It’s a case of supply and demand.

As more people have access to health insurance, there is need for more health care providers, and the pinch is felt in northern Sonoma County especially when patients need mental health services and speak only Spanish.

In response, the county and The Healthcare Foundation Northern Sonoma County, the only funder exclusively focused on health for northern Sonoma County, is trying to lure local bilingual students into health care careers.

“There is absolutely a shortage,” said Susan Castillo, the county’s community mental health section manager. “In general there’s a huge shortage, and it’s huge in psychiatry.”

In California, nearly one in six adults has mental health needs, and one in 20 suffer from serious mental illness. The rate among children in the state is even higher at one in 13 children, according to the California Healthcare Foundation.

In northern Sonoma County, roughly from northern Santa Rosa to Cloverdale, only one third of parents who rated their children as having definite or severe mental health issues had visited a mental health provider in the past year, and Latino children were considerably less likely to have had a visit than Caucasian children, according to a 2016 St. Joseph Hospital Mental Health Needs Gap Report.

One of the biggest problems is the centralization of services in Santa Rosa, and a lack of reliable and consistent transportation, said Debbie Mason, CEO of The Healthcare Foundation Northern Sonoma County. Families may have one car that they share, or take the bus, which takes all day from Cloverdale to Santa Rosa and back, and that means a missed day of work.

Many people also have reservations about going to see psychologist or psychiatrist for mental health problems.

Miscommunication can occur when both parties speak the same language, let alone when they don’t. Patients also feel more comfortable when they can speak freely with their doctors in their own language.

The problem is exacerbated by some providers who say they are bilingual, when they actually are not, Mason said.

“It’s been a silent and growing epidemic and the fires make it that much worse. People will think they are fine, trying to keep things normal for the family, but there is a lot of post traumatic stress disorder experienced after giant disasters like this. You’re running on adrenaline for three or four months, and all of a sudden it becomes an issue. The question then is, where to go for help?” said Mason.

Alliance Medical Center, with clinics in Healdsburg and Windsor, does have a robust Behavioral Health Department and serves many of the Latino families in the region. It saw about 850 behavioral health visits last year.

The center is fortunate to have five therapists, four of which are bilingual, and each sees 9 - 12 patients per day, and the wait for an appointment is only about a week, said Maria J. Alvarez, Ph.D., bilingual bicultural psychologist, and director of the center.

Alliance only has two psychiatrists on staff, however, and each devotes only eight hours per week to the center. One is bilingual, the other is limited bilingual.

If Alvarez has a new patient who is bipolar, for example, the wait to see the psychiatrist for medication is about five months.

“We juggle the schedule, we beg, we plead to get the urgent patients in. There is incredible stress. Sometimes we have three (of these patients) per week. It’s an amazing challenge,” Alvarez said. “There’s a lack of doctors, and it’s going to get worse.”

Recruitment and retention and meeting the demand

The shortage of health care providers in general can be attributed in part to the passage of the Affordable Care Act which in 2014 gave millions of more people access to health insurance.

Also in 2014, Medicare began Mental Health Parity, which greatly lowered the copayment for most mental health outpatient treatment.

Alvarez said she is an aggressive recruiter, but luring providers to Sonoma County is difficult, not because of the job itself, but because of the high cost of living and the housing shortage, now made worse by the fires.

“It’s an added layer on top of the overall shortage,” she said.

To address the dearth of providers, Sonoma County has been trying to encourage bilingual students of all ages to consider a career in health care through a number of programs.

They include health care workforce conferences at Santa Rosa Junior College, and outreach at Roseland Academy to elementary students.

“We’re growing and focusing our energies on local students, reaching down deep,” said Castillo.

The Healthcare Foundation Northern Sonoma County is launching an initiative which promises to place more bilingual mental health professionals in the region with the Mental Health Pipeline Project.

“While doctors are important, this is also about all mental health providers, which includes marriage and family therapists, licensed social workers, school counselors, mental health nurse practitioners – the whole continuum of mental health providers,” Mason said.

Over the past summer, the foundation held a number of sessions with more than 50 nonprofit providers that serve the region. Health and social service providers and interested parties representing 39 organizations.

They repeatedly reported the severe shortage of mental health professionals as the single most challenging issue they struggle with, particularly for clients that need bilingual and bicultural assistance, and those needing evening and weekend visits.

Families struggle to find providers that are bilingual and bicultural and if they can find one, often wait up to six months for an appointment, Mason said.

“We knew it already, but to hear it from providers with such urgency, and with such emotion from residents… lack of timely access to mental health professionals was a near crisis situation even prior to the fires,” she said.

One of the participants, Reach for Home, a homeless services organization based in North Sonoma County, houses 65 individuals for a year while helping them get their life together. Ninety percent are Latino.

With the immigration crackdown on Latinos from the current federal administration, and growing deportation fears, Colleen Carmichael, executive director of Reach, said trust in sharing personal information is also a huge factor in wanting to see a Spanish-speaking doctor who also understands the culture, and what people are going through.

“They don’t feel welcome or safe,” she said. “There is a lot of fear and hesitation in that population to see a healthcare provider in the first place, and the amount of stress, unemployment, the fires, and no bilingual providers are (extra) barriers.”

The foundation’s Pipeline Project has partnered with the University of California San Francisco and Sonoma State University, which both have graduate level programs that produce mental health professionals.

Those graduates, with a master’s degree in therapy, have to intern with a doctor for two years. The foundation, which already provides scholarships to these students, will assist them in finding local internships, and will also offer stipends to offset living costs.

The foundation will also offer the doctor-employer funds for a sign-on bonus, and when the internship is completed, a retention bonus to pass on to the student.

“If we have 10 -12 more therapists on the ground it will augment the situation greatly for people to get counseling. While this approach might not make a big dent in the problem in a metropolitan area, in a sparsely populated rural area like northern Sonoma County, adding more professionals over a few years, can make a very big impact. It directly addresses the problem: Get them, pay them, and keep them here,” Mason said. “We are getting in front of students in a few weeks and we know from the scholarships we already do that they will deeply appreciate it.”

The Mental Health Pipeline Project is funded initially with $100,000 each year for a number of years. That funding comes from the Bancroft Foundation and the Foundation for Global Sports Development.

The first year, the foundation plans to focus on residents of Healdsburg and Windsor, by partnering with Alliance. The foundation will test the model in its first year and make revisions as needed before bringing in other partners, Mason said.

Initial discussions are also under way with middle and high schools about providing mental health support services.

Cynthia Sweeney covers health care, hospitality, residential real estate, education, employment and business insurance. Reach her at Cynthia.Sweeney@busjrnl.com or call 707-521-4259.