Module 2: Core CHW Competencies › Lesson 2.8 · 6 sections · ~40 min

Mental Health and Substance Use

Learning Objectives

Identify common types of mental illness.
Recognize factors that influence mental health — genetics, brain chemistry, life experiences, family history.
Describe strategies for supporting mental health and well-being (promotion, prevention, treatment, recovery), and barriers to receiving services.
Define substance use disorders (SUDs) and describe their impact on individuals' lives.
Recognize the prevalence of SUDs in California and trends in drug- and alcohol-induced deaths.
Identify common treatments for SUDs — behavioral therapies, medication-assisted treatment, recovery support services — and the barriers to receiving treatment.

Mental health and substance use in CHW work

Mental health and substance use can affect a person's healthcare and the social determinants of health. These problems can happen to anyone, regardless of age or background. They can be serious — but treatments exist.

Your role as a CHW

CHWs don't provide mental health treatment. You give support, suggest resources, educate, and help people find the help they need. You're part of the care team and can recognize when someone has a mental health or substance use disorder. Sometimes you're the first person someone talks to about getting help.

Types of mental illness

Mental health involves how we feel, think, and act — emotions, thoughts, relationships, stress, choices. Mental illnesses are health conditions that change how we feel, think, or act — often all three. People often feel upset and have trouble at work, school, or with family and friends.

Several factors affect mental illness:

Body — genes and brain chemistry
Things that happen to us — trauma, abuse
Family history

Five types of mental illness

Slide 1/5

Anxiety Disorders

Cause excessive worry, fear, dread, and uneasiness. Examples: generalized anxiety disorder, panic disorder, specific phobias.

The spectrum of mental health

Mental health is a continuum from healthy to not healthy. Some people can take care of themselves or manage with help from friends and family. Others need help from professionals. Your job is to recognize where someone is and help them get the level of support that fits.

The Mental Health Continuum

Stage 1 of 4

Healthy - Patient presents with normal functioning

Key Points

✦Moods go up and down normally
✦Able to handle tough times
✦Goes to school or work regularly
✦Sleeps well and on a regular schedule
✦Maintains normal relationships with friends and family
✦Engages in normal activities such as socializing, hobbies, etc.
✦Feel good about ourselves and comfortable with others

CHW Support

Encouragement to maintain self-care and support from friends and family

Mental health in California

1 in 6

Californians experience mental illness

1 in 24

have serious mental illness that disrupts daily life

1 in 6

adult Californians experienced 4+ ACEs in childhood

40%+

increase in young people hospitalized for mental health emergencies (past 10 years)

Early onset

Serious mental illness usually starts before age 25. Without early help, children and adolescents are especially vulnerable.

Suicide in California

In 2017, more than 4,300 people in California died by suicide — twice the number killed by someone else that same year. Rates are highest in rural areas with limited mental health services. In Trinity County (rural Northern California), 34 per 100,000 die by suicide — more than 4× the rate in Los Angeles County.

988 Suicide & Crisis Lifeline

Free and confidential, 24/7. Dial or text 988 from any phone to connect with trained crisis counselors. The old number (1-800-273-8255) still works and connects to the same service. In an immediate crisis, dial 988 or 911.

Call or text 988 — Suicide & Crisis Lifeline

Promotion

Creating good environments and conditions that help people stay healthy and deal with tough situations. Also promoting all types of mental health services.

Why people don't get the care they need

More Californians are needing ER care for mental health hospitalization — but there are fewer hospitals that can provide it. Almost half of California counties have no adult mental health beds. Pediatric beds are also insufficient.

In 2019, only about 37% of Californians diagnosed with mental health problems actually got the help they needed — lower than the national average.

Even people with private insurance struggle. California mental health patients are much more likely to see out-of-network providers than other types of patients.

The Medi-Cal gap

Medi-Cal Health Plans cover mild or moderate mental illness, but not serious mental illness. People with serious mental illness rely on their county's resources, and the unclear division of responsibilities causes gaps in care.

Resources to know

County crisis hotlines — Every California county has a 24/7 hotline. Find your county at the DHCS website.
Insurance mental health number — Call the toll-free number on the back of every insurance card.
988 Suicide & Crisis Lifeline — Call or text 988 from any phone for support during a crisis.
911 — For immediate medical emergencies.

Knowledge Check — Matching

Match each type of mental illness to its description.

