Emerging Themes – Challenges and Opportunities

Emerging Themes – Challenges and Opportunities

The mental health landscape in California is evolving, and the Commission has a unique ability to rapidly respond to changing circumstances.

The mental health crisis was an epidemic before the COVID-19 pandemic exacerbated negative trends. Challenges such as homelessness, substance use disorders, and youth suicide continue to worsen throughout the state. Marginalized LGBTQIA+ populations and California communities of color face significant obstacles to receiving services. Mental health practitioners and resources have never been under greater strain.

Growing demands for behavioral health services

The COVID-19 pandemic brought significant challenges as more Californians and families experienced mental health challenges and the growing substance abuse epidemic firsthand.

Mental health needs, especially in youth and children, are intensified by isolation and the impact of social media. Mental health is the number one reason children ages zero to 17 are hospitalized and suicide is the number two cause of death for young people ages 10 to 24 (2020 California Children’s Report Card). Marginalized and excluded populations, including those who identify as Black and Brown, Native American, Asian American and Pacific Islander; girls and women; the LGBTQIA+ community, and those with disabilities, continue to face heightened challenges. Structural inequities and macro threats, such as racism, the climate crisis, socioeconomic inequality, housing instability and gun violence, also lead to worse mental health outcomes and an increased need for mental health care and supportive services.

Behavioral health elevated as a shared priority

Through the MHSA, communities are prioritizing prevention, early intervention, community-defined practices, innovation, and engaging people with lived experiences. Young people are publicly discussing mental health, while community groups, schools, and counties are collaborating to deliver needed care. This momentum is elevating mental health as a policy and funding priority. One-time funding through the California Children and Youth Behavioral Health Initiative, Student Behavioral Health Incentive Program, and the Mental Health Student Services Act are being reinforced by reforms to existing systems such as CalAIM.

Mental health is attracting the attention of philanthropies and private investors. From 2018 to 2020, over $9.8 billion was donated to mental health causes (Candid 2021). Venture capital funding for digital mental health start-ups increased from $25 million in 2011 to more than $2.5 billion in 2020 (Rock Health 2021).

Evolutions in treatment & care delivery

The rise of mobile devices and digital capabilities has revolutionized tele-health services, with the share of tele-behavioral health outpatient visits doubling from 2019 to 2021 (Kaiser Family Foundation 2022). Recent innovations in diagnostic technology and services are changing the mental healthcare landscape. For example:

• New medicines show promising results for treating chronic depression
• Emerging interest in psychedelics offers hope for improving options for treating disorders like major depressive disorder and post-traumatic stress disorder. (World Economic Forum 2021)
• Future breakthroughs in precision medicine are expected to improve disease classification, shorten treatment duration, and limit suboptimal treatment outcomes. (American Physiological Society 2023)

In tandem, care delivery is improving. Integrated community care with a “no wrong door” approach, the shift of mental health care into primary care settings, expanded roles for peer providers, and the adoption of wrap-around services show promising signs for making care more accessible and effective for every Californian. These evolutions increase the need to integrate fragmented funding sources, streamline regulations, and evaluate the efficacy of programs to ensure that the highest quality of service is being delivered to Californians regardless of the delivery model.

Strain on practitioners, resources, and consumers

Pressure on practitioners and financial resources has grown dramatically over the last four years, creating even more challenges for consumers to access care. This includes:

• Nationwide shortage and burnout of behavioral health workers. Some 50% of behavioral health providers have experienced burnout and 30% of providers left their job. (Substance Abuse and Mental Health Services Administration 2022)
• Lack of culturally competent practitioners with lived experience. Barriers include low pay, lack of career pathways, and credentialing and licensing requirements. (Healthforce Center at UCSF 2018)
• Inadequate financial resources. Low reimbursement rates, difficulty billing private insurers for services, and severe financial strain on hospitals contribute to soaring provider costs. (Association of American Medical Colleges 2022)
• System fragmentation and capacity constraints are complex for consumers to navigate.
• Nearly 9.4 million Californians live in communities without enough mental health professionals. (NAMI California 2021)

Accelerating pace of change

More change is likely to come even quicker in the future. The next decade is expected to bring a better understanding of and responses to the impacts of genAI and social media, as well as promising innovations in consumer-centered care.

To succeed in the next decade, California needs a resilient system that can direct and integrate resources to changing needs. Public agencies, including the Commission, will need to adapt priorities and strategies in response to the opportunities and impacts of these trends.