The Accessibility of Mental Health Services in LA

Exploring Mental Health Services from the Societal Perspective

Introduction

With the increasing concerns about mental health diseases and distress, there are now more mental health providers serving the greater Los Angeles community than in past decades. The availability and range of mental health services have expanded, aiming to decrease the stigma surrounding mental health and emphasize the importance of happiness and well-being. Mental distress and clinically diagnosed disorders can significantly impair our daily functioning, emotional regulation, and social behavior.

Considering the paramount importance of mental health as well as the adequate services opening for users, it seems plausible that community providers and agencies are on the right path in ameliorating mental health issues. However, I have seen people suffer from mental distress and do not utilize the resources to cope. At a group level, is it a concern for specific populations? From a humanistic perspective, it will be most optimal if all LA residents learn their rights and utilize the services equally.

In this project, I will explore the accessibility of mental health services, the variations of receiving mental health services in the context of race and inome, and any geographical vulnerabilities of getting services.

History

A Top-down Perspectives of Mental Health Story in California

To delve into mental health issues and accessibility in Los Angeles, we should first examine a brief history of how California has addressed these challenges. Initially, the primary focus was on treating mentally ill patients, and institutional care became the prevailing approach to accommodate a large number of individuals struggling with mental health problems. During the Victorian era, institutional facilities were widespread in rural areas, as people believed that fresh air and a pleasant environment could aid in the healing of psychological distress (Moore 2018). However, many of these facilities became overcrowded and overloaded, resulting in diminished effectiveness and increased operational costs.

Left: Napa State Hospital; Right: Stockton State Hospital

For instance, Stockton State Hospital, originally known as the Insane Asylum of California at Stockton, was the first public hospital established to provide a sanctuary for mentally ill patients. It was founded in response to the psychological distress experienced by many prospectors during the turbulence of the Gold Rush in 1849. At the time, existing hospitals were ill-equipped to effectively treat the large number of individuals suffering from mental health problems. It is important to note that individuals with psychological vulnerabilities were involuntarily sent to the hospital, but the quality of care provided was suboptimal. Some even questioned whether the hospital served more as a madhouse for socially-disapproved individuals (Gilbert 2010). As the hospital faced overwhelming numbers of patients due to the involuntary hospitalization of individuals with developmental disabilities, it struggled to deliver satisfactory services and became associated with patient neglect and abuse. Consequently, additional hospitals were opened to alleviate the overcrowding situation. Napa State Hospital, one of the psychiatric hospitals, was established with the aim of reducing overcrowding at Stockton State Hospital. Once self-sufficient, it remains the oldest hospital still in operation today.

From Institutional Care to Community-based Service

One of the biggest challenges faced by many hospitals in California was overcrowding. The rapid population growth led to a shortage of staff, inadequate treatment outcomes, and insufficient facilities to accommodate the growing number of patients who deserved equal treatment under all circumstances. Consequently, there was a shift towards community-based services shortly after these chaotic conditions. Reforms included the enactment of the Short-Doyle Act in 1957, which increased funding for community mental health providers to offer services in neighborhoods, making it more convenient for people to seek help nearby instead of having to travel to rural areas (Moore 2018). The Lanterman-Petris-Short Act in 1968 put an end to involuntary commitment, further reducing the population of hospitals.

With continuous efforts, California has become one of the states that seems to have sufficient centers and counseling services in major cities. Community-based services encompass a wide range of offerings, such as assessments, case management, crisis intervention, medication support, peer support, and other rehabilitative services. These services primarily target individuals with low to moderate mental health risks, as stated by LACDMH (Los Angeles County Department of Mental Health). Meanwhile, state hospitals continue to serve patients committed through civil and criminal acts (Moore 2018).

MH Providers in Los Angeles

LACDMH - Los Angeles County Department of Mental Health

The Los Angeles County Department of Mental Health (LACDMH) is the largest county-operated mental health department in America. LACDMH offers services through contracted programs and its own dedicated staff, who work in collaboration with schools, courts, organizations, and other county departments. Through these concerted efforts, LACDMH has been able to assist an average of over 25,000 residents each year.

