Dissatisfaction with Mental Health System Remains High — Two in Three Californians Believe Improvements Are Needed to Better Treat People with Serious Mental Illness

More than half of Californians who tried to make an appointment report having trouble finding a mental health provider who takes their insurance, compared to only 14% who say the same for physical health care. All told, 81% of Californians say it is important for state policymakers to focus on increasing access to mental health care in 2024.

Rising costs for all types of care remain a major area of concern: 53% of Californians say they have skipped or postponed care due to cost in the last year — a number that climbs to 74% among people with low incomes. Nearly four in 10 Californians now report carrying medical debt.

This year’s poll finds views shifting on other issues: Views are mixed on whether the state is making progress toward racial equity in health care, while the effects of climate change are having growing health impacts, especially for Californians with low incomes and those who speak Spanish.

California’s mental health care system isn’t working for millions of Californians, and large majorities say improvements are needed to treat people with serious mental illness and to expand limited access to mental health care providers, according to the newly released 2024 CHCF California Health Policy Survey conducted by the California Health Care Foundation and NORC at the University of Chicago. The poll, an annual snapshot of Californians’ views on health issues, was conducted from September 18, 2023, through October 25, 2023, among a random representative sample of 3,431 adults age 18 or older living in California.

Two in three respondents told pollsters improvement is needed in treatment of people with serious mental illness, with 42% saying “significant” improvement is necessary. More than half of Californians who tried to make an appointment, meanwhile, say they have had trouble finding a mental health provider who takes their insurance — compared to only 14% who report difficulty finding providers who take their insurance for physical health care. More than half of Californians who tried to make an appointment report waiting longer than they thought reasonable to see a mental health provider. And 81% of Californians think increasing access to mental health treatment should be an “extremely” or “very” important priority for state policymakers in 2024.

The high cost of care also continues to be a major area of concern for Californians: More than half (53%) say they skipped or postponed care due to cost in the last year — a number that grows to 74% among Californians with low incomes. More than half of those with low incomes who skipped care (54%) say their condition got worse as a result. Three in 10 Californians say their ability to access high-quality, affordable care has gotten harder in the last few years. More than a quarter of Californians (28%), and nearly half of Californians with low incomes (46%), report trouble paying medical bills. Close to four in 10 Californians (38%), and over half of Californians with low incomes (52%), report having medical debt.

“Access to mental health care and the rising cost of care have emerged in this year’s poll as two of the health issues Californians are most concerned about,” says Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation. “Californians have strong views on the need to improve treatment options for people experiencing serious mental illness — and they are increasingly frustrated with their own personal access to mental health providers. The high cost of care, meanwhile, is a perennial issue we’ve seen in poll after poll: This year’s survey finds once again that rising health care costs are negatively impacting the lives of millions of Californians.”

“Whether it’s helping get people off the streets or making it easier for anyone experiencing mental health issues to see a doctor, it’s clear from this new CHCF poll that improving mental health care services must remain a top state priority,” says Senator Susan Talamantes Eggman, chair of the Senate Committee on Health. “The CHCF poll also highlights a range of other issues that we will all need to focus on in this year’s health policy debates — from promoting racial equity in the health care system to building a health workforce that looks more like California.”

This year’s CHCF health survey finds health care issues rank at the top of Californians’ list of state policy priorities — with 93% of Californians with low incomes, in particular, ranking health care alongside combating inflation as “extremely” or “very” important. Other top health policy priorities addressed by the poll include:

• Racial equity. Californians report mixed views on progress toward racial equity in health care. Although 43% of Californians overall believe the state has made “a great deal of” or “some” progress in achieving racial and ethnic equity in the health care system in recent years, 44% of Black Californians and 33% of Latino/x Californians say the state has made “only a little progress” or “no progress at all.”
• Behavioral health. One in four Californians (25%) say they or someone close to them has needed treatment for serious mental illness, and one in five (21%) say the same for substance use or addiction issues. Large majorities believe the state needs to strengthen treatment options for behavioral health challenges, with 67% saying improvement is needed for people with serious mental illness and 64% for substance use or addiction treatment.
• Health workforce. The state’s ongoing shortage of health professionals continues to be a challenge in many communities. Nearly half of Californians (46%) think their community does not have enough mental health care providers, including psychologists and therapists, to serve the needs of residents. And 42% say their community does not have enough nurses or primary care providers.
• Climate and environment. Extreme weather is a growing health issue for many Californians, with more than half (53%) saying they are “very” or “somewhat” worried about the effect of weather and environmental factors such as extreme heat, floods, wildfires, and air quality on their or a family member’s physical or mental health. That number climbs to 65% for people with low incomes. Californians who speak Spanish (82%) are more likely to be “very” or “somewhat” worried than those who speak English (52%) or Chinese (51%). One in five Californians (21%) — and 29% of people with low incomes — report having physical health impacts this year due to extreme weather.
• Artificial intelligence. CHCF asked Californians for the first time this year about their comfort using artificial intelligence (AI) in health care. More than half of Californians overall (53%) — across almost every income, racial, and ethnic group — report being “not very” or “not at all” comfortable with the use of AI in health care. Multiple factors are contributing to this discomfort, with 73% of Californians saying they fear AI will lead to medical errors, 70% reporting discomfort interacting with AI instead of human care professionals, and 52% worrying about privacy and security.
• Hospitals. With hospital finances making headlines last year, nearly half of Californians (46%) are “very” or “somewhat” worried about hospitals in their communities closing. Californians with low incomes (61%) are more likely to be “very” or “somewhat” worried than those with higher incomes (42%). The poll also finds, however, that only 8% of Californians live in a community where a hospital closed in the last year.
• Housing and homelessness. The state’s lack of affordable housing continues to have health impacts on many Californians. Eighteen percent of Californians have either experienced or had someone close to them experience a period of homelessness in the past five years. Californians with low incomes (36%) are more likely to say they or someone close to them has experienced homelessness than Californians with higher incomes (14%). Black Californians (32%) and Latino/x Californians (24%) are more likely to report this experience than White (15%) and Asian Californians (8%).

Poll results will be published at 12:01 AM (PT) on Wednesday, January 31, 2024, and can be found at this link after that time: The 2024 CHCF California Health Policy Survey – California Health Care Foundation

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