Public forum identifies gaps in mental health

By Reggie Ellis

Mental illness is not only difficult to deal with, it is difficult for many to even discuss. Melissa Urena of Woodlake hesitantly made her way from the audience to the microphone to tell the story of her grandmother, who suffered from depression.

When she was young, Urena said her grandmother had always seemed sad but the family did not know why. It was only when she grew up that she understood that her grandmother had been kidnapped and raped when she was younger and later in life was verbally abused by her husband. A few years before she died, Urena said her grandmother went to HHSA to get help. Without any transportation and little to no money, she said her grandmother rode a bus to the adult mental health clinic in Visalia. When she arrived, the clinic said she was not eligible to be admitted and they turned her away. A few days later she swallowed half a bottle of painkillers she used to ease her arthritis pain and had to be rushed to the hospital.

"She told the doctors it was an accident but we knew the truth," Urena said. It was a sad commentary on a depressing condition of a deficient system. Urena's pain came across loud and clear as her voice weakened over the speakers at the Exeter Memorial Building last Thursday night. She was one of 25 people to talk at the Tulare County Heath and Human Services Agency's fifth and final forum asking for public input on how to spend Proposition 63 money.

Mental Health Services Act

Known as the Mental Health Services Act (MHSA), Prop. 63 imposes a tax on personal income exceeding $1 million annually. Passed in November, the measure will help expand mental health services to persons currently disabled by mental illness, persons showing signs of mental illness in need of prevention services and to families and caregivers of those affected. The forums were held to gather public input on how HHSA can use the money to better serve county residents.

These funds are deposited in the State Treasury in the Mental Health Services Fund. It is estimated the tax will generate $254 million this fiscal year, $683 million in '05-'06 and approximately $690 million in '07-'08 with increasing amounts in following years. Tulare County is conservatively estimated to receive between $15-$20 million in the first three years.

Dr. Cheryl Duerksen, assistant agency director for Tulare County HHSA, said "MHSA can't be used to supplant ongoing services or replicate services. It can only be used to expand service to the four main age groups and to become more culturally competent."

The four main groups are children, transitional age youth (18-25), adults and older adults (55 and older). Cultural competence means having mental health clinicians that are either bilingual or bicultural. According to the California Department of Mental Health's website, "While small counties and communities may believe in cultural competency, they can have a difficult time finding not only bi-lingual/bi-cultural staff but also competent interpreters. This makes delivering cultural competency services that much more difficult. This is an area in which the MHSA can be particularly helpful. The Education and Training component of MHSA must assess and address these issues and provide technical assistance."

Cultural competency

Cultural competency was one of the main concerns expressed by residents of Woodlake and Farmersville. Using an interpreter, Rosio Gonzalez spoke on behalf of a Mexican women's association in Woodlake and asked for bi-cultural doctors.

"When we go to a regular doctor, we see an American doctor, and there is a connection missing," she said. "Sometimes we don't get appropriate treatment." Another Hispanic man said that even when there is an interpreter available, much information is lost in translation.

Anna Madrigal Garcia with Family Health Care Network, a private health care facility, said there are gaps in delivery of service to people who cannot afford or don't have the means to get from their home to a clinic, and even when they get there there is often no one who speaks Spanish.

"It is not unusual that women come in and we have to wait for the crisis center to come," she said. "The time and money spent waiting is a waste of tax payer money."

Larry Gates said half of the county's population is Hispanic and that they should be viewed as a resource and not a barrier to helping prevent depression and suicide in youth.

"There is a lot of relational poverty in today's youth that is covered up with electronic substitutes," he said. "Their way of life, an older style with strong family and social ties, is a resum

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