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Golden State Crisis:

Half of Californians Who Need Mental Health Services Are Not Getting Treatment 

With ongoing national debate focusing heavily on the Affordable Care Act and access to medical care for all Americans, the topic of mental health is getting lost in the dialogue. Consider this: if a life-threatening virus outbreak were to suddenly infect 20 percent of our population, the response from the medical community and everyday citizens to mitigate the threat would be far-reaching and immediate. So why is so little attention paid to mental health issues which directly impact one in every five Americans?

In California, the incidence of mental health issues closely mirrors the national experience. Nearly 1 in 6 adults has a mental health need in the state, and approximately 1 in 20 suffers from a serious mental illness.1 The rate among children is even higher: 1 in 13 suffers from a mental illness that limits participation in daily activities. This translates to over one million adults who live with serious mental illness, and almost half a million children with serious mental health conditions.2 Even more alarming is the fact that about half of adults and two-thirds of adolescents with mental health needs in California do not get treatment.3

Research published within the mental health community has examined the reasons why people avoid seeking help for mental health problems, showing there are significant barriers.4 The most prevalent factor is social stigma: fear others will view a person negatively if he or she seeks help. There is also the fear of sharing one’s emotions with someone outside the family and friends circle. Additionally, some cultural or ethnic backgrounds can be less open to therapy and the notion of “seeking help” to feel better.

Commonly experienced mental health issues include anxiety, depression, bipolar disorder, and post-traumatic stress disorder (PTSD).

An adult with mental illness has abnormal mental, behavioral or emotional experiences which disrupt life’s activities; it could be a serious, moderate, or mild functional impairment. Someone with a severe mental illness (SMI) experiences substantial impairment on a daily basis and faces challenges in otherwise routine activities.

Impact and Cost of Mental Illness on Communities

Untreated mental illness costs California businesses nearly $7.9 billion annually in worker absenteeism and reduced productivity. A RAND Corporation study found that people with depressive symptoms spend more days in bed than those with disabilities, arthritis, back problems, lung problems, or gastrointestinal disorders.5 Mental illness and mental health conditions are an important public health issue; if left untreated, they can devastate families, dismantle a career, end a marriage, or cause other serious difficulties. Mental illness can sometimes lead to physical ailments and conditions, including high blood pressure, stroke, or heart attack.6

California spends over $1 billion7 to treat 15 percent of the prison population with documented mental illnesses,8 or roughly 33,000 inmates.9That does not include local corrections costs or the total expense to the criminal justice system.

Consider these statistics:

  • Mood disorders, including major depression and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.
  • Individuals living with serious mental illness face an increased risk of having chronic medical conditions.
  • Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.
  • Over one-third (37 percent) of students (age 14-21+) with a mental health condition, who are served by special needs educational programs, drop out of school. In fact, students with mental illness comprise the highest dropout rate.10
  • Suicide is the 10th leading cause of death in the U.S., the 3rd leading cause of death for people aged 10–24, and the 2nd leading cause of death for people aged 15–24.
  • More than 90 percent of children who die by suicide have a mental health condition.
  • Each day an estimated 18-22 veterans die by suicide.11

Finding Treatment

Clearly, with debilitating mental illness rampant in our society, it is long overdue that we as a nation increase the focus on de-stigmatizing the act of getting help. Far from being a sign of weakness, seeking treatment is an act of bravery. The California Association of Marriage and Family Therapists (CAMFT) recognizes the gap in mental illness prevalence and the services available. The association is doing its part to fill these unmet needs among California’s residents and is shining a light on the issue so that those who are suffering feel validated, not diminished, in their decision to seek treatment. Marriage and Family Therapists (MFTs) are the most easily accessible mental health professionals in the state, far outnumbering psychologists, counselors and psychiatrists. MFTs are mental health professionals trained in psychotherapy with a wide range of treatment modalities, and licensed to diagnose and treat moderate to severe clinical problems including anxiety, depression, addictions, post-traumatic stress disorder (PTSD), self-harm and other behavioral problems.12

It is critical that mental health problems in children and adults be identified and treated to minimize consequences to their health, relationships, productivity and to society. MFTs can fill that void. Here is how some of these mental health issues may impact you or a loved one.


Adult women in California are more likely than men to experience serious mental illness. The incidence in females increases according to age, from 2 percent in women aged 18 to 20 to a peak of over 6 percent in the 35 to 44 age bracket. Women are twice as likely to experience depression, with 12 percent of women being affected versus 6 percent of men; this can take the form of bipolar disorder or postpartum depression, among other psychopathologies. Women suffering from depression often turn to alcohol abuse. And while much attention has been devoted to post-traumatic stress disorder (PTSD) in male and female soldiers returning home, the reality is that this condition presents twice as often in women than men, unrelated to soldiering abroad. It can result from sexual violence, domestic abuse or childhood trauma, among other causes. In people suffering from an eating disorder, women account for 85 percent of bulimia and anorexia cases and approximately 65 percent of binge eating disorders.13


Men are more likely to mask depression using unhealthy coping methods such as drinking alcohol or abusing drugs. In fact, men are five times more likely to abuse alcohol than women. With societal stigmas that equate mental illness with diminished masculinity, men often have difficulty admitting to any prolonged illness--mental or physical. The World Health Organization reports that prevalence of alcohol dependence is more than twice as high in men than women, and they are more than three times as likely to be diagnosed with antisocial personality disorder.14 One in 20 men suffer from depression, with the highest incidence in men aged 40 – 59.15 Fourteen percent of males experience anxiety disorder, with approximately 75 percent of all suicides committed by men.

