ITUP Blog: Snapshot: Examining Behavioral Health in California

August 8, 2024

By Abeerah Siddiqui

Snapshot: Examining Behavioral Health in California

This ITUP blog highlights landmark legislative bills that have set the foundation for the transformation of the behavioral health policy landscape in California. Following the summary of key state-led initiatives, we have compiled a list of behavioral health resources available across each ITUP-specified region.

Note: this is not a comprehensive list of all the behavioral health bills and behavioral health resources that are available. If you have questions about a bill not listed here or behavioral health resources not listed, please feel free to contact us at info@itup.org.

Behavioral Health in California

Behavioral health refers to the behaviors that affect an individual’s well-being, encompassing mental, emotional, and social aspects.[i] Behavioral health care refers to the prevention, diagnosis, and treatment of those conditions, such as mental health, substance use, substance use disorders, etc.[ii]

Californians have faced an unprecedented rise in behavioral health crisis, following the effects and impacts the COVID-19 pandemic has had on mental health. Rising rates of depression, anxiety, and substance use, coupled with the impacts of economic stress, have heightened demand for behavioral health care.[iii][iv] In addition, many Californians face significant barriers to accessing behavioral health care services, including long wait times, insufficient availability of providers, and geographic disparities.[v] The historic workforce shortage in California, particularly with mental health professionals, including psychiatrists, psychologists, and licensed therapists, exacerbates wait times and limits the capacity of the behavioral health care delivery system to meet the growing demand and need for services.[vi]

A significant portion of the unhoused population in California struggles with behavioral health issues. The intersection of homelessness and mental health or substance use disorders presents a critical challenge, with many individuals lacking access to the necessary support and treatment.[vii] Behavioral health services in California are often fragmented with care spread across various public and private systems resulting in gaps in service delivery and difficulties in care coordination.[viii]

Addressing California’s behavioral health crisis requires a comprehensive approach involving increased investment, improved coordination, and a focus on expanding access to care for all Californians, especially those in historically marginalized and underserved communities. California has made strides in continually evolving the behavioral health care delivery system to meet the needs of its diverse populations through landmark legislative bills and initiatives like Mental Health for All.

Key Legislative Bills

Key Major State-Led Behavioral Health Initiatives:

  • Mental Health Services Act (MHSA) – Enacted in 2004, also known as Proposition 63, MHSA is a landmark piece of California legislation designed to enhance mental health services throughout the state. The MHSA Act aims to transform the mental health system by improving services and support for individuals with mental health issues and supports a variety of community-based programs and services. The majority of the funds are allocated to counties, allowing them to tailor mental health programs to meet the specific needs of their communities.
  • California Advancing and Innovating Medi-Cal (CalAIM) – Launched in 2022 and led by California’s Department of Health Care Services (DHCS), CalAIM is a comprehensive reform aimed at transforming California’s Medi-Cal program focused on improving the quality of care, reducing health disparities, and enhancing the overall effectiveness of the Medi-Cal health care delivery system. CalAIM represents a significant shift towards a more integrated, person-centered approach in Medi-Cal, aiming to enhance health care service delivery, address social determinants of health, and reduce health disparities in California communities. For more information about CalAIM, see ITUP’s CalAIM Summary and Timeline (2022 Update) Fact Sheet.
  • Children and Youth Behavioral Health Initiative (CYBHI) – Announced in 2021, the CYBHI seeks to create a more accessible, equitable, and effective behavioral health system for young Californians. The initiative is a multi-year, multi-department investment plan focused on enhancing mental health services and support structures for children and youth across California. The CYBHI represents a comprehensive strategic effort to improve mental health support for Californians aged 0-25 years old, addressing both immediate needs and long-term goals for better mental health outcomes.
  • Proposition 1 (Prop 1) – A ballot measured that appeared on the November 2022 ballot designed to address affordable housing and homelessness issues in California. Officially known as the Affordable Housing and Homelessness Prevention Bond Act of 2022, Prop 1 authorizes $4.4 billion in bonds to address the state’s urgent housing needs, improve living conditions for vulnerable populations, and support efforts to prevent homelessness.
  • Behavioral Health Continuum Infrastructure Program (BHCIP) – Under DHCS, the BHCIP is a key initiative designed to enhance and expand the infrastructure supporting mental health and substance use disorder services. The BHCIP aims to improve the availability and quality of behavioral health services by investing in physical infrastructure, service capacity, and innovative service models.
  • California Behavioral Health Community-Based Organization Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration – Introduced in 2021, the BH-Connect Demonstration is a Medicaid Section 1115 Demonstration designed to enhance the integration and coordination of behavioral health services, particularly targeting individuals with complex needs. The demonstration focused on developing and testing innovative service delivery models to improve the quality and efficiency of behavioral health care across the state.
  • Medi-Cal Mobile Crisis – Housed as a component of California’s Medi-Cal program, the Medi-Cal Mobile Crisis offers rapid, in-person response to individuals facing mental health emergencies. This community-based intervention aims to stabilize the situation on-site, reduce the need for emergency room visits, and connect individuals to appropriate care and resources.

