Healthcare funding decreases are expected to take place in the next several years which will impact the most vulnerable populations living with mental illness and substance abuse disorders. As financial pressures grow, the need for effective policy that improves access to care will become increasingly important.
Behavioral health challenges are widespread in California. More than 5.5 million adults in California live with a mental health condition, over 1.2 million experience a serious mental illness that significantly affects their ability to function in daily life, and 5.6 million experience a substance abuse disorder. 1,2
When people are unable to access behavioral health services in the community, they often turn to hospital emergency departments. Emergency departments are designed to treat acute medical conditions, yet they often serve as the entry point for individuals experiencing psychiatric crises or complications related to substance use. In California, mental health and substance use disorders make up roughly one third of diagnoses in hospital emergency departments and inpatient settings.3
Utilizing emergency departments to treat behavioral health issues strains the healthcare system. Patients experiencing behavioral health crises usually require longer evaluations and coordination of care, including psychiatric placement or social services. As a result, emergency departments can become overcrowded, and individuals may wait longer periods for appropriate care. Hospitals must then manage both the immediate crisis and the social and behavioral health needs of these patients.
Recent policy reforms in California attempt to address these challenges. The Behavioral Health Services Act (BHSA) and the BH-CONNECT initiative, part of the state’s Medi-Cal transformation efforts, are designed to strengthen the behavioral health system and improve access to services. These policies focus on expanding community-based treatment, increasing coordination between healthcare and social services, and supporting individuals with serious mental illness and substance use disorders.
A goal of these reforms is to shift care away from emergency departments to a more appropriate setting. When behavioral health services are accessible in outpatient and community settings, individuals are more likely to receive treatment before their condition worsens, thereby potentially reducing reliance on emergency departments and improving health outcomes.
The success of these policies will depend on sustained implementation efforts, workforce capacity, and care coordination across healthcare and social service systems. As healthcare funding pressures increase, policies that improve access to behavioral health treatment may help protect vulnerable populations while easing strain on hospitals and emergency departments. Providing access to the appropriate level of behavioral health care is a key component in building a more stable and responsive healthcare system.
Author Bio
Huma Shah, DrPH, MPH, FACHE
Dr. Shah is the Program Director of the Master’s in Healthcare Administration program and an Associate Professor at the School of Public Health. She also supports Medi-Cal transformation initiatives as a CalAIM facilitator. Her research focuses on health policy, leadership, clinical outcomes, and behavioral health.
Dr. Shah is the Program Director of the Master’s in Healthcare Administration program and an Associate Professor at the School of Public Health. She also supports Medi-Cal transformation initiatives as a CalAIM facilitator. Her research focuses on health policy, leadership, clinical outcomes, and behavioral health.
References:
- National Alliance on Mental Illness. (2023). Mental health in California: State fact sheet. https://www.nami.org/wp-content/uploads/2023/07/CaliforniaStateFactSheet.pdf/.
- Kelleher, C., & Rozier, K. (2025). Substance use in California almanac. California Health Care Foundation. https://www.chcf.org/resource/substance-use-in-california-almanac/.
- California Health Care Access and Information. (2024). Behavioral health providers, encounters, and diagnoses in California’s hospital inpatient and emergency department settings. https://hcai.ca.gov/visualizations/behavioral-health-providers-encounters-and-diagnoses-in-californias-hospital-inpatient-and-emergency-department-settings/.
- California Department of Health Care Services. (2025). Behavioral Health Services Act county policy manual (Version 1.3.0). https://policymanual.mes.dhcs.ca.gov/__attachments/347832365/Behavioral%20Health%20Services%20Act%20County%20Policy%20Manual-V.1.3.0-202506.pdf?inst-v=c1c5ec63-dd27-4662-9449-b44a7f6431a8.