Children and Adolescents

Depression is one of the most prevalent mental health disorders among adolescents.16 Between 2005 and 2009, approximately 8 percent of teens in California reported that they had experienced an episode of major depression in the previous year. The rate for California adults during that same period was 6 percent.

Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0–6. The most common traumatic stressors for young children include accidents, physical trauma, abuse, neglect, and exposure to domestic and community violence. Young children are exposed to traumatic stressors at rates similar to those of older children. In one study of children aged 2–5, more than half (52.5 percent) had experienced a severe stressor in their lifetime.17

Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ)

Members of the lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) community may experience more mental health challenges than other people, as a result of prejudice and societal biases. LGBTQ individuals are almost three times more likely than others to suffer a mental health condition such as major depression or generalized anxiety disorder. They may also experience substance abuse, post-traumatic stress disorder and thoughts of suicide more readily than others. In fact, LGBTQ youth are four times more likely--and questioning youth are three times more likely--to attempt suicide, experience suicidal thoughts or engage in self-harm than straight people. Between 38 and 65 percent of transgender individuals have thoughts of suicide, and for LGBTQ youth between ages 10 and 24, suicide is one of the leading causes of death. An estimated 20 to 30 percent of LGBTQ people abuse substances, compared to about 9 percent of the general population.18

The Solution

Fortunately, all of these issues can be successfully treated by MFTs. It is time to end the stigma of pursuing treatment for mental health conditions. According to the American Association for Marriage and Family Therapy (AAMFT), numerous research studies validate the effectiveness of marriage and family therapy in treating the full range of mental and emotional disorders.19 Clients agree:

  • Surveys show that almost 90 percent of clients report an improvement in their emotional health after treatment.
  • Nearly two-thirds report an improvement in their overall physical health.
  • Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent.
  • When a child is the patient, parents acknowledge that their child’s behavior improved in nearly 74 percent of cases; their ability to get along with other children significantly improved; and their academic performance in school was heightened.

With thousands of MFTs in California providing a wide array of treatment modalities, there is no longer a reason to delay seeking help. Finding a qualified MFT is as easy as visiting Nearly 8,000 MFTs on this site are available to provide relief and promote healthy, happy and productive lives.


1 California Healthcare Foundation’s Mental Health Care in California: Painting a Picture July 2013 
2 National Alliance on Mental Illness State Advocacy 2010: California Fact Sheet
3 California Healthcare Foundation’s Mental Health Care in California: Painting a Picture July 2013 
4 David L. Vogel, Stephen R. Wester, and Lisa M. Larson, “Avoidance of Counseling: Psychological Factors That Inhibit Seeking Help,” Journal of Counseling & Development Fall 2007, Volume 85
5 “Making Employee Mental Health Your Business,” Screening for Mental Health, Inc. August 26, 2014 ( April 20, 2016), para. 5.
6 “Anxiety and Physical Illness,” Harvard Health Publications, Harvard Medical School, July 2008 ( accessed April 30, 2016), paras 2, 4, 11, 12.
7 “California Prison Healthcare Costs Soar Under Federal Receiver,” Prison Legal News, October 2014 ( accessed February 4, 2016), para. 8.
8 “How many individuals with serious mental illness are in jails and prisons?” Treatment Advocacy Center, November 2014 ( accessed February 4, 2016), para 1.
9 “Mental Illness in California Prisons,” New York Times, April 10, 2013 ( accessed February 2, 2016), para. 1.
10 Martha L. Thurlow, Mary F. Sinclair, and David R. Johnson, “Students with Disabilities who Drop Out of School—Implications for Policy and Practice,” NCSET, June 2002 ( : accessed February 6, 2016), para. 7.
11 “Mental Health by the Numbers,” National Alliance on Mental Illness ( : accessed February 4, 2016), para. 4. 
13 Everyday Health
14 “Gender and women’s mental health,” World Health Organization, ( : accessed February 20, 2016), para.12.
15 “Suicide and silence: why depressed men are dying for somebody to talk to,” The Guardian August 15, 2014 ( accessed February 20, 2016), para. 
16 Mental Health, United States, 2010, HHS Publication No. (SMA) 12-4681 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012)
17 Egger, H., & Angold, A. (2004). Stressful life events and PTSD in preschool children. Paper presented at the annual meeting of the American Academy of Child & Adolescent Psychiatry,Washington, DC.)
18 “LGBTQ,” National Alliance on Mental Illness ( accessed March 6, 2016), para. 2-14.