Finding Hope in a Fragmented Behavioral Health System
By: Cristian Ayon, SDSU Graduate Student
As the population ages, the need for accessible and culturally responsive behavioral health services continues to rise. Yet, for many older adults and their families, these services remain out of reach due to a range of systemic barriers, including limited insurance coverage, a shortage of trained behavioral health professionals, and a fragmented care system. Social determinants of health such as transportation, low health literacy, and financial constraints further limit access while cultural factors, including stigma around mental health, discourage many from seeking support.
In a 2024 issue brief about the mental health workforce, Substance Abuse and Mental Health Services Administration (SAMHSA), identified a growing national shortage of behavioral health professionals, noting that this workforce gap continues to limit access to treatment and essential support services. SAMHSA identifies provider shortages that are compounded by high out-of-pocket costs, fragmented insurance coverage, and clinician burnout, as being barriers for older adults. As these systemic challenges persist into 2025, social work and community-based programs across California are increasingly overwhelmed by the volume of older individuals seeking services that are no longer readily available through traditional healthcare networks.
Violet’s story exemplifies these challenges, yet is also a story of resilience. At 63-years-old, she spent months navigating the healthcare system in search of behavioral health support for herself and her teenage son, Spruce. Violet experienced severe bouts of anxiety and depression while also managing the care of her son, who lives with autism and schizoaffective disorder. After repeated denials and dead ends from multiple providers, she turned to a resource that may seem unconventional but is becoming increasingly common for people navigating complex systems: The San Diego Public Library.
As libraries step into the modern age, they are evolving into dynamic community hubs that offer far more than just books. Today, libraries provide essential services such as tax filing assistance, business advice and social services, creating inclusive spaces for people of all walks of life to meet and access services to improve their quality of life.
The San Diego Public Library, in particular, offers a wide range of programs tailored to older adults, including mind-body fitness classes, social meetups, digital literacy and online safety workshops, community resource fairs, blood drives, free clothing, Veterans Affairs Aid, and lifelong learning opportunities. In the past, the Central Library even hosted an onsite mental health clinic that supported unhoused individuals with emergency housing, healthcare access, and substance use disorder treatment.
A unique aspect of the San Diego Library system is its social work internship. Unlike most unpaid placements in the field of social work, this opportunity not only provides compensation to interns but also highlights the importance of meeting clients where they are, offering future social workers hands-on experience in a truly community-centered setting. And that’s where I come in! During my first year as a social work graduate student, I was placed at the San Diego Library and had the opportunity to work with many people like Violet.
While having trouble logging into the computer, Violet shared some of her recent challenges with a librarian, who then referred her to me for support. She confided in me that she had been searching for services for several months, to no avail. And in the meantime, Spruce’s symptoms had been escalating and had been experiencing hallucinations, while Violet was falling into a deep depression. She broke down in my office, feeling hopeless and scared. We were able to connect her with emergency services in East County, and she expressed gratitude for finally receiving the help she wanted.
This story, unfortunately, is not unique. Many older adults, particularly those navigating the care system alone, face stigma, structural exclusion, long waitlists, and the emotional toll of navigating it without a manual. These barriers are compounded by systemic issues such as policy delays, underfunded programs, and a lack of cross-sector coordination. While my experience as an intern at the San Diego Public Library showed me that this model of care holds real promise, it also reinforced how important it is for information and services to be accessible, clear, and easy to navigate.
To help guide us in the current landscape of behavioral healthcare access for older adults and more promising models for increasing the health and well-being of older adults, please join us for this month’s CEAL Healthy Longevity webinar with featured speaker Amanda Berry, MSW, MPH. Amanda is a seasoned public health advocate and Government Affairs Manager at Health Center Partners of Southern California. She will help unpack the policy and practice realities shaping behavioral health access for aging populations. With dual degrees in public health and social work, and experience serving on the County of San Diego’s Behavioral Health Advisory Board, Amanda brings a systems level lens to one of today’s most urgent and under addressed public health issues.