Behavioral Health Resources in California

The annual ITUP Equity Collaboratives convene a variety of stakeholders, ranging from local health care delivery systems and public health partners to key health care stakeholders and community champions from across California to discuss challenges impacting the health care delivery system and opportunities to address those issues. This year, ITUP is focusing on creating an equitable health care workforce, including participant-led discussions on innovative strategies to leverage behavioral health providers and other allied health professionals. Register for the in-person Los Angeles and Orange County Collaboratives here to join the conversation in determining how the health care workforce can better reflect the communities it serves!

The following section below incorporates ITUP-specified regional behavioral health resources. Additionally, learn more about regional health coverage through our 2024 Regional Health Coverage Fact Sheets linked to their respective regions.

Note: this is not a comprehensive list of all behavioral health resources available across each ITUP-specified region. If you have questions about a behavioral health resource not listed, please feel free to contact us at info@itup.org.

San Diego/Imperial Counties

North Rural Counties (Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Yuba)

Central Coast Counties (Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura)

Orange County

Central Valley Counties (Fresno, Inyo, Kern, Kings, Madera, Mariposa, Merced, Mono, San Joaquin, Stanislaus, Tulare, Tuolumne)

Inland Empire Counties (Riverside, San Bernardino)

North Central Counties (Alpine, Amador, Calaveras, El Dorado, Napa, Placer, Sacramento, Solano, Sonoma, Yolo)

Bay Area Counties (Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara)

LA County

Next Steps

As policies and initiatives continue to be introduced and implemented across the state, it will be imperative to assess how the behavioral health crisis in California evolves continually. This blog is meant to provide a succinct overview of the current landscape, introduce important actions that have been taken thus far, and provide resources as they pertain to ITUP Regional Equity Collaborative counties. However, ITUP is currently working on an in-depth Behavioral Health Policy Toolkit which will provide more nuanced information regarding present and proposed policies. To be the first to read the toolkit, sign up for the ITUP newsletter here.

References

[i] Williams, N., What Is Behavioral Health: A Comprehensive Guide, Community Health Centers, April 2024, Accessed: July 19, 2024.

[ii] American Medical Association, What Is Behavioral Health?, August 2022, Accessed: July 19, 2024.

[iii] Holt, W. & Hahn, T., Mental Health in California: Waiting for Care, California Health Care Foundation (CHCF), July 2022, Accessed: July 29, 2024.

[iv] Valentine, A. & Brassil, M., Substance Use in California: Prevalence and Treatment, California Health Care Foundation (CHCF), January 2022, Accessed: July 29, 2024.

[v] California Hospital Association (CHA), Key Messages: Learn What’s Driving Challenges in Behavioral Health Care, 2024, Accessed: July 29, 2024.

[vi] Wiener, J., Unanswered Cries: Why California Faces a Shortage of Mental Health Workers, CalMatters, September 2022, Accessed: August 2, 2024.

[vii] Streeter, J. L., Homelessness in California: Causes and Policy Considerations, Stanford Institute for Economic Policy Research (SIEPR), May 2022, Accessed: August 2, 2024.

[viii] Department of Health Care Services, Assessing the Continuum of Care for Behavioral Health Services in California: Data, Stakeholder Perspectives, and Implications, Accessed: August 2, 2024.