After Napa County officials held several public meetings aimed at banishing the stigma that surrounds mental illness, one fact became clear: More work needs to be done.

“People have the sense that something is really wrong with them if they have a mental illness, or that they have done something to cause a mental illness in a loved one,” said Rob Weiss, executive director of Family Service of Napa Valley, a local nonprofit dedicated to mental health care.

“And there continues to be discrimination against people with a mental illness. We’re trying to break that down, but the perceptions are still very prevalent.”

Weiss’ point was palpable Tuesday night, when more than 250 Napa County residents packed McPherson Elementary School’s multi-purpose room to discuss ending the stigma and creating better access to mental health care. As people diagnosed with mental illnesses sat together – sharing experiences with loved ones and health care professionals – the chatter was open and free-flowing. But whenever a reporter neared one of the many tables in the room, people began to speak in hushed tones, or often stopped talking completely.

“It was great to see such a big turnout, but it’s sad that shame and fear still permeates the mental health community,” said Weiss. “Obviously, there is more work to do.”


Tuesday’s forum was the culmination of several months of city meetings on mental illness held throughout the county. Led by 27 local young people – half of whom have been diagnosed with a mental illness – the meeting gave local health professionals the opportunity to discuss de-stigmatization and the delivery of mental health services.

As is often the case with diseases, ending stigma is considered the last hurdle to tackling meaningful treatment options, officials.

“Look at cancer,” said Weiss. “Twenty-five years ago, people who were diagnosed with cancer would often hide it because they felt like it was their fault. But now, it’s openly discussed. And treatment and public awareness has improved. We need to see the same thing happen with mental illnesses.”

But Weiss admitted that it is difficult to end stigma when public perception is rampantly misguided. He pointed to recent high-profile homicides committed by people with mental illnesses as a prime reason for the inaccurate beliefs the public holds.

“People often miss the fact that those who are committing violent crimes are often not receiving treatment for their mental illness, or they are self-medicating,” he said. “When treated properly, people diagnosed with mental illnesses usually lead normal, productive lives.”

But the uphill climb facing mental health does not end with negative perceptions. It also involves inadequate access to care.

Confusing, expensive system to navigate

Currently, the county’s Health and Human Services department offers mental health services to those diagnosed with a severe mental illness. The county’s programs provide emergency care at a reduced cost to people with the most severe diagnoses – typically those who cannot care for themselves.

But most people who are diagnosed with a mental illness do not need emergency care, leaving them struggling to navigate the complicated web of the mental health system privately.

According to the California Healthcare Foundation, Napa County has almost 67 psychiatrists for every 100,000 people — making it the third highest ranked county in the state for access to psychiatric care, behind only San Francisco and Marin counties. Contributing to the high number of psychiatrists here is the presence of Napa State Hospital.

Private treatment comes at a cost. Many health insurance plans do not cover private mental health care, or do so at a substantially lower rate than physical medical care. And the separation of care, the unequal treatment offered to those with mental illnesses, only furthers society’s unwillingness to treat mental illnesses like any other disease, said Weiss.

“Honestly, I think access to treatment can be hit and miss in Napa County,” said Weiss. “There are gaps between those who need emergency help immediately and are served by the county, and those who need less help, but cannot afford it on their own. That’s why it is so important to offer affordable care, so that no one is denied access because they can’t afford it.”

Weiss said that partnerships between the county and local nonprofits are vital to ensuring access to care for everyone. Right now, it’s the best option Napa has to fill in the gaps between private, fully subsidized care and incredibly expensive private care, he said.

Moving in the right direction

Despite the ongoing issues of stigma and access to care, problems that plague most jurisdictions across the state, Weiss felt positive about Tuesday’s meeting.

“Just the fact that so many people turned up to have an open dialogue is heartening,” he said. “People in this community obviously know that mental health is important, and they are taking steps to talk about it, to bring it out of the shadows and to make sure that everyone has access to care.”

Napa resident Juanita Pena understands the ongoing struggles of people with mental health all too well. Her daughter was diagnosed with schizoaffective disorder in the late 1990s — leaving Pena and her family struggling to access care.

“What the county really needs is an organization dedicated to helping families help those who are diagnosed with mental illnesses,” she said. “That’s what Napa is still missing to this day.”

One of the suggestions brought forth at Tuesday’s meeting was a plan that Pena has been working on for more than a year: Bringing a Napa chapter of the well-known National Alliance on Mental Illness, or NAMI, to Napa County.

“We’ve been exploring an idea of opening a NAMI facility here, that is partnered with Sonoma County’s outfit,” said Pena. “It would offer families immediate support and a place where they can feel like they are heard. That’s what I didn’t have when my daughter was diagnosed.”

Pena, who works for the local nonprofit Parents Child Advocacy Network, a parent-led organization dedicated to helping families of children with special needs, said that she struggled to help her daughter because she didn’t have adequate support herself.

“How can you be expected to help your loved one, when you can’t help yourself?” she asked. “You can’t. We really need something like NAMI to truly support the families.”

As a member and certified trainer of NAMI, Pena will teach a class at the end of summer for family members of adults who are diagnosed with severe mental illnesses, such as schizophrenia, bipolar disorder or borderline personality disorder.

“People can gain insight from this class,” she said. “Those who have taken it describe its information as life-changing for families.”

Weiss said that such efforts, coupled with the public turnout at Tuesday’s meeting, prove that Napa is heading in the right direction when it comes to supporting the mental health community.

“We have been gathering good data about the needs of Napa County,” he said. “My hope is that we continue to stay focused on mental health issues, and continue to prioritize them. It comes down to two core issues. People need to be able to access care without fear, and they need to be able to afford it.”