California has long struggled to invigorate its behavioral health system and expand its workforce to meet the needs of residents, especially in rural areas like the far north, Christine Mai-Duc of KFF Health News reported on August 6.
“Six years ago, the California Future Health Workforce Commission warned of a 'severe and growing' shortage across the behavioral health field, including psychiatrists, therapists, social workers, and substance use counselors, and noted that two-thirds of Californians with a mental illness go without treatment,” Mai-Duc wrote. “Since then, Gov. Gavin Newsom and state lawmakers have set out to transform the behavioral health system, with the legislature dedicating more than $1 billion to train and recruit providers.”
However, Mai-Duc noted, “The shortage has only worsened since the pandemic, which exacerbated mental health and addiction issues for many. In April, state health officials revealed that California was short roughly a third of the 8,100 psychiatrists and 117,000 licensed therapists it needed based on 2022 data. The state’s limited training capacity is making it hard to replace the number of retiring practitioners. As a result, existing workers are buckling under the workload while patients without quick access to help during a crisis are turning to costly emergency care.”
Under Newsom, the state has increased funding for youth preventive care, revised conservatorship laws, and established a court-