Widening the path to behavioral health services in California is urgently needed

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OPINION — California is making a significant investment in behavioral health, and that investment is urgently needed. But if we want to see lasting change, we have to look beyond the buildings being funded and ask a more fundamental question: Where does a person go when they need help today

Hospitals are an essential piece of California’s behavioral health puzzle. But they are not the only piece. The state’s investment through the Behavioral Health Services Act and Proposition 1 will have the greatest impact if it is matched by equally urgent investments in outpatient care, workforce development, housing, funding continuity and coordination across the systems and counties that serve people in crisis.

That urgency is becoming even more apparent as California expands who can access services through the CARE Act. Senate Bill 27 widens eligibility for California’s CARE Act to include people with bipolar I with psychotic features and certain justice-involved individuals.

The change may take place through the courts, but its impact will be felt throughout the health care system — including at the hospital door. As more people become eligible for CARE Act services, local hospitals and outpatient providers need the capacity to absorb the people that expanded eligibility identifies.

Hospitals can play an important role in creating that path to care that meets people before, during and after a crisis, not just in the moment it happens. With a $14.9 million award through the Behavioral Health Continuum Infrastructure Program and Prop 1, Northbay Health is developing a Behavioral Health and Addiction Medicine Center in Fairfield (scheduled to open in June 2028) that will include a 24/7 Behavioral Health Urgent Care model, not currently available anywhere else in the region, alongside a mental health clinic and outpatient substance use treatment. 

The center is being designed with some of the people most likely to fall through gaps in the current system, including people experiencing homelessness, justice-involved individuals and foster youth aging out of care — the kind of tangible infrastructure the CARE Act conversation needs behind it.

The biggest gap in California’s behavioral health system isn’t only a shortage of inpatient beds; it’s the space between the emergency room and ongoing community care. When those connections do not exist, people can end up cycling repeatedly through emergency departments or falling out of care altogether. Hospitals can help close that gap without turning every behavioral health need into an inpatient stay. By using their around-the-clock operations and county partnerships, they serve as an important entry point for stabilizing people in crisis and connecting them with the services they need to continue their care.

Older adults on Medicare, particularly those managing co-occurring conditions, can face significant barriers to accessing appropriate services. Medicare access and reimbursement must be built into a medical system’s growth from the start, not added later. The same discipline applies to Medi-Cal, which covers a large share of the Californians this system exists to serve. Sustaining funding streams like BHSA and Medi-Cal over the long term, not just in the year they’re announced, will be what determines whether this progress holds.

None of this work starts from zero, and it shouldn’t have to. Partnerships between hospitals, counties and community health departments on post-discharge access have shown what it takes to keep someone from falling through the cracks after a hospital stay. Similar collaborations focused on homelessness have shown what it actually takes to reach people who fall outside conventional care pathways. The Fairfield center isn’t a new direction. It reflects an approach California will need more of; systems built to work together from the start.

But a hospital-based behavioral health center can’t carry California’s behavioral health strategy on its own. The state still needs outpatient care people can actually get into, and a workforce large enough to staff the services being built. It needs housing and supportive services for people living with serious mental illness, and it needs stronger coordination, so a person’s care does not start over every time they move between providers, counties, schools or other systems.

Success will be measured by whether someone experiencing homelessness, a justice-involved patient stepping down from a CARE Act placement, or a foster youth aging out of the system has somewhere real to go, at 2 a.m. or on a Tuesday afternoon — that didn’t exist before.

That’s the standard California’s broader behavioral health investments should strive to meet — not just more places for care, but more pathways to it, and ways to stay connected once someone arrives.

Lois Cross is vice president of government relations for Northbay Health.