Service Planing Area

The department emphasizes that their mental health services are distributed equally in terms of age and race-ethnicity, with a focus on promoting hope, recovery, and wellbeing. They boast an expansive and inclusive network of services that are evenly located across the Service Planning Areas (SPAs). SPAs are geographical regions defined due to the large size of Los Angeles County. As depicted on the map, the county of Los Angeles is divided into 8 districts. This classification enables the Department of Public Health to analyze and provide more relevant public health and clinical services, tailored to the specific health needs of the residents living in those districts.

SPA in Los Angeles

The SPA framework addresses geographic boundaries when planning for public health, including mental health services. LACDMH has indeed made satisfactory progress in optimizing the availability and capacity of services within each SPA, which bodes well for mental health planning across all areas. As you slide the map to the right, you'll notice an abundance of mental health centers and counseling service facilities within each SPA, with the majority located in populated areas. However, there are a few locations on the outskirts of Los Angeles where utilization of services is lower, reflecting the lower demand in rural areas. It's important to note that the distribution of facilities is not uniform across the county, with a concentration in the central area, the South of SPA 4 Metro LA, and the middle of SPA 2 San Fernando.

MH Counseling Services and Centers

The positive outcomes are indeed promising, especially considering that a significant number of mental health facilities are located within the SPAs. However, as you slide to the left and the SPA polygons disappear, you will notice significant gaps and empty areas where the distribution of facilities is uneven. Most of the facilities are concentrated along the freeways and main roads, leaving certain areas with fewer options for mental health services.

MH Centers

There is an uneven distribution of mental health centers in Los Angeles, with a concentration of facilities in areas such as the San Fernando Valley, Long Beach, and the western part of downtown Los Angeles. Additionally, many mental health centers are situated near main roads and freeways, implying that access to mental health services may be more convenient for individuals who own vehicles or have access to public transportation.

MH Counseling Services

The number of mental health counseling services is fewer compared to that of mental health centers. Similarly, there is a cluster of mental health counseling services located in the west of downtown Los Angeles. However, it is worth noting that most counseling services are located away from major roads.

Overall

Similar distribution patterns can be observed for both mental health centers and counseling services in Los Angeles. The key takeaway is that mental health centers have greater coverage within the city but require access to a car, while counseling services cater to individuals who may not have the ways to travel. An issue arises for those without access to a vehicle, as they face greater challenges in utilizing these services. This is particularly relevant for low-income groups who may struggle to afford reliable transportation or may experience traffic. As for whether the government assists vulnerable groups in dealing with health problems, various programs and initiatives are in place to provide support. However, the extent and effectiveness of these measures may vary, and it is important to continuously evaluate and improve existing systems to ensure equitable access to healthcare for all individuals.

In addition to transportation problems, it is intriguing to observe the clustering of service locations in specific areas rather than a more even distribution. There may be reasons why the government decided to build more centers in certain regions to meet the needs of the population. Unfortunately, the Public Health Department does not provide further explanation regarding the division of SPAs beyond geographic factors and its partnership with LACDMH to ensure stable and sufficient resources for the public to utilize. Obtaining additional information is necessary to delve deeper into the development of mental health services in Los Angeles and to address issues of social justice.

Network Adequacy

Network Adequacy data from LACDMH Geospatial Initiative

Network adequacy refers to the availability of doctors or providers who accept one's insurance for visits. According to the outpatient: adult data and psychiatry: adult data from LACDMH, their providers are located in close proximity to areas with high client density, particularly in downtown LA and South LA. This suggests that services are equitable and accessible for those who truly require assistance. However, it appears that the service in Lancaster and surrounding areas may not be as sufficient.

