APPLE VALLEY, Calif. – About 85 miles northeast of Los Angeles, in the high desert, sit the ruins of George Air Force Base. From World War II through the end of the Cold War, activities on the site helped prepare pilots for battlefields worldwide. But today, a new fight is taking place at the decommissioned base.
Symba Center is a free clinic that operates out of a former gym that was converted into a wellness center for the community during the Covid-19 pandemic. While providing services to the area’s most vulnerable residents was always a challenge, providing mental health was even more difficult, according to co-founder and pharmacist Shawn Smith.
The U.S. Health Resources and Services Administration has recognized that Symba Center is in a geographically-designated Health Professional Shortage Area for both primary and mental healthcare. Smith said that the shortage is even more acute as it relates to the population he and his colleagues are caring for.
“People on the street usually have tremendous needs for mental healthcare… There are a very limited number of psychiatrists and therapists here, and we wanted to offer services for people who could not get an appointment at all because they don’t have insurance,” Smith said. Symba Center found that about 40% of the homeless shelter occupants they care for suffer from major depressive disorder and general anxiety disorder.
“The major factor leading to homelessness among our population is a mental health disorder,” Smith said.
In Northern California, a similar lack of resources faced Jose Perez, a licensed marriage and family therapist, and the care team at Samaritan House, a nonprofit that runs free clinics in San Mateo and Redwood City. Perez was hired in 2020 to start a mental health department but faced acute shortages.
“We realized the need for mental health care was huge,” he said after the clinic started implementing initial screenings. “The demand was there, but we had no staff,” Perez said, adding that, in total, only 10 hour-long appointments, paid for by the clinic, were available each week. He reported a 43% increase, year-over-year, in mental health referrals to his clinics.
Last year, Symba Center and Samaritan House were two of 11 free and charitable clinics which received a $75,000 grant to expand mental health care access to some of the most vulnerable populations in the United States. Over $17 million worth of mental health-targeted Teva pharmaceuticals were also made available to over 400 free and charitable clinics.
As a result of the grants, free and charitable clinics have been able to hire additional staff, launch internship programs, offer educational resources, including group sessions, increase collaborative efforts with local organizations and providers, and implement mental health screening programs for their patients. In total, these clinics have screened, directly and indirectly, about 22,000 people.
These developments have helped address not just mental health care needs but also primary health care needs.
“If people aren’t feeling good about themselves, they are less likely to take showers, clean their house, eat healthy, take meds, and are more likely to do destructive behavior,” said Smith. “Before the grant, there were not too many places to refer to. There’s a service gap… This has allowed us to expand our services to a whole new model.”
Smith said Symba Center is now caring for twice as many patients as before regarding mental healthcare. There have been other benefits as well.
“The more services we can offer, the more we can be available to patients, the more they trust us to provide care for them,” he said. Symba Center has been able to hire a licensed marriage and family therapist who oversees graduate interns. They have also started offering trauma-informed education to shelter staff.
At Good Samaritan, which serves a largely immigrant population, Perez said a large focus has been on implementing culturally competent care given by bilingual providers. They have started a training program and hired both a full-time and a part-time clinical and a group facilitator. He said that his clinic does not usually use the term “mental health” which he said has a negative stigma in the Latino community.
“Instead, we use the word ‘consejeria’ (counseling) or ask ‘do you need someone to hear you out?’” said Perez. “We use those terms to get them in the door and then plan what mental health is and how we can help them.”
Beyond language, Perez said treating patients with culturally competent care leads to better results.
“’I look like you, I can help you, I want to help you’… We take time to build rapport, without it they’re (patients) not going to be open to treatment. Otherwise, I’m just someone telling them what to do,” he said, adding that he is also an immigrant.
Still, even with care tailored to the local community, some people do not feel comfortable broaching the subject. Recognizing this, Perez ordered informational booklets on a range of mental health topics, such as depression, grief, anxiety, stress, family violence, suicidal ideation, and alcoholism. Each one is about 15 to 20 pages long and offers techniques that readers can use to help address these conditions.
Perez said the most popular topic in Redwood City, which has a more recently-arrived immigrant client base, has been depression, followed by stress and grief. In San Mateo, which has more elderly patients, it has been those, plus self-esteem and co-dependency.
The differing, though related, focuses across Symba Center and Good Samaritan reflect how free and charitable clinics respond to the specific needs of their communities. Free and Charitable Clinics and Pharmacies provide care to about 2 million people in the U.S., according to the National Association of Free and Charitable Clinics.
Ultimately, Smith said, it always comes back to the patients.
“If you can provide a level of service to someone and promote healing to make sure people can really focus on themselves, you remind them they have a purpose in life, and they have an opportunity to live a life they’ll be proud of.
“I think each person deserves an opp to have services provided to them so they can see themselves being treated well. It’s providing dignity to humanity,” Smith said.
Funding for these programs was made available through Community Routes: Access to Mental Healthcare, a partnership between Direct Relief, the National Association of Free and Charitable Clinics, and Teva Pharmaceuticals, which provides financial and medication support to clinics expanding access to mental health services.