Kevin Gobee is always on his toes. As an intern at the Village in Long Beach, a comprehensive mental health care facility for the homeless and recently homeless, he and the other interns and volunteers learn complicated skills on the fly. The patients – known at the Village as “members” – rely on these skills to get through their everyday lives. There's a lot of pressure. 

He works with a field trainer, going to members’ homes to check on them and take them to lunch and to the Housing Authority and doing just about anything it takes to help improve their lives.

One member was particularly difficult to engage and build a relationship with, at first. So the field instructor went with him to a Metallica concert.

“He was one that actually kind of threw me for a loop when I first got there,” Gobee said of the member. “He has a beard, long hair, doesn’t have the best of hygiene, and you can’t really understand what he’s saying, and he kind of mutters to himself. But he’s into Metallica.”

Mental health interns work in high-pressure environments where money is tight.

Alexander Young, a health services expert at UCLA, said that tight budgets mean that service providers often rely on interns and volunteers.

“It’s hard to know how to allocate the scarce funds in the system. And these mental health services have to care for people with very little money, so they can’t pay physicians very much,” he said. “So they bring in very well-meaning young people who want to do a good job but don’t often have a lot of training.”

Furthermore, the ideal types of care that these facilities want to provide are expensive. Full-service partnerships, which are available to some members at forward-thinking facilities like the Village, Lamp Community (downtown L.A.) and Didi Hirsch (Culver City) are the flagship programs of the Los Angeles Department of Mental Health. But less than five percent of people who use DMH services qualify for such in-depth programs, estimates Cathy Warner, director of adult services at the Los Angeles Department of Mental Health.

The future of mental health care remains largely up in the air because of policies being enacted at the national, state and local levels.

On one hand, mental health in California will get a significant boost because of President Barack Obama’s recently passed health care reform act, which will extend health insurance coverage to 4.7 million Californians, according to a UCLA study released on Feb. 15. That number accounts for two thirds of uninsured Californians and some of that coverage will be for mental health care.

On the other hand, mental health programs like the Village and other facilities run by groups like Mental Health America of Los Angeles rely heavily on funding from the state. Some of that funding is in jeopardy because of Gov. Jerry Brown’s proposed budget, which will also cut $1.7 million from Medi-Cal and reduce supplemental security insurance payments.

Dylan H. Roby a research scientist for the UCLA Center for Health Policy Research, said the full effects of the new state budget remain uncertain, but will largely depend on how counties deal with California’s realignment plan, or the plan to assign responsibility of services to county governments. He said in an email that, as with any realignment, this one could result in an “unfunded mandate” issue.

“If the resources given to counties end up under-funding mental health in the long-term, you could certainly see impacts accruing to under-served communities related to cuts in services, layoffs of counselors and physicians, closure of clinics, inability to cover brand name drugs, etc…,” he said. “The counties with lower mental health and substance abuse needs might be fine under their allocation, but others will be at risk due to higher service need and other issues like coordination of care with county facilities.”

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Gobee described his immersion at the Village as a kind of on-the-job training where he was allowed to learn from his mistakes.

“Before, I didn’t have a lot of knowledge about mental health, and maybe actually a little bit of fear, so when I first got there, I was kind of flying blind,” he said.

Gobee went grocery shopping with a member recently. The man didn’t really know how to shop for food, so the intern’s job consisted of finding out what the man could make on his own in his tiny apartment with his tiny stove and his tiny refrigerator. He tried to guide the man on how to save money shopping and how to make food last. “You can’t go shopping at CostCo and get the huge value-sized things.”

“He actually told me he had messed up cooking pasta,” Gobee said. “He was afraid to buy uncooked chicken, so that’s something we’re going to work up to.”

Part of the job is motivating the members to improve their lives, but Gobee learned the hard way that not everyone responds the same way to the same motivational techniques. For one member, that motivation just put more pressure on the person’s fragile state of wellbeing. The member confronted him about it. Their conversation lasted for an hour and a half.

“It was just this emotional salad that started as this simple conversation that turned into anger, that turned into laughter, and then there was a lot of crying toward the end,” he said. “It was kind of a rollercoaster.”

Sometimes it takes an extraordinary effort to make connect with a member. Gobee is reminded of this when he talks about the field trainer who took the long-haired, metal-loving member to the Metallica show.

“Maybe it sounds like you’re slipping through he cracks of what’s actually social work,” Gobee said. “But really, taking him there helping improve his life and helped my field instructor engage with this member and build a relationship with him.”

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