The Untold Story of COVID’s Impact on California’s Mental Health

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REMAKING HEALTH CARE

By Mark Kreidler

The pandemic’s effect on Americans’ mental health was almost axiomatic. From the beginning, the uncertainty about COVID 19’s spread and ever-rising death toll, paired with lockdowns that left tens of millions jobless or facing severe income cutbacks, produced waves of anxiety and depression across the country — at levels four times those reported in 2019.

California was not spared, with 2 million jobs lost in the first months of the pandemic and more than 2.7 million overall. (The state has since returned to pre-pandemic job levels, though not all the same jobs were recovered.) Millions of households were thrown into financial or physical emergencies, and almost a quarter of Californians reported experiencing either severe or moderate psychological distress in 2020 alone.

Those who’ve lived in the state for the past few years wouldn’t necessarily be surprised by any of that. In a place of more than 39 million people, with the equivalent of the world’s fourth largest economy, no statewide crisis could ever be considered minor.

But there’s a kicker: Those effects, including debilitating mental and emotional issues, were not felt equally. And as researchers continue to sift through the pandemic data, it’s clear that California’s most vulnerable residents endured some of the most difficult moments — and continue to suffer.

“It’s a very clear, direct line,” said Imelda Padilla-Frausto, a research scientist at the UCLA Center for Health Policy Research. “We were actually seeing, in real time, people losing their jobs or their incomes or having their lives disrupted in other significant ways, and seeing how all of that contributed to their stressors and resulting poor mental health.”

new report from the CHPR, coupled with one it produced last November, brings that picture into close focus. Mining responses from the statewide 2020 California Health Interview Survey (CHIS), researchers found that adults who experienced increased interpersonal conflict at home during the pandemic — over financial shortfalls, child care issues, kids in lockdown — had a higher likelihood of poor mental health or “severe impairment,” meaning stress so bad it interfered with their ability to work or go to school, do household chores, socialize, etc.

Lifting adults and households out of financial crisis may alleviate some of the pressures that can lead to psychological distress in the first place.

The primary driver of some of those stressors was money, and its disproportionate effects on certain racial or ethnic groups tell a tale. In 2020, according to CHIS data, 15% of Latino adults in California lost a job, and 26% had their income or work hours reduced. Both figures were well above those of white adults in the state (11% and 22% in the respective categories).

Black adults, meanwhile, were three times more likely than white residents to have difficulty paying their rent or mortgage (16% vs. 5%). Latino residents were twice as likely as whites to struggle in that same area.

Some of the results of those stressors showed up in the UCLA center’s findings. According to Padilla-Frausto and co-authors Nicole Pereira and Hilary M. Wright, adults who said they couldn’t pay for basic necessities during the pandemic were twice as likely as others to report an increase in interpersonal household conflict, including “snapping or yelling.” Those who couldn’t find or afford child care were three times more likely to experience such conflicts as those who said they didn’t have difficulty with child care, based on the CHIS data.

Psychological distress was more prevalent in homes that reported such increases — and upticks in physical conflict, too. Adults who said they’d had an increase in physical “punishment,” as the UCLA report put it, were nearly six times more likely than others to report serious psychological distress. And often, the authors said, the underlying stressor was money.

“We kind of knew there were going to be increases in all these categories, because the pandemic’s effect on people’s lives and livelihoods was that dramatic,” said Padilla-Frausto. “Job losses and reductions in hours were seen in all races and ethnicities, too. But where we really saw the inequities was in people’s ability to withstand such financial losses.”

That is one reason why Padilla-Frausto, like many other researchers in her field, wants to place some of the focus on the front end of the process. Without a doubt, California still struggles to provide mental health care to residents who need it. But lifting adults and households out of financial crisis may alleviate some of the pressures that can lead to psychological distress in the first place.

“We’ve been seeing increases in serious psychological distress for years in California, and the cost of living is at the heart of a lot of it.” —  Imelda Padilla-Frausto, research scientist, UCLA Center for Health Policy Research

The state’s larger economic data comes into play here. According to the Public Policy Institute of California, Black and Latino families make up 43% of California’s overall population, but account for 58% of its very lowest earners, those in the bottom 10% of income. For every $1 earned by a white family, a Black family earns 60 cents and a Latino family 50 cents, the PPIC found.

Millions of lower income Californians already live right on the line financially; they’re a bad month or two away from depleting their savings or falling behind on rent or mortgage. Researchers with the Massachusetts Institute of Technology’s Living Wage Calculator say that in a four-person household in California with two adults working, each of those adults would need to earn more than $30 per hour, full-time, in order to keep the family afloat. That’s almost twice the minimum wage.

Pandemic financial relief measures have come and gone, but they remain instructive. The PPIC used U.S. Census Bureau data to estimate that federal stimulus money kept 1.7 million Californians out of poverty in 2020, and the state’s own expansion of unemployment insurance helped rescue another 1 million. That is a powerful endorsement for the effect of direct government assistance, and while it’s not foolproof, it is a critical weapon with which California could continue to attack poverty — and, potentially, lessen the crushing need for mental health services.

The UCLA team will focus in coming months on the provisional side of those services, attempting to determine how — or how much — inequities in access to such care are affecting residents. The Affordable Care Act included poor mental health as a core condition to be treated, but the system supporting that treatment is not close to being built out, and some providers are clearly going to have to be prodded to do it.

Mark Kreidler

In the meantime, raising wages for the lowest earners, along with a recommitment to direct financial aid, could alleviate some of the psychological stress that was building long before the pandemic exposed and exacerbated it. “We’ve been seeing increases in serious psychological distress for years in California, and the cost of living is at the heart of a lot of it,” Padilla-Frausto said. The state must reconsider its levels of support for struggling families before personal financial crises become full-blown mental health emergencies.

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