TL;DR;

California faces a severe mental health crisis with 6.3 million adults (21%) experiencing mental illness annually, while undergoing historic reforms through several statewide initiatives.

• 1.5 million adults have severe mental illness; 82% of homeless individuals report lifetime mental health conditions.
• Youth depression rates jumped from 10.5% to 17.5% in a decade; 1 in 8 youth had suicidal thoughts.
• 37% shortage of non-prescribing mental health providers (43,000 needed).
• Only 38% of mental health ED visits had primary care follow-up within 30 days.
• Major infrastructure expansion is underway to address infrastructure and workforce gaps.

California’s mental health care delivery system is at a historic inflection point, as multiple reform initiatives converge to fundamentally reshape care delivery, coordination, quality expectations, and the behavioral health data landscape. This transformation is happening with the backdrop of a significant mental health crisis. Over 6.3 million adults – approximately 21% of the adult population in California – experienced some form of mental illness in the past year (Figure 1 below). This includes 1.5 million adults who faced severe mental illness (Figure 2). Among individuals experiencing homelessness, 82% reported having had a mental health condition in their lifetime (Figure 3). For youth, the rate of depression has increased significantly from 10.5% a decade ago to 17.5% in 2023 (Figure 4). One in eight youths had serious thoughts of suicide in the past year, a quarter of whom attempted to take their own lives (Figure 5). Geographic disparities paint a troubling picture across rural counties, where suicide rates can be as much as six times higher when compared to more densely populated regions (Figure 6).

Accessing mental health care in California requires navigating through a fragmented network of county behavioral health departments, managed care plans (MCPs), community providers and hospital-based services. In 2023, 39.5% of teens delayed or did not receive needed mental care (Figure 7), and 47.5% of adults needing help for emotional/mental health or substance use problems did not visit a professional in the past year (Figure 8). Access challenges are, in part, driven by systemic workforce and physical capacity constraints. The state faces a substantial shortage of mental health clinicians, with an estimated 38% of the demand for psychiatrists (3,100 providers), and 37% of the demand for non-prescribing providers (43,000) remaining unmet (Table 1). This workforce gap is further compounded by an aging workforce, with psychiatric mental health nurses serving as one stark example – an estimated 67% are retiring within the next 5 years (Table 2).

Hospitals represent an important access point for individuals with mental health conditions. Although the total number of psychiatric beds has increased in recent years, California lacks an estimated 7,800 psychiatric beds across acute, subacute, and residential settings (Figure 9). In 2024, California hospitals had close to 207,000 discharges from acute psychiatric beds, 4% higher when compared to a year prior, and with an average length of stay of 10.1 days (Figure 10). The emergency department (ED) represents another important access point. Over 4.1% of ED visits (roughly 612,000) in 2023 were due to mental health reasons (Figure 11). When leaving the ED, only 38% of mental illness-related visits had primary care follow-up within 30 days, down from 47% in 2022, and significantly worse than national benchmarks (Figure 12).

To address workforce, infrastructure, and programmatic gaps, and break the trend of worsening mental health, California is undergoing a seismic transformation across mental health care delivery, coordination, quality, and financing. The implementation of Proposition 1 will invest $6.4 billion in building missing infrastructure, from crisis stabilization to supportive housing. The Community Assistance, Recovery, and Empowerment (CARE) Act is already creating alternate pathways to institutionalization, with the goal of stabilization in the community. The Children and Youth Behavioral Health Initiative (CYBHI) is investing $4.7 billion through 2026 to build up mental health capacity and implement school-based interventions. CalAIM and BH-CONNECT are integrating mental health as part of a whole-person approach to care delivery. Finally, the State’s Population Health Management (PHM) strategy seeks to unite local health jurisdictions, MCPs, and the broader behavioral health delivery system under a shared vision that prioritizes care coordination, improves access to appropriate levels of care, and emphasizes keeping people with severe mental illness in communities (rather than institutions) whenever possible. As the implementation of these initiatives continues to mature, so will the volume, veracity, and quality of behavioral health data. Consequently, accurate baseline measurement is critical to our health system’s ability to monitor effectiveness and maximise the impact these historic investments can have on the mental health of Californians.

Thinqpoint is developing the Public Health Atlas, a next-generation public health analytics platform that will democratize access to advanced intelligence. Today, the Atlas already has numerous indicators related to social and mental health needs nationwide. To enable local health jurisdictions, managed care plans, and safety net organizations better identify community mental health needs, our team will release on the Atlas California-specific insights with baseline and evaluation utility. We are optimistic that the behavioral health care delivery system can bend the curve of worsening mental health, and are excited to deliver tools and insights that will shine a light on both the opportunity, as well as the progress.