Currently, it is true that mental health services in Los Angeles are equitable and adequate. However, the SPA may limit the humanistic perspective, which can tell a different story about accessibility. While living in less affluent neighborhoods can negatively impact mental health, such as being more prone to depression for those living near highways, it may seem less important when compared to systemic discrimination and income levels. The SPA framework does not evaluate other causes that are more likely to contribute to psychological distress. However, with the help of spatial technologies, we can consider multiple variables in assessing the development of mental health services and determining the accessibility and equity of resources based on individual utilization. It is important to recognize that there are numerous factors that influence the development of mental health services and the determination of accessibility and equity of resources.

Project Interest

In this project, I aim to investigate two variables: income and LA traffic. While the question of whether money can buy happiness remains debatable, studies have shown that individuals with an annual income below $75,000 can experience a greater level of happiness. Financial worries can be a significant source of stress, so it would be intriguing to explore how LA County and LACDMH have addressed mental health issues within the low-income group over the years.

Meanwhile, Los Angeles is notorious for its heavy traffic congestion. Navigating through the city during peak hours can be intimidating, but driving remains the most time-efficient means of transportation for LA residents to reduce their commuting time. The transportation infrastructure forms a complex network that expands within and between SPAs, serving as a crucial factor in determining geographical accessibility to reach mental health services.

Income

Below Median Income & Mental Health Service

The grey polygons on the map indicate regions with below-median income. These lower-income regions are primarily located in San Fernando Valley, downtown LA, South Bay, and other inner areas of the county. It is surprising that mental health facilities are aligned with these lower-income groups, indicating that individuals with low income can access medical consultations and treatment within a short distance. Improving the mental health of the low-income group seems to be one of the key goals for LACDMH.

However, it is concerning that the locations of mental health facilities seem to favor a specific population. Firstly, using median income as a strict cutoff may not accurately capture the extent of poverty, as individuals who meet the minimum annual median income may still experience significant financial hardship without receiving the same level of attention they deserve. This group often faces challenges in accessing welfare benefits and struggles to meet basic expenses such as rent and bills. They appear to be at a disadvantage when it comes to receiving mental health care, while the focus seems to be primarily on the below-median income group, who receive more attention and benefits from government planning.

Secondly, concentrating most facilities in low-income areas may perpetuate the stigma associated with seeking mental health help among all low-income individuals. This adds to the burden of discrimination faced by the low-income population, as others may assume that poverty is synonymous with despair and the need for assistance. In reality, individuals from all walks of life can experience psychological barriers and require support.

It is important to consider the diverse range of individuals who may need mental health services and ensure equitable access for all, regardless of income level.

LA Traffic

LA Traffic: Different Representations

Traffic plays a significant role in geographical mobility and accessibility in Los Angeles. Due to the limited convenience of public transportation, LA residents heavily rely on traveling to fulfill their basic living needs. When it comes to accessing mental health care, long travel times can be a major obstacle, leading to lower attendance rates and a terrible counseling experience. This poses a concern for decreasing accessibility and mobility in receiving adequate mental health services.

​​These two maps provide insights into the severity of traffic congestion in Los Angeles, depicted in two different representations. The heat map offers an overview of the alarming levels of traffic throughout LA, although the density of the heat may obscure some details. On the other hand, the map on the right allows for a closer examination of the traffic counts in close proximity to the facilities, as shown above. The data reveals that downtown LA is the most heavily affected by traffic, followed by South LA and San Fernando Valley. According to the Department of Public, these areas predominantly fall within SPA 4, SPA 6, and part of SPA 2, respectively.

It is important to highlight that these SPAs correspond to areas with below median income, where low-income families are predominantly located. However, it is interesting to note that the low-income group in the South Bay region does not face significant traffic congestion. This reveals an inequality in accessing mental health services within the low-income group based on geographic factors. In the following analysis, we will delve into the specific SPAs that face the dual challenges of traffic congestion and low-income residency, with a focus on examining the impact on different racial communities.

Disadvantage SPAs:

Disadvantaged SPAs from the Department of Public Health in Los Angeles

These SPAs are minority-dominated, with a high percentage of individuals having less than a high school diploma, especially among Latinos. They are low-income, and many of them are foreign-born. They are mostly affected by these distresses that contribute to mental health issues. Having more mental health centers situated in these areas is thought to be effective in terms of resolving network adequacy. However, overcrowding in these areas may discourage them from seeking help. For instance, people are not willing to stay in traffic to seek healthcare; instead, they would use that amount of time to earn a living and maintain their livelihood. LACDMH did not mention the rate of patients utilizing the resources in each SPA. It is questionable to ask, how can we make mental health more accessible to everyone?

Conclusion

The accessibility of mental health services in Los Angeles has significantly improved over the years, with a focus on reducing stigma and promoting well-being. However, there are still challenges in ensuring equitable access for specific populations. While mental health centers are generally distributed across the county, there are disparities in the availability and utilization of services in certain areas. Low-income communities face barriers related to transportation and may have limited access to mental health resources. Additionally, the concentration of facilities in low-income areas may perpetuate stigma and overlook the mental health needs of individuals above the median income level. Furthermore, traffic congestion in Los Angeles poses a significant obstacle to accessing mental health care, particularly for residents in heavily affected areas. It is essential to address these issues and ensure that mental health services are accessible to all residents, regardless of income, race, or geographical location. Continuous evaluation and improvement of existing systems, along with a humanistic perspective, can help create a more equitable and accessible mental health care environment for all individuals in Los Angeles.

Sources

The basic dataset for this project was examined and analyzed from the official website of LACDMH. LACDMH utilizes spatial technologies to improve the accessibility of mental health services in Los Angeles, taking into consideration place and space using the SPA framework. The department provided heat maps that contain useful information about the demand for the service, represented as client density. However, the website itself does not interfere with the concept of SPA and the corresponding demographic in each area. To explain how LACDMH planned its services and to justify if the planning was distributed equally among all racial populations, a secondary source from the Los Angeles Department of Public Health was required. This source helps determine whether every resident of LA, regardless of their location, is able to access the service.

Apart from the missing SPA detail, LACDMH's Geospatial Initiative does not discuss any other variables that contribute to the location of the facilities. As a result, it is challenging to find data that supports whether LA residents have access to the service. I evaluated two variables in two directions: income and LA traffic. All of this data was obtained from LA Geohub, and I created maps using ArcGIS. One limitation of this project is that it does not provide conclusive evidence to support social justice, as there are various factors that impact service accessibility. However, this project focuses specifically on LA since income and traffic are among the significant obstacles that many LA residents face.

Lastly, I have read and quoted relevant information from ABC News and official hospital websites for writing the History of Mental Health Story in California. These sources are credible and provide insights into the transition of mental health services, highlighting the shift from sending patients to psychiatric hospitals to establishing community-based centers and facilities. This transition has led to increased service availability, implying that more people would have access to these services if location wasn't a barrier. However, without knowledge of the demographic makeup of these locations, it becomes challenging to assess accessibility and make informed decisions regarding resource allocation for improvement.

Bibliography

“Geospatial Initiative.” Department of Mental Health, dmh.lacounty.gov/gis/.

Gilbert, Lori. "Hospital legacy shrouded in mystery." Recordnet, 26 Oct. 2010,  www.recordnet.com/story/lifestyle/columns/2010/10/26/hospital-legacy-shrouded-in-mystery/51425784007/ .

"Los Angeles County Department of Public Health." Los Angeles County Department of Public Health, publichealth.lacounty.gov/.

Moore, Sarah. "A Brief History of Mental Health Care in California." ABC10, 18 Apr. 2018,  www.abc10.com/article/news/local/california/a-brief-history-of-mental-health-care-in-california/103-537434252 .

"Napa State Hospital." California Department of State Hospitals, www.dsh.ca.gov/Napa/.

"Understanding the Lanterman-Petris-Short (LPS) Act." Disability Rights California,  www.disabilityrightsca.org/publications/understanding-the-lanterman-petris-short-lps-act .