Amid the mental health staffing crisis, Medi-Cal patients are helping each other

Three people gathered in a classroom on a recent rainy afternoon listened intently as Derrick Cordero urged them to reverse their negative feelings.

“What I’m hearing is that you’re a beginner,” he told one participant who had been gardening but longed for a community to share the hobby with.

Cordero, 48, led the discussion at Holding Hope, a weekly therapy group for people struggling with mental health. Anyone receiving mental health services through Solano County can participate.

A former member, Cordero is now a volunteer leader of the group. He originally joined in 2020 while dealing with mental illness and substance use – and found that sharing with others who have been through similar trials can be deeply healing.

“Not all of us will talk about” the pain, said Cordero, who is covered by Medi-Cal, California’s Medicaid program that insures low-income people. “But when one does it, another one does it, and the next week another one does it, and it becomes like connective tissue.”

These groups can offer essential support in a public system beset by labor shortages, Cordero said. Two are run entirely by peer leaders who help build trust by sharing personal experiences, said Cheryl Aconi, a marriage and family therapist who works for Solano County and runs Holding Hope with Cordero.

“You are among your peers,” Aconi said. “You are among people who have lived and shared experiences that you often may not get with your therapist because we have to respect our boundaries.”

In California, mental health care for Medi-Cal enrollees is provided by managed care insurers and county mental health plans. Among its services, Solano County Behavioral Health provides case management and appointments with therapists and psychiatrists, plus five groups ranging from Holding Hope to a group journal.

In 2022, California began allowing counties to use Medicaid dollars to pay peer support leaders for their work, a perk that 51 of the state’s 58 counties have adopted, according to the state Department of Health Services. To be eligible, individuals must complete training and become certified by the California Mental Health Authority.

Cordero has not yet been paid for his work with Holding Hope. He said he is gaining experience as a volunteer and plans to seek certification when the next training is held.

Cordero’s family immigrated to California from the Philippines, and the tension between his American and Filipino identities caused anxiety as a child, he said. He first thought about killing himself around the age of 13 and didn’t feel he could be honest about his mental health with his family.

“I had American issues for my parents and family who had a traditional Filipino paradigm,” he said.

Cordero was diagnosed with borderline personality disorder in his 20s and was addicted to marijuana and methamphetamine throughout his life. Amid these challenges, Cordero took human services courses at Solano Community College and began speaking to high school classes about mental health and addiction. When that program ended, the loss of structure was destabilizing, he said.

“I just dived into substance abuse,” Cordero said.

He missed his daughters’ graduations. His diabetes is not being treated and his addiction is getting worse.

During the COVID-19 pandemic, social distancing restrictions made it difficult for Cordero to obtain illegal drugs. He experienced severe withdrawal symptoms, along with a blood infection and complications from untreated diabetes. This led to a series of hospital visits, and during one of them, Cordero was enrolled in Medi-Cal.

After recovering, Cordero contacted Solano County seeking mental health treatment. He was told there would be a wait for a therapist due to COVID-19 and staff shortages, but was encouraged to visit Holding Hope in the meantime.

He quickly became involved with the group, and after about a year of his presence, the former leader encouraged Cordero to take on a bigger role, he said.

“It was great to talk and I could ramble on forever,” Cordero recalls. “She said, ‘I think you can do better than that.’

He started managing the group with Akoni in January.

Not every person who seeks mental health help is ready or needs a therapist, but for those who do, groups and peer support can provide connection and community while they wait, said Emery Cowan, director of behavioral health at Solano County.

At least 90 percent of city and county behavioral health agencies that responded to a survey commissioned by the California Association of Behavioral Health Directors in 2021 reported difficulties recruiting psychiatrists, licensed clinical social workers and licensed marriage and family therapists .

Districts cited numerous staffing challenges: they typically cannot offer salaries comparable to the private sector; they don’t appeal to candidates who want to work remotely or have flexible schedules; and have trouble finding and retaining providers with the training and experience to handle the complex patient population.

Cordero was paired with a psychiatrist immediately upon his appointment. He finally added his name to the waiting list for a therapist in 2022 and said it took about a year to be matched with someone.

Solano County Behavioral Health relies on Medi-Cal-certified peer leaders and volunteer peer leaders like Cordero to lead groups, help clients prepare for appointments and develop recovery plans.

“They’ve been through that experience, they know how hard it is, they’re more willing to do it because they want to help people just like them,” Cowan said. “They were that person.”

Cowan and Cordero acknowledge that group therapy isn’t for everyone. Discussing personal challenges or traumatic incidents in front of a group can be embarrassing, and some people need more individualized care.

But for those who are a good fit, there is a community to be found.

At the recent Holding Hope gathering, participants discussed relationships and loneliness. Cordero shared that he still finds it difficult to maintain close ties with family and friends and that he feels lonely.

He repeatedly encourages his peers to reframe negative thoughts and experiences, explaining that suffering can begin to feel comfortable, almost like a routine, and that breaking out of that routine can feel challenging.

To make his point, Cordero returned to a certain phrase several times during the hour: “The road to pain is a well-trodden path.”