S1: Welcome in San Diego , it's Jade Hindman. Today. We're talking about San Diego's struggling mental health care system and what workers are experiencing. This is KPBS Midday Edition. Connecting our communities through conversation. With. Thousands of Kaiser mental health workers across Southern California are on strike for their second week. They are asking for more pay and better working conditions. Their grievance speaks to an ongoing problem for many mental health care workers across the state. They're overworked , short staffed , and unable to meet the needs of patients. Lizette Ma is a licensed marriage and family therapist working in the South Bay , where she focuses on increasing access to mental health care for the Latino community. She joins me now to talk about the challenges of the industry and how it impacts those seeking care. Lisette , welcome to Midday Edition.
S2: Thank you for having me.
S1: So I started by mentioning the mental health care workers on strike at Kaiser. But the problems aren't just limited to Kaiser.
S2: And I think we started feeling the effects shortly after during the pandemic. You know , I honestly when I was I had just opened up my private practice in 2019 and then the pandemic hit and I thought that we were going to go down because I was like , okay , everything's shutting down , business is going to go down. And we got the exact opposite effect. There was the phone was ringing off the hook and we couldn't meet the demand. Not only myself and I was also a director of Homeless Children and Women's Center at the time , and we were also severely impacted there. The number of clients and patients that were coming in for the private practice for the Homeless and Children's Center , and for every other program that that was out there for mental health was severely impacted. And we were trying to do our best. And we were , you know , to a capacity taking extra people , working extra hours. And I think not only the mental health community , but the whole all of health care providers got significantly affected by this. I think we worked through it. But I think as soon as , you know , everything kind of went back to normal. That's when it hit us that we were all burnt out. Mhm.
S1: Mhm.
S2: Yeah. I think that with the pandemic , just to speak on some of my patients and my clients , some of those very depressed individuals , they were not going out. They were not getting interactions. So they got really , really depressed. They got more depressed than they originally were before the pandemic. I say it myself because I quit my job after the pandemic , because I was severely burnt out. Um , I just I was working about 20 hour days for the duration of the pandemic , you know , not seeing my family working extra hours. I think a lot of people pushed themselves to the limits. And after the pandemic and even during the pandemic , they were reaching out more because there is no distractions from the actual mental health. Some people can and some interventions. We tell people , you know , get distract yourself from it , go out , hang out with friends , do an activity. And during the pandemic , all that was stripped away. So then you were left with just your thoughts and your feelings , and it was very hard to suppress. And that I think that's why a lot of individuals were really kind of forced to face what was going on or what had been going on for a while , but they were able to kind of suppress and ignore. And during the pandemic , because we stripped everything off , it was like it was in your face. Now we have to deal with it. Mhm.
S3: Mhm.
S1: Given that , you know , so many health care workers had to step away from their work due to burnout and the need was greater.
S2: I was just asked a question a little while ago , and I was thinking back a few years ago , I want to say 2016. I was working at a community clinic , and I remember as joking around during our staff meeting that we were swamped. We were like , we actually just booked an appointment a month out and we were like , oh my goodness , we need to hire more people right now. Wait times anywhere in the county are 4 to 6 months. Some people have eight months to get somebody in. And I think just the weights in general are due because , you know , there's less staff. The caseload are a lot of cases. Individuals or providers are asking for smaller caseloads in order for us to keep the staff happy. We tried to reduce caseloads to make it more manageable. Cases that are coming in are more severe , which makes it it makes it a heavier case caseload for the provider. For example , a typical provider could have 20 or 30 clients a week , and some of them could , you know , be moderate to acute. Um , and some are very acute. And now with the progression of mental health and just the limitation of access , a lot of the cases that are coming in that we're seeing there are a lot more severe than what we're seeing before.
S1: And you would attribute that the severity of cases because of the delays in care 100%. Mhm. So , you know , talk about the ramifications of these longer delays in getting someone seen by a therapist or social worker. The cases are a heavier lift because the the mental health issues are more severe. But what else ? How else does that impact people.
S2: That well , it also impacts. Just think about the whole system in itself. Right. So if we have an individual that was screened by their primary care doctor or the school counselor that's saying , hey , this kid is showing signs of depression or this kid's showing signs of anxiety , we refer them out. Typically we can get the kid in within a few weeks , we can get some sort of an intervention. So we can typically manage those symptoms relatively quickly. Right. And we use something called solution focus at the beginning that we do 12 sessions. We can handle it. We teach them skills. And then if the symptoms were really light , the client could manage them and be okay. If this kid waits six , seven , eight months , sometimes the anxiety of this kid starts to handicap them. For example , I had a kiddo that was referred to us. But about six months ago , we finally had time for him and we brought him in and the mom had said had that his symptoms had significantly worsened. He was anxious in class. Sometimes he would cry to go to school , but he was fine. He was able to push through it. By the time we saw this kid , he was missing 3 or 4 days of school. The school was contacting the mom , the social workers at school and the psychologists at school were trying to , you know , get involved. The kid was so severely anxious that a psychiatrist got involved. The psychiatrist referred prescribed medications. So that's one case. Another case is that they come in so depressed that by the time that they come in , sometimes we're doing a suicide assessment and the kids are actively suicidal. So then we have to refer them for inpatient. And even if you ask county mental health , they barely have enough beds , even when the police does 5150 or we call someone to get hospitalized , sometimes people are just waiting in the hall for a bed. So it's not even outpatient services is also inpatient services that is being affected. Yeah.
S3: Yeah.
S1: Sounds like it's really hitting kids and young people the hardest. But.
S2:
S1: And , uh , and this is , this is what you're seeing in the high schools.
S2: That's what we're seeing in the high schools and unfortunately in elementary schools and middle schools as well. Mhm.
S3: Mhm.