Terms

Anxiety Disorders

Mood Disorders

Psychotic Disorders

Eating Disorders

Dementia

Definitions

Loss of touch with reality, often with hallucinations (e.g., schizophrenia).

Serious, often fatal problems with how people think about food, exercise, and body size.

Unusually high or low emotions compared to the situation (e.g., depression, bipolar disorder).

Inability to remember, think, or make decisions, often with mood changes.

Excessive worry, fear, dread, and uneasiness (e.g., panic disorder, phobias).

Knowledge Check

Which of the four approaches to supporting mental health focuses on stopping problems before they start — for example, teaching kids about the dangers of drugs?

APromotion

BPrevention

CTreatment

DRecovery

Substance Use Disorders (SUDs)

Substance use disorders (SUDs) happen when people use drugs or alcohol so much that it causes problems — not doing well at work, school, or home, getting sick, becoming disabled. Long-term use can change the brain, making it hard to stop even when someone wants to.

Like other chronic diseases, SUDs can be prevented, treated, and managed. Recovery is possible with help and support, though there's always risk of relapse.

Prevalence in California (2018)

of Californians (2.7M people) had trouble with drugs or alcohol

~6%

had trouble with alcohol

~3%

had trouble with illicit drugs

Young adults face higher risk

2×

young adults (18-25) are twice as likely to have an SUD

34%

of young adults used marijuana in the last year

of young adults used cocaine in the last year

Adults 26+ are almost 3× more likely to have problems with alcohol than illicit drugs.

Opioids in California

More and more Californians are using opioids. They can help people with pain — but are very addictive and dangerous. Heroin and fentanyl are two that are often abused.

300%

increase in ER visits for heroin overdoses (2006-2017)

5-9%

of CA ER drug-related visits are due to opioids

200%

increase in ER visits for non-heroin overdoses (2006-2017)

Drug and alcohol deaths in California

Since 2004, fewer Californians have died from drug overdoses than in the rest of the US. CA deaths have stayed flat since 2013, while national deaths have risen. Drug- and alcohol-caused deaths in California are:

Most common in people 36-64 years old
More than 2× more likely to be male
Most prevalent in the American Indian/Alaska Native population

In 2017, of 1,882 opioid deaths in California, over 70% were caused by prescription opioids. Heroin overdose deaths have stayed flat since 2014, but fentanyl overdose deaths grew by more than half from 2016-2017.

Behavioral Therapies

Help people who are unsure about getting help or quitting drugs find motivation to change from within. Cognitive Behavioral Therapy teaches skills to identify and change behaviors causing problems. Family therapy can help young people by considering family relationships and dynamics affecting drug use.

How Californians actually use SUD treatment

1 in 8

patients in SUD treatment received residential care

received hospital care

1 in 3

received medication

Most Californians in treatment get outpatient services. The total number of facilities has decreased — except outpatient facilities offering medication-assisted treatment, which grew 180-233%.

Geographic barriers to detox

In 2016, only 26 California hospitals were allowed to help with addiction, with just 771 total beds in 10 counties. People needing intensive medical detox face real geographic and access barriers.

Resources for people experiencing SUDs

Knowledge Check

Which statement about substance use disorders (SUDs) is accurate?

ASUDs only affect people who lack willpower and cannot be treated.

BLike other chronic diseases, SUDs can be prevented, treated, and managed, and recovery is possible with support.

CLong-term substance use has no lasting effect on the brain.

DSUDs are most common among young adults under 18.

Knowledge Check — Select all that apply

Which of the following are common treatments for substance use disorders? Select all that apply.

Behavioral therapies, such as Cognitive Behavioral Therapy and family therapy

Medication-assisted treatment (MAT) combined with counseling

Recovery support services, often delivered by peers in recovery

Withholding all support until the person stops using on their own

Lesson Takeaways

🌟 Lesson takeaways

We covered mental health problems and substance use disorders — the different types, what causes them, and how common they are in California. We explored the mental health continuum, from stages people can manage on their own to those requiring professional help, and we looked at treatment options and the obstacles people face: too few providers, insurance coverage gaps, and regional disparities. As a CHW, knowing the resources available in your state — and your relationship with patients — can be the bridge that gets someone the help they need to follow the best treatment plan for them.

🎉Great work!

📅

Coming up

At the end of this module, you'll join a live discussion with your cohort and an instructor. Great work — we'll see you there.

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