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Our Mental Health Care System Was Already Strained. Now With COVID-19, It's 'Cabin Fever Times 10'

(Rebecca Plevin / KPCC)
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The effects of the COVID-19 pandemic are starting to ripple through an already-taxed mental health care system -- with social distancing a particular challenge for people who were already struggling before the current national emergency.

Here's one example:

There are about 3,200 licensed board and care homes in L.A. County. They range in size from converted private homes to apartment buildings. These non-medical facilities are home to thousands of elderly people and those living with a severe mental illness.

And people with mental illnesses who live in these homes are accustomed to venturing out for therapy sessions and group activities. But because of social distancing rules, many adult day programs have stopped providing those services in person.

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"Now that the adult day centers are closed, the residents are (at their board and care homes) 24 hours a day," said Barbara Wilson, a social worker who runs a non-profit that connects people with mental health services.

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The freezing of adult day programs is putting extra strain on people who run board and care homes, like Elizabeth Bijou, who operates a San Fernando Valley facility that's home to six men.

"I do my best to encourage everybody that things are going to get better," Bijou said. "But it's hard to say things aren't as bad as they seem when it's on T.V. and every day they say it's worse."

Her residents are accustomed to taking part in group therapy sessions with psychiatrists, Bijou said. Their programs aren't simply adult babysitting, she added.

"They have their medication that they take, they have their housing that provides support," Bijou said. "But they need that group therapy side and that piece of the puzzle. With that piece missing, they feel it, is all I can say... Everybody's getting cabin fever times 10."

Lydia Missaelides, former Executive Director of the California Association for Adult Day Services, said she worries about the effects of isolation on people's mental health, on their depression and anxiety. Some adult day centers have started offering check-ins and group sessions over the phone. But Missaelides said the in-person day programs are a lifeline for so many people.

"(They get) peer support and socialization and all the benefits that accrue from that as well as the side benefit -- a very important one -- of providing respite to the person's family member or caregiver," Missaelides said.


These new pressures come as dozens of board and care homes have shuttered in the past few years due to funding issues that existed well before the pandemic.

Many serve low-income clients who use most of their Supplemental Security Income -- about $1,000 a month -- to pay for their care. "'(Board and cares) are supposed to provide three meals a day, two snacks, medication management and 24-hour staff for 35 dollars a day," Wilson said. "That's nuts."

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Last year, the L.A. County Board of Supervisors directed county health officials to find additional funding for board and cares from federal, state and private sources. Governor Gavin Newsom's proposed budget includes more than $1 billion to fight homelessness, and some of that money would be allocated for board and care homes.

But with the coronavirus pandemic changing everything, advocates like Wilson worry that the promise of more assistance for board and care homes will be put on pause. "We need to have emergency funds to all the board and care homes that take these populations," Wilson said.

For now, board and care operators like Bijou are just taking things day by day, trying to adapt to the increased stresses of the new coronavirus reality.

"I try to encourage the guys to just think of it as we're all shipwrecked here together," Bijou said. "I don't know if that's any better or any worse, but they seem to relate to that a little bit better."


Some resources from our friends at CalMatters: