By Kerry Beth Cottingham, LMSW, Director of Advancement, San José Clinic

San José Clinic and St. Luke’s Health have long partnered on strategies to increase access to care. As nonprofit health care ministries affiliated with the Catholic Church, both organizations share a mission to serve the sick, needy and vulnerable. San José Clinic exclusively serves our uninsured, uninsurable, and low-income neighbors, many of whom are patients of St. Luke's Health, and St. Luke's Health has leveraged its resources to support that mission. As the need for our behavioral health services rises, we increasingly rely on a team approach to care.

More Than One Population in Need

San José Clinic has offered a behavioral health program since 2016. As in most of the country, the COVID-19 pandemic greatly exacerbated the need for counseling services in our patients, 80% of whom are Hispanic and 70% of whom are women. 

While many of our patients have mental health needs due to daily stressors, we also serve a large number of patients with advanced or chronic health conditions such as diabetes and hypertension. We recognize that individuals diagnosed with those conditions have higher rates of depression and anxiety across the board than those without chronic disease. In addition, we help many survivors of human trafficking, the vast majority of whom require behavioral health support.

Addressing Barriers to Care 

Barriers to providing behavioral health services vary across populations. Some of the most significant issues include:

• Access to reliable transportation

• Lack of paid time off work

• Stigma associated with seeking mental health care

In Hispanic communities especially, it can be hard to change perceptions regarding mental health issues. That’s why we incorporate behavioral health into primary care. We conduct depression screenings for all new patients, disease-management patients and women seeking gynecologic and pregnancy care, hoping that doing helps normalize patients discussing their moods and mental states. Our providers work to establish trust as a means to reduce the association of stigma with mental health care. 

Creating a health home for patients at the clinic builds rapport, so that if we do suggest patients talk to our full-time licensed professional counselor on staff or make referrals to other behavioral health providers, the patients are more likely to trust our team and to listen to their recommendations.

Staffing Is an Issue

Like much of the U.S., we face persistent behavioral health provider staffing shortages. As a community clinic serving a largely Hispanic population, we face additional issues that include:

• Cultural competency. We provide valuable learning opportunities for developing professionals, but we must have staff who understand how to provide the culturally competent care needed to build trust.

• Language. The medical community must better encourage Spanish-speaking students to seek careers in behavioral health care and to serve their communities.

• Specialized training. We need more trauma-informed providers who understand how to work with victims of human trafficking and domestic violence.

Another ongoing issue continues to be the low pay for so many behavioral health professionals, especially those who want to treat underserved populations. Funding for these positions must be addressed so students feel confident they can support a family if they pursue this line of work. We need a multi-pronged approach to growing the provider base, ensuring people are compensated adequately and trained properly to serve these vulnerable populations.

Vital Community Partnerships 

Our community partnerships with St. Luke’s Health and other organizations continue to boost access to care. As a partner of the United Way of Greater Houston, we are part of an integrated client journey with a streamlined referral system of networked organizations. We have also partnered with the Catholic counseling service Gratia Plena to involve our full-time licensed professional counselor (LPC) and LPC interns in providing additional care and access to a developing pipeline of new, younger professionals going into the field.

In addition, we partnered last year with America Cares to expand our behavioral health telehealth services. Around 10% of our total visits for behavioral and non-behavioral health issues are virtual, which helps address the transportation and PTO issues of our clients. We continue to leverage new technology options as they become available.

Systemic Issues Require Creative Stakeholder Solutions

In Houston, one of every four residents lacks health insurance. Texas leads the nation in uninsured residents. Lack of health insurance translates to lack of access to behavioral health care. When people cannot afford basic necessities, mental health care is not a priority, even though mental health struggles negatively affect the entire family, not only the patient. 

Clinics like ours that create a health home are best positioned to build the trust necessary to provide behavioral health services, as opposed to the increasing reliance on urgent care facilities. A holistic approach to health care is key to improving physical and mental health. Because poverty is a systemic issue, one clinic alone can’t solve the problem. 

Stakeholders need to understand that addressing these challenges requires funding clinics like ours. To find solutions, we also need creative collaboration with others who understand the complexities of the issue. There’s no perfect answer, but our partnership with St. Luke’s Health is a step toward improving access to care for generations to come.