Supervisors Support Mental Health Care for “Missing Middle”


SAN JOSE – Today, the Santa Clara County Board of Supervisors unanimously approved the creation of a pilot program to ensure the “missing middle” have access to outpatient mental health treatment (motion by County Supervisor Joe Simitian, second by County Supervisor Otto Lee). The missing middle are residents who earn a bit too much to qualify for Medi-Cal, do not have access to good commercial insurance, or cannot pay for care out of pocket.

“The mental health needs of the missing middle in our health care system have been overlooked for far too long,” said Simitian. “This new effort will help folks who need mental health help be able to access affordable outpatient services. It’s good for patients, good for families, and good for our community. We ought to close the gap that has allowed too many people to slip through the cracks.”

“We’re all facing stressful times and the rising costs to live in this area leaves too many people making barely enough to make ends meets,” said Lee. “Our neighbors who need mental health care often go without because of financial worries. We need to open access to affordable mental health services so more neighbors can receive care.”

According to a 2021 survey on mood disorders published by the National Association for Mental Illness (NAMI), access and cost are major barriers to treatment. Lack of treatment can have significant economic and social impacts, including loss of productivity, job loss, divorce, homelessness, imprisonment, drug addiction, and even death by suicide. 

“Services for the missing middle are challenged by issues of insufficient and unstable funding,” said Marsha Deslauriers, Executive Director of Community Health Awareness Council. “The elevated pandemic-driven demand for services coupled with the rising costs of delivering care are a challenge. We expect these issues to continue in the months and years to come.”

Accessible and affordable outpatient services are essential to avoiding the high costs and societal harms from inpatient treatment, hospitalization, or a lack of treatment. Some individuals receive these services from public programs, others use commercial insurance. Coverage options are often imperfect, due to high out-of-pocket costs and a decline in the number of psychiatrists accepting public insurance.

“Families often find it difficult to find and pay for qualified mental health professionals,” said Marico Sayoc, Executive Director of CASSY (Counseling and Support Services for Youth). “We need to meet families where they are and connect them to treatment. Having more affordable outpatient services available will only help strengthen our community.”

It is expected County staff will report back to the Health and Hospital Committee on August 24, 2022, and the Board of Supervisors on September 13, 2022, with options for a pilot program. “I’m open-minded about how we solve the problem,” said Simitian. “We could subsidize outpatient mental health care at nonprofit clinics for middle income County residents, identify alternative methods for mental health care service delivery, or push private insurers to really provide the coverage the law requires. But we have to face up to the fact that people in need aren’t getting the help they require.”

The Simitian/Lee effort also directs County staff to identify which residents should qualify for such a program, and how many residents could be served by a pilot.

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