S1: Do you think this is a result of the pandemic or something else.
S2: I think it's a little a combination. I did an interview a few years ago and they asked me , what do you think is going to be the effects of the pandemic. And I said , we don't even know yet. I think we're not going to know until 5 or 6 , ten years from now. And I think right now we're starting to see some of that. A lot of these kids , you know , the five , six year olds that were not in preschool. And the transition stage of getting them integrate to socialization , some of those kids were seeing sometimes that a little bit more anxious kids , that they're not used to the big groups or that are so used to isolating themselves and playing with social media and video games and the tablets , and they prefer to do that because they did it for so long , and instead of introducing them when they're two or 3 or 4 to school , they were all homeschooled for two years. There's that. And then also because I think the school's one good thing , I think , is that the schools are doing a better job at screening , especially with the districts that I work with. They send out mental health surveys and they're assessing for anxiety , depression , suicide , abuse. So they're kind of assessing for everything. And then once they get those results , they refer out to outside providers or school contracts like myself. So I think there's more eyes on the kids now. And we're trying to catch them early , which is great. But for example , at Vista High , which is in the school district of Vista , California , last year , we assessed , I think it was about 3200 students. And out of all those surveys that we did for mental health , 600 of them were indicated that they needed mental health services. Unfortunately , at the time , we didn't have the space nor the providers to take on all 600 kids. So we had to assess all those 600 kids and try to prioritize who was going to get services first.
S1: This is KPBS Midday Edition. We're back after the break. Welcome back to KPBS Midday Edition. I'm Jade Hindman. We continue our conversation about San Diego's struggling mental health care system with Lizbeth Ma , a licensed marriage and family therapist working in the South Bay. Well , I mean , aside from having enough providers , there is the issue of having providers within the community. That's a challenge , especially in the South Bay. You focus your practice on San Diego's Latino communities , Amenities , and you actually relocated your practice to better serve the Latino community. Tell me about. That.
S2: That. Yes. So I am Latina Mexican descent , and I opened up my first private practice in 2018 , in La Jolla , California. Um , at first I was a cash practice because credentialing takes forever. That's another barrier. I was getting many , many clients that need a Spanish speaking clinician that needed therapy in Spanish , or they just wanted a therapist that they could relate to that looked like them , spoke like them that understand , understood the culture. And I kept on getting more and more of those clients or some of them that were like of mixed race , that wanted someone that they connect to. My last name is mom , my husband's Chinese and I'm Mexican , and I have a mixed child too. So I think just the culture itself is very important. And then just within the Asian culture , I also understand that it's very hard for Asians within the Asian culture to reach out for help. Um , so I wanted to make sure that I embrace that the cultures that are really close to me and that I love and embrace , that I could provide some of that. So after a year , I made the decision that if I was going to serve the communities that I love , it was best for me to move down to Chula Vista. So right now , I have my two practices in Chula Vista so I could better serve my community.
S1:
S2: I see the shift , um , not to the point that I would like , but I think it's moving slowly. Mhm.
S3: Mhm.
S1: Well , I mean , you are painting a picture of mental health care and the system facing many challenges , especially when it comes to children. It is just heartbreaking. So what do you think needs to happen to improve the situation.
S2: And this is a simple answer for a very big problem. I think we just need double the amount of providers that we have right now. Right now we're carrying very large caseloads , and including in my private practice , I still carry a full caseload in my practice , even though if you talk to most practice owners that own a good practice and a solo practice , most of them do more management and supervision. And I still have a full caseload. And that is because the need of , you know , those desperate calls that come in of , you know , please , I have no no one else to reach out and nobody can help me. Nobody's helping me. And I have a child on my own. So sometimes I just imagine myself being on the other side of the line and just , you know , not getting help for your child. It's really heartbreaking. And this is another issue , right ? We have we have associates in my practice too , and trainees. And that also takes time because a trainee needs it for every ten hours. We have to supervise them an hour. So if they have a full caseload we're spending two , three , four hours with them. If they're working 40 hours a week. So that also takes away hours that a licensed provider could be seeing a patient.
S1: Well , let me ask you this. Do you think that the work of providing mental health care in and of itself is a heavy lift in terms of , of really sort of getting involved in hearing and trying to repair people in that in a sense.
S2: I think that's a that's a bias , a question for me. I'm a mental health provider , and I do think maybe it's because I specialize in severe mental health. So I am treating the ones that require a little bit more of the heavy lifting schizophrenia , bipolar or psychosis. Trauma. Mental health providers are actually the ones that are paid the least if you compare to all health care providers. And yet we are taking on these large caseloads. We see patients weekly. We're dealing with people that have schizophrenia , bipolar , suicidal , depression , trauma. So some of it is very heavy. Or sometimes you hear these stories and there's a secondary effect of secondary trauma that the providers taking. So I to answer your question directly , I do think it's very heavy lifting. Mhm.
S3: Mhm.
S1: Is there anything else you'd like to add or say before we wrap.
S2: I think this is a very rewarding field which I'm very passionate about. I think it's sad that a lot of mental health providers or people that looked and desire to be a mental health provider before are getting a little turned off by it just because of what's going on right now. But I do believe it's very rewarding. And I think if done with balance and with grace , and if you have the right support , it could be very rewarding and it could be a balanced job. I think unfortunately , just right now , because of the amount of referrals and people that need services , it is a little overwhelming for everyone in the community , whether you are in the private sector or public sector. Um , but the good thing is that there's the demand , right ? And at least something has changed that people are asking for help. So if I could see the silver lining in this , or like the good of it is that people are asking for help.
S1: Lizbeth Ma is a licensed marriage and family therapist here in the South Bay. Lisette , thank you so much for joining us.
S2: Thank you so much for having me.
S1: That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose. Everyone.
