luck didn’t improve. After contacting at least seven local therapists’ offices, who all told her they didn’t accept Medi-Cal, Iannaci was ready to give up, she said.
With out-of-pocket costs ranging from $175 to $200 an hour, the process made her feel like a “loser,” Iannaci said.
“There’s nowhere to go,” Iannaci said. “I don’t think (therapy) should be free, but I think more therapists could perhaps work on a sliding scale.”
A spike in need
There is no doubt that the pandemic has exacerbated the need for mental health services, particularly impacting marginalized communities who already have less access to care, said local therapist Junie Abito.
After reopening her practice, Rose Junie Therapy, located in Long Beach and Los Angeles, after the first three months of the pandemic, Abito was inundated with calls, she said.
Since then, the need has only continued to climb; in 2022, Abito’s practice has already received nearly double the amount of referrals in 2021, and she has seen a significant increase in children and couples seeking services, she said.
“We lived in social isolation for so long, and we were living in a state of uncertainty and trauma response,” Abito said. “This anxiety is still looming over people’s lives . . . because we’re still trying to keep our head over water—the trauma, the grief and uncertainty are still lingering.”
Many people using private insurance to connect to services are seeing waits of three months, and many therapists, including those at Abito’s practice, do not accept insurance, as insurance companies typically only pay therapists a small portion of their hourly rates, Abito said.
“The journey to get therapy should be affirming. It should be inspiring. It should be as easy as making a dental appointment, but it isn’t—it’s stress-inducing. It’s costly. It’s confusing to navigate,” Abito said. “If you tie that into a person of color, who comes from a different socioeconomic background, who may or may not have insurance, who already has traumas and troubles, it’s going to be really difficult for them to obtain services.”
According to city data, in 2020, 8.81% of people in Long Beach were uninsured, an increase from 8.5% in 2019. In the same year, 26.6% of people with insurance had Medi-Cal insurance, and 7.7% had Medicare, which covers older adults and people with certain disabilities.
For those on Medi-Cal like Iannaci, who are typically directed by the LA County Department of Mental Health to local nonprofits for mental health services, “those spaces are essentially full right now,” said Long Beach Health Department Director Kelly Colopy.
But the need across populations is widespread, and a stark increase in mental health needs among youth and among the city’s unhoused populations is particularly troubling, Colopy said.
While statistics around mental health vary, according to the National Alliance for Mental Health, in February 2021, 46.1% of adults in California reported symptoms of anxiety or depression, and of those adults, 21.9% were unable to get needed counseling or therapy. Of the 1.56 million adults in California who did not receive needed mental health care, 35.3% did not because of cost.
Cost is a primary prohibitive factor particularly for marginalized communities, who also disproportionately experience barriers such as cultural stigma, language, transportation access and competing responsibilities and stressors.
“Managing mental illnesses is not easy—it is possible, but you need the right levels of service and the right levels of care and support systems,” Colopy said. “We really want to be working toward that, but at this point, there’s not sufficient capacity within Long Beach to be able to meet the needs, nor in the surrounding jurisdictions.”
While the city does not have data regarding the number of mental health care workers, between a rise in need and burnout causing some therapists to leave the field, there’s certainly a shortage of those workers in Long Beach, said Colopy.
‘A marathon,’ not ‘a sprint’ for therapists
Many practices including Rose Junie Therapy currently have a waitlist, and many therapists like Abito have made extensive efforts to expand their services through providing telehealth and increasing sliding scale and pro bono offerings, Abito said.
“We were providing services and preparing for this sprint,” she said. “We needed to prepare for a marathon.”
Meeting the increased need while juggling challenges with insurance and affordability have led many therapists to experience constant feelings of fatigue and burnout, Abito said.
“I felt responsible for meeting the needs of my clients and my community,” Abito said. “Especially as a woman of color, when I’d get referrals in regards to a Filipino family, I felt a lot of guilt in not being able to take on a new client.”
Lack of culturally relevant care
At Abito’s practice, which has expanded from only Abito to a team of six since the pandemic, every therapist is a bilingual woman of color who identifies with a range of cultural and ethnic backgrounds, Abito said.
“A lot of our clients seek out our services because of the different languages we speak,” Abito said.
Access is even more complicated for people of color who want a culturally relevant therapist, as the majority of therapists are White. In 2015, according to the American Psychology Association, 86% of psychologists in the U.S. workforce were White.
For Abito, who moved to the United States from the Philippines when she was around 8 years old and offers services in Tagalog, it took her 10 months to find a Filipina therapist for herself.
“It’s feeling accepted and feeling like that person across from me is understanding my experiences and trauma, without overexplaining myself,” she said. “A lot of clients who come and seek our services is because we look like them . . . it allows our clients to feel safe and allows them to be vulnerable and allows them to open up a space of healing.”
For Abito, asking herself what she can do to address systemic barriers is a constant question on her mind.
“It boils down to what I am in control of, and that’s how I manage my team, the clinicians I hire, their cultural background, how they can bring that forward in their work—that’s how I’ve addressed it,” Abito said.
Addressing the workforce need
While the number of licensed behavioral health providers in the state increased by 20% between 2016 and 2020, this was no match for the recent increase in need for mental health support, Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, told CalMatters.
As for statewide efforts, Gov. Gavin Newsom hopes to emphasize mental health workforce development in his recent master plan for kids’ mental health, with plans to bring in 40,000 new mental health workers.
While Long Beach is looking toward efforts to build up its mental health workforce, particularly of people of color, it will take time, said Colopy.
“It’s not like by next year, we’re going to have a whole new round of workforce,” she said. “We have to continue to build that workforce over time.”
At Cal State Long Beach, internal discussions are focusing on adding seats to the university’s psychology programs, which have seen an increase in interest since the pandemic, said Bita Ghafoori, chair in the Department of Advanced Studies in Education and Counseling.
“We’ve always had a lot of interest, but since the pandemic, it’s nearly tripled,” Ghafoori said of the master’s degree in counseling psychology program, one of three graduate counseling/psychology programs currently available.
Workforce demand for mental health services is a contributing factor to the rise in interest, and most students in CSULB’s counseling psychology, school psychology or school counseling programs easily gain employment after graduation, Ghafoori said.
The counseling psychology master’s program typically accepts 25 to 30 students a year due to Board of Behavioral Sciences standards, which require a certain level of supervision and faculty available per student, Ghafoori explained.
Apart from potentially increasing faculty numbers, the department is examining the possibility of adding a doctoral program, which is also of high need in California, Ghafoori said.
“We are looking at a variety of different things,” Ghafoori said. “There’s just so many different things to consider.”
Local efforts to meet increased need
Within the city, the Health Department has been working on efforts to expand and streamline access to services, both for people with private insurance, and people on Medicaid, Colopy said.
“COVID really really exacerbated trauma and mental health for people, and the systems just haven’t been designed to manage it yet,” Colopy said. “We are really working on it. We’re paying a whole lot of attention to it for the city of Long Beach.”
Efforts included the formation of a mental health advisory board this year, engaging about 30 people from across higher education institutions, the Long Beach Unified School District, the LA County Department of Mental Health and local nonprofit organizations and hospital systems, Colopy said.
The group plans to have its initial report by the first quarter of 2023, she said.
Of the $3 million in health equity grants from the city as part of the Long Beach Recovery Act, the largest focus of those grants were around mental health, Colopy said.
Among the city’s efforts to meet the increased need include the compilation of a mental health resource guide and the establishment of a bench of Black mental health providers to specifically address the need within the city’s Black population, Colopy said.
The city is also currently in the process of hiring for its community crisis response team, an alternative to police responding to mental health crises, an effort that will be launching as a pilot program early next year, Colopy said.
As local and state officials continue to determine the best course of action, in the meantime, many Long Beach residents like Iannaci are still being left behind.
In July of this year, Iannaci resumed her search to find a therapist—but once again, it was to no avail, and she ultimately decided to stop pursuing therapy at the time.
While she will eventually attempt again to find a therapist, it won’t be while she is still on Medi-Cal insurance, she said.
“It really impacted me, not being able to talk with my feelings, it kept me stuck,” Iannaci said. “The rat-race of calling when you’re so depressed—it’s so hard to keep up with the calls and everything.”
Abito encourages anyone who is able to utilize an out-of-network session to do so, and to ask therapists about offering sliding scale or pro bono services or groups, she said.
“For minorities, it feels like there’s this debt of gratitude, but my advice for them is if you do this: Imagine what you’re showing your partner, your kids,” Abito said. “You just have to be courageous enough to send that email . . . there are providers who really do care about the community and who really want to help as much as we can.”