Amid mental health staffing crunch, Medi-Cal patients help one another

KFF Health NewsMar 19 2024

Three people gathered in a classroom on a recent rainy afternoon listened intently as Derrick Cordero urged them to turn their negative feelings around.

"What I'm hearing is that you're a self-starter," he told one participant, who had taken up gardening but yearned for a community with which to share the hobby.

Cordero, 48, is guiding the discussion at Holding Hope, a weekly therapy group for people struggling with mental health. Anyone receiving mental health services through Solano County can participate.

A former member, Cordero is now the group's volunteer peer leader. He initially joined in 2020 while dealing with mental illness and substance use — and found that sharing with others who had been through similar trials could be deeply healing.

"Not all of us are going to speak about" pain, said Cordero, who is covered by Medi-Cal, California's Medicaid program, which insures low-income people. "But when one does, another does, and then next week another does, and it becomes like a connective tissue."

These groups can offer essential support in a public system beset by workforce shortages, Cordero said. Two are run entirely by peer leaders, who help build trust by sharing personal experiences, said Cheryl Akoni, a marriage and family therapist who works for Solano County and leads Holding Hope alongside Cordero.

"You're amongst your peers," Akoni said. "You're amongst people who have lived and shared experiences that you often might not get with your therapist because we have to keep our boundaries."

In California, mental health care for Medi-Cal enrollees is provided by managed care insurers and county mental health plans. Among its services, Solano County Behavioral Health provides case management and appointments with therapists and psychiatrists, plus five groups, ranging from Holding Hope to a journaling collective.

In 2022, California started allowing counties to use Medicaid dollars to pay peer support leaders for their work, a benefit 51 of the state's 58 counties have adopted, according to the state Department of Health Care Services. To qualify, individuals must undergo training and get certified by the California Mental Health Services Authority.

Cordero isn't yet getting paid for his work with Holding Hope. He said he's building experience as a volunteer and plans to seek his certification when the next training takes place.

Cordero's family immigrated to California from the Philippines, and the tension between his American and Filipino identities caused anxiety as a child, he said. He first thought about killing himself around age 13 and didn't feel he could be honest about his mental health with his family.

"I had American problems for my parents and family who had a traditional Filipino paradigm," he said.

Cordero was diagnosed with borderline personality disorder in his 20s and was addicted to marijuana and methamphetamine throughout his adult life. Amid these challenges, Cordero took human services courses at Solano Community College and started to speak to high school classes about mental health and addiction. When that program ended, the loss of structure was destabilizing, he said.

"I just dove headlong into substance abuse," Cordero said.

He missed his daughters' school graduations. His diabetes went untreated, and his addiction grew more severe.

During the covid-19 pandemic, social distancing restrictions made it difficult for Cordero to obtain illegal drugs. He experienced severe withdrawal symptoms, along with a blood infection and complications from his untreated diabetes. This resulted in a series of hospital visits — and it was during one of these that Cordero was enrolled in Medi-Cal.

After he recovered, Cordero contacted Solano County seeking mental health treatment. He was told there would be a wait for a therapist due to covid-19 and staffing shortages but was encouraged to attend Holding Hope in the meantime.

He quickly took to sharing in the group, and after about a year of his attending, its former leader encouraged Cordero to assume a bigger role, he said.

"It was great to talk, and I can ramble forever," Cordero recalled. "She said, 'I think you can do better than that.'"

He started leading the group with Akoni in January.

Not every person who seeks mental health help is ready for or needs a therapist, but for those who do, groups and peer support can provide connection and community as they wait, said Emery Cowan, director of Solano County Behavioral Health.

At least 90% of the city and county behavioral health agencies who responded to a survey commissioned by the County Behavioral Health Directors Association of California in 2021 reported difficulty recruiting psychiatrists, licensed clinical social workers, and licensed marriage and family therapists.

The counties pointed to multiple staffing challenges: They generally can't offer salaries comparable to the private sector; don't appeal to applicants who want to work remotely or have flexible schedules; and have trouble finding and keeping providers with the training and experience to handle the complex patient population.

Cordero was paired with a psychiatrist right after his intake appointment. He finally added his name to the waitlist for a therapist in 2022 and said it took about a year to get matched with someone.

Solano County Behavioral Health relies on Medi-Cal-certified peer leaders and volunteer peer leaders, like Cordero, who run groups, help clients prepare for appointments, and craft wellness recovery plans.

"They've lived that experience, they know how hard it is, they're more willing to do it because they want to help people just like them," Cowan said. "They were that person."

Cowan and Cordero acknowledge that group therapy isn't for everyone. Discussing personal challenges or traumatic incidents in front of a group can be intimidating, and some people need more individualized care.

But for those who are a good fit, there is community to be found.

At the recent gathering of Holding Hope, participants discussed relationships and loneliness. Cordero shared that he still finds it difficult to maintain close bonds with family and friends, and that he feels lonely.

He repeatedly encouraged his peers to reframe negative thoughts and experiences, explaining that anguish can start feeling comfortable, almost like a routine, and that breaking out of that routine can feel challenging.

To emphasize his point, Cordero circled back to a particular phrase several times over the hour: "The path to pain is a well-carved path."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.