A year and a half into the pandemic, Lisa Albers’ 16-year-old came out as a trans young woman. Together, the family — including Lisa’s husband and their youngest child — helped in choosing her new name: Kira.
Following their instincts and the advice of Kira’s doctor, Lisa and her husband sought out a therapist who specialized in working with transgender teens, only to find themselves facing an uphill battle.
“My husband and I hoped to provide Kira with support, but we also wanted her to have another person to talk to if she wasn’t comfortable sharing with us — someone who could help her navigate the social issues of transitioning at her age,” explains Lisa, who is a medical consultant in CalPERS’ Clinical Policy and Programs Division.
Today, Lisa and the CalPERS health team are helping lead statewide efforts to improve behavioral health access and services for our 1.5 million health program members.
“We were given the names of three therapists who were believed to have experience with transgender teens and then we were essentially told, ‘Good luck,’” Lisa recalls. “We soon learned none of them were available.”
Lisa combed the internet looking for Sacramento-area therapists with the right experience and found there weren’t many. It took her nearly eight weeks to find a therapist and schedule an appointment, and that’s still considered a good turnaround time. She acknowledges her familiarity with the health care system gave her an advantage.
“It would be devastating to be unable to find a therapist and get help for your child,” Lisa says. “We’re very lucky. Our experience was nothing compared to the frustration and disappointment many people face when trying to find a mental health provider.”
What Is Behavioral Health and Why Is It So Hard to Access?
Behavioral health is an umbrella term that generally refers to mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms, according to the American Medical Association. Behavioral health care refers to the prevention, diagnosis, and treatment of those conditions.
Demand for and access to these services have taken a huge hit, as rates of stress, anxiety, depression, and substance use have increased substantially since the start of the pandemic. Young people, especially LGBTQ+ youth, are struggling with their mental health and seeking support at rates significantly higher than before the pandemic. The result is there aren’t enough therapists to keep up with the growing demand. And even if you can find a therapist taking new patients, you’re often faced with wait times that can last months.
“We all know the pandemic took an enormous toll on everyone,” Lisa says. “It exposed mental health issues and exacerbated what was already there, particularly in teenagers. We’ve seen similar issues here at CalPERS, with members calling in understandably frustrated because they can’t find a mental health professional.”
What CalPERS Is Doing About It
Lisa and the health team are committed to helping CalPERS do something about this. In the 2024-28 contracts for our Health Maintenance Organization (HMO) plans, they’ve added new requirements for behavioral health, intended to expand and improve access to these services. The bottom line: CalPERS is holding health plans more accountable when it comes to providing behavioral health services.
“Everybody knows we’re facing a shortage of behavioral health providers. This can be even more challenging if you’re looking for a therapist with a shared background or culture that you can identify with,” Lisa says. “Because there’s such a shortage, we can’t necessarily ensure that everyone finds providers that match their preferences, including when it comes to a preferred language. But that is ultimately the goal.”
What Our Members Have to Say
To gather more insight on our members’ experiences in accessing behavioral health services, CalPERS partnered with the UC Davis Center for Healthcare Policy and Research. It led to the CalPERS Behavioral Health Access Project, which surveyed CalPERS members enrolled in one of our health plans from January 1, 2020, to mid-October 2021.
Not surprisingly, the survey results reflect what’s being seen on a national scale.
Of the more than 10,000 CalPERS members who responded to the survey, more than half considered seeking behavioral health care. Of those who received care:
- 61% were unable to get an in-plan appointment within two weeks
- 46% identified difficulty finding a provider as the biggest barrier to care
- More than half received care outside their health plan
- LGBTQ+ members were more likely to report a lack of timely access to care
“We know our members need better access to behavioral health services, yet they’re having difficulty getting it,” Lisa says. “Our contracts with health plans are our most important lever in ensuring they provide the best care for our members. It’s how we hold them accountable.”
What It Means
Language has been added to health plan contracts, outlining our new requirements for behavioral health. It states:
- Health plans will be required to provide CalPERS with detailed reports that include the number and location of behavioral health providers, and whether members are able to get appointments in a timely manner.
- Health plans will be required to communicate with their members on the types of behavioral health services available to members, including telehealth, and how to access these services.
- Health plans will be required to promote the integration of behavioral health care and primary care.
Lisa believes behavioral health should go hand-in-hand with primary care, as you can’t be physically healthy if your mental health is suffering.
“Members shouldn’t have to go to their primary care doctor and get treatment and medications for physical health issues, only to get a referral for a therapist and have to wait weeks to months before being seen,” she says. “Integrating the two leads to more immediate, ‘whole person’ care.”
CalPERS Partnered with Covered California and California Department of Health Care Services
CalPERS is also working with the California Department of Health Care Services and Covered California to push for similar requirements surrounding behavioral health. “Between our three agencies, we represent 17 million Californians,” says Lisa. “That’s an enormous amount of people and organizational strength to bring to the table when talking to health plans about needing to improve the quality of mental health care.”
The goal is to ensure CalPERS members receive exceptional health care in all areas, with a heightened focus on behavioral health because the current climate is unsustainable.
“When you realize that you or a family member need a therapist or some other mental health professional, there’s just heart sink. There’s a feeling of dread because you know it’s an uphill battle,” Lisa says. “We have no way to fix that immediately, but we’re trying with these new requirements.”