California now has more conclusive data on the uniquely different experiences of communities of color in their interactions with system of mental health care. In 2017, CPEHN sponsored AB 470 (Arambula), which required the Department of Health Care Services (DHCS) to improve the Statewide Performance Outcome System for specialty mental health services (SMHS) to identify mental health disparities at the county or statewide level. DHCS now provides publicly available data on disparities in mental health utilization, access, and outcomes. Assembly Bill 512 builds upon the findings from AB 470 and requires the California Department of Health Care Services and local county mental health departments to use this conclusive data to set performance goals to reduce disparities in California’s communities of color.
Despite California’s investments in mental health care, several key findings from the improvements to the Statewide Performance Outcome System show the need of communities of color for great quality and access in mental health care.
On average, 4.3% of adult Californians are diagnosed with serious mental illness. Latino, African American, Native American, multi-racial, and LGBTQ+ adults have rates of serious mental illness above the state average.[i] The Statewide Performance Outcome System allows for stratification by certain population demographics like sex, gender, race, ethnicity, primary language and other data elements. Findings from the improvements in the Statewide Performance Outcome System, laid out in AB 470, shows that Asian and Latino Californians were half as likely as Whites to initiate and engage in mental health treatment in 2016-17. The improvements in the Statewide Performance Outcome System shows that while Black Californians engage with the specialty mental health system at disproportionate rates, their outcomes pale in comparison to other populations.
The graph below shows that despite higher rates of inpatient treatment over 50 percent of Black Californians wait more than 8 days to step down from an inpatient setting to a lower level of care. AB 470 shows that race play a significant role in California’s ability to seek out effective help for mental health challenges.
In comparison to other racial and ethnic groups, the time to step down from an inpatient setting to a lower level of care is significant worse for Black Californians. The graph below shows it takes twice as long for Black Californians to step down from an inpatient setting to a lower level of care than it does for most other racial or ethnic groups, despite no evidence of less need.
Alaskan Native or American Indian
Asian or Pacific Islander
Median Days to Step Down
Racial Disparities in Small Counties
Improvements to the Statewide Performance Outcome System show that these racial disparities exist in Californian’s small counties, despite overall fewer number of people from communities of color.
The improvements in the Statewide Performance Outcome System shows that mental health utilization also varies dramatically by language, and that these disparities are not improving over time. The graph below shows that only 1% of Californians whose primary language is Spanish, Cantonese, or Vietnamese are engaged with the mental health system, compared to 3% of English.
The improvements in the Statewide Performance Outcome System also shows that language disparities are not improving over time. The graph below shows that the disparity between non-English speakers compared to English speakers in specialty mental health care has actually worsened between 2013 and 2017.
Disparities in Sexual Orientation and Gender Identity (SOGI)
The Statewide Performance Outcome System allows for stratification by certain population demographics like sex, gender, race, ethnicity, primary language and other data elements. The Statewide Performance Outcome System will allow for stratification by sexual orientation and gender identity (SOGI). LGBTQ+ individuals face a number of mental health disparities, including higher rates of mental health disorders, higher rates of substance use, and higher rates of suicide. Findings from AB 470 will inform state and local strategies to address disparities in LGBTQ+ communities. DHCS will post first set of AB 470 reports with SOGI data in December 2019.
Disparities Reduction Goals
Findings from improvements to the Statewide Performance Outcome System can help counties craft accurate strategies for reducing mental health disparities in communities of color, who will become an estimated 62% of the state’s population by 2030.
Brought forth by AB 470, disparities exist in Californian’s system of specialty mental health care, but the identification and incorporation of culturally and linguistically appropriate performance measures in public mental health system is lagging. California’s other health systems will begin to incorporate mental health performance measures without a clear role for DHCS specialty mental health care. Managed Care Plans will now be required to adhere to a number of Centers for Medicare and Medicaid Services (CMS) mental health performance measures, and perform at least as well as 50% of Medicaid plans. DHCS has also not incorporated managed care mental health data into the Statewide Performance Outcome System, despite the need to improve integration in health and mental health between counties and Managed Care Plans.
Disparities data is currently being made available by DHCS. However, California has not used this data to develop goals. Assembly Bill 512 requires the California Department of Health Care Services to develop culturally and linguistically appropriate performance measures to improve access to mental health care for California’s communities of color.
 Holt, W. Adams, N. (2013). Mental Health in California: Painting a Picture, California HealthCare Foundation, http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20M/PDF%20MentalHealthPaintingPicture.pdf. Accessed March 13, 2019.