California voters approved Proposition 1 last year, allocating $4.4 billion to support mental health and substance use disorder treatment. This funding was added to the state’s existing $1.8 billion Behavioral Health Continuum Infrastructure Program (BHCIP), aimed at expanding the capacity of behavioral health services across the state. However, a recent report by the California Legislative Analyst’s Office (LAO) urges state lawmakers to reassess the program’s effectiveness before disbursing further funds. The analysis raises concerns about inequities in how the money is allocated and whether it truly addresses the areas of greatest need.
Challenges with Small Counties and “Launch-Ready” Projects
Ryan Miller, the LAO analyst behind the report, pointed out that a significant number of small counties are missing out on program funds. This is largely due to the preference given to “launch-ready” projects, which require substantial planning, including architectural and engineering work. For smaller counties, this requirement creates a barrier, as they often lack the resources to put together such complex applications. As a result, larger counties with more people and financial resources are better positioned to compete for funding.
Miller’s concerns are particularly focused on rural and underserved regions, where there is a strong demand for behavioral health services but fewer local resources to support such large-scale projects. The Southern San Joaquin Valley, for example, has been highlighted as a region with significant unmet need but has not seen an increase in beds for mental health or substance use disorder treatment despite being part of the state’s priority areas.
Inequities in Bed Distribution
The LAO report also sheds light on an uneven distribution of newly added behavioral health beds. While many new beds have been created in the four regions with the least need — including large metropolitan areas like San Diego and Los Angeles — the Southern San Joaquin Valley, which faces a disproportionate burden of mental health issues, has not seen similar investments.
This imbalance raises questions about the efficacy of the BHCIP in targeting areas of greatest need. While counties with higher populations might argue that they require more resources, it’s essential that the funds be distributed in a way that reflects where the highest levels of mental health challenges and substance use disorders are occurring, regardless of population size.
Medi-Cal Focus and Equity Concerns
One of the main goals of the BHCIP was to focus on Medi-Cal enrollees, a group that is disproportionately affected by mental health and substance use disorders. Miller acknowledged that this targeting of Medi-Cal beneficiaries is a positive step, ensuring that funds are directed toward those who need them most. However, the LAO report emphasized that more needs to be done to ensure that underserved communities — including children, people involved in the justice system, and Native American populations — are adequately reached.
Adriana Ramos-Yamamoto, a health policy analyst at the California Budget and Policy Center, echoed this sentiment, arguing that the amount of funding allocated to behavioral health services is insufficient to meet the needs of these communities. She stressed that while the funds are important, they won’t resolve systemic issues such as the state’s healthcare staffing shortage or the need for more housing options, which are not addressed in Governor Gavin Newsom’s budget proposal.
Program Limitations and the Need for Comprehensive Solutions
Despite the infusion of funding, the LAO report highlights that many of the projects funded by the BHCIP are still in the planning phase. For example, Sacramento County is using the funds to open new treatment centers and create additional beds for both adults and children. However, Elizabeth Zelidon, a spokesperson for the Sacramento County Department of Health Services, pointed out that while the projects are funded, the services provided at these centers are not yet available.
This underscores a broader concern: simply building more treatment centers and adding beds will not solve the problem unless there are enough trained professionals to staff these facilities and ensure that services are available to those who need them most. The state’s existing behavioral health workforce is already stretched thin, and there are no provisions in the current funding for addressing the staffing shortages, which further compounds the challenge of providing timely and effective care.
Next Steps: Focus on Data and Equity
The LAO is urging lawmakers to push for more data on the program’s reach and impact, particularly in terms of equity. This includes tracking how effectively the program is serving vulnerable populations, such as children, Native American communities, and individuals involved in the criminal justice system.
Additionally, the LAO suggests that more targeted investments are necessary to ensure that mental health services are truly accessible and equitable for all Californians. While the funds from Proposition 1 are a step in the right direction, a more comprehensive approach is needed to address the root causes of the state’s mental health crisis, including healthcare access, staffing shortages, and the need for stable housing.
Conclusion: Rethinking Behavioral Health Funding
As California moves forward with its behavioral health initiatives, it is essential for lawmakers to evaluate how funds are being distributed and ensure that they are reaching those who need them most. While Proposition 1’s funding represents a significant investment in the state’s mental health infrastructure, the LAO’s report suggests that a more thoughtful, data-driven approach is required to ensure that the funds are being used effectively and equitably.
The challenges of behavioral health care in California are complex, and the state’s current funding levels and distribution mechanisms may not be sufficient to address the full scope of the issue. As the LAO recommends, careful evaluation and adjustments to funding priorities will be necessary to build a more equitable and efficient system of care for all Californians.
