California budget threatens funding for mental health teams

from Ana B. IbarraCalMatters

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On an early spring evening in Glendale, a 37-year-old woman is confined and weak from being denied food and water for several days. Her mother calls for help. She tells a crisis counselor that her daughter has been hearing voices and has expressed a need to “kill” those voices. She won’t go to the doctor.

Then James Gonzalez and Katerina Cabello back off. They are in casual clothes – khakis and jeans paired with sweatshirts. No sirens blaring in an unmarked white minivan.

Gonzalez and Cabello are among the 75 mobile crisis response teams Los Angeles County operates around the clock. Licensed and trained as behavioral health crisis first responders, these two-person teams respond — in person, with backpacks and clipboards — to calls from 988, the crisis line or the county’s mental health hotline. Gonzalez and Cabello work for the Sycamores, a nonprofit agency that contracts with the county.

Across California, demand for these kits — an alternative to badges and sirens for people in their darkest moments — is growing. But just as they are proving their worth, the federal funding that fueled their growth will end. That push, that of Gov. Gavin Newsom, is missing budget plan proposes to change the service from a compulsory benefit to an optional one, which means that the state does not have to cover the funding shortfall.

Counties that decide to keep the service would have to pay for it themselves at a cost of $150 million to $200 million a year. When counties can’t afford it, crisis teams could shrink or disappear altogether if the Legislature approves the governor’s budget proposal.

A boost in mobile crisis services

Convincing a person in crisis to accept help is a skill. You have minutes, sometimes less, to gain trust.

When Gonzalez walks into the living room of a client in crisis, he’ll quickly scan the room, looking for family photos, religious artifacts, trophies, anything that might help him connect. He has seen people in various stages of vulnerability: a woman who feels the world on her shoulders after leaving an abusive relationship; a teenager feels so much anger that he attacks his father.

Knowing when to be gentle and when to be strict is also a skill. After more than an hour in Glendale, Gonzalez and Cabello got their client to drink some water and convinced her to go to a nearby hospital for IV fluids—once there, she finally agreed to a psychiatric evaluation.

“Mental health can be pretty brutal,” Gonzalez said. “I’ve dealt with it as a parent. I don’t want our users to feel that. I want them to feel like we’ve really done something for them.”

Two days later, he and Cabello connected on the call in Glendale. The grown daughter did not meet the criteria to be placed in psychiatric custody, but after the team shared treatment options and resources, the mother reported that she was eating and feeling better.

When personal help is needed, teams meet people where they are – homes, schools and workplaces – and serve everyone, regardless of income or insurance status. Although the program began as a Medi-Cal benefit for low-income residents, the teams also serve the uninsured and those with private insurance — counties can bill private insurers for behavioral emergencies.

In 2023, California made mobile crisis response a statewide benefit when a federal law offered a financial incentive for it: The federal government would temporarily cover 85 percent of the costs, up from the usual 50 percent. At the time, people with mental health and substance use disorders account for one-fifth of all emergency department visits in California — a pressure point the state said mobile behavioral health teams can help address.

Mental health advocates and counties knew the extra federal money was temporary. What caught them off guard was what followed: Instead of covering the gap when the increased rate fell, the state planned to make the service optional, funding it only through March 2027 before shifting the burden to counties. “It was really a surprise to us that this program was on the cutting edge of receiving unanimous support,” said Tara Gamboa-Eastman, director of government affairs at the Steinberg Institute.

State officials say the weather is imminent. The expiration of the extended federal match coincides with a projected state budget deficit of nearly $3 billion for the upcoming fiscal year and $22 billion for next year.

“The administration proposed redesigning this as an optional benefit to be offered at the discretion of counties as the most sustainable way to move the program forward,” said H.D. Palmer, a spokesman for the California Department of Finance.

State lawmakers who favor keeping the service challenged the department in a recent hearing. “We’ve invested so much money in creating and improving infrastructure that we’re not going to keep up,” said Sen. Carolyn Menjivar, D-San Fernando. “Is this a waste of our money?”

County weighting options

In San Joaquin County, when a young woman was mentally disturbed because she couldn’t afford her rent, the local crisis team visited her repeatedly to stabilize her. They also helped her find affordable housing. “No other team can be as persistent as a mobile crisis team,” said Faye Vieira, director of San Joaquin County Behavioral Health Services.

Funding changes could force San Joaquin to return to fewer teams available only from 8 a.m. to 5 p.m. Her biggest concern is the loss of trust among the community the county has spent the past two years courting.

“We made vehicle purchases and put money into advertising,” Vieira said. “You can tell by our referral numbers that people are using this.” Crisis calls in the county are up 15 percent this year compared to last, she said.

In Monterey County, the story is similar. The county began limited mobile crisis services in 2015, but struggled to expand them until the federal push. “We’ve been trying to look for expansion for years because we saw the value,” said Melanie Rhodes, the county’s director of behavioral health. “We saw the people we were helping.” Without continued funding, she said, the county may be forced to downsize.

Rural San Benito County has launched its Mobile Crisis Program just last year – it took officials there months to find an outside provider to come in and offer the service. The program there is just starting to gain momentum.

“We know we can’t afford it without the federal dollars,” said Rachel White, director of behavioral health for San Benito County.

The pressure is hitting counties that are already shouldering other rising health care costs. Starting in July, counties will have to direct one-third of their mental health budgets to housing chronically homeless people. In the coming year, they will also have to restart health programs for people who will lose their Medi-Cal coverage under the rules related to the federal spending bill signed by President Trump in 2025.

Even for the state’s largest county, that’s a pinch. Since the state mandate went into effect just over two years ago, Los Angeles County has doubled its mobile crisis teams.

Officials with the Los Angeles County Department of Mental Health said they don’t yet know if they will have to make cuts, but having to absorb the additional costs will stifle their plans to expand and better meet demand.

“It’s definitely going to hurt,” said Reuben Wilson, chief of alternative crisis response at the Los Angeles County Department of Mental Health. “We’re trying to reduce our response time so we can get there faster; law enforcement is becoming more and more dependent on us. We’re really in a growth period and it seems really premature to stop support.”

A promising alternative to help

A national study shows that non-police behavioral health professionals — like county crisis teams — do a better job than law enforcement at keeping people out of emergency rooms and connecting them to psychiatric care.

“Engaging clinical teams in the community can prevent costly emergency room care and lead people to contact mental health care after the crisis incident has resolved.” a small-scale study by Michigan Crisis Response Teams found. A separate California analysis found that alternative crisis response programs reduced the number of unnecessary psychiatric incarcerations.

California’s own data is incomplete. As of January 2024, the Department of Health has approved more than 73,000 personal mobile crisis claims through Medi-Cal alone—and because of typical claims delays, actual use is likely higher. Counties collect volume and some demographic data, but no statewide analysis of results exists. That won’t be possible until the state begins collecting outcome data, which is expected to begin later this year.

As counties wait for the governor’s final budget, the calls continue to come in.

Gonzalez and Cabello had not heard of the proposed funding change. They’re not sure what that would mean for the Sycamores or teams like theirs. What they do know is that people suffer.

On a recent call, Gonzalez and Cabello found a father and uncle restraining a 19-year-old man who was having outbursts of rage. The police were the first to respond but were unable to solve the problem. The situation called for help like Gonzalez and Cabello. They spoke to the young man.

“Dad called and thanked us,” Gonzalez said. “He said no one had ever been able to help him like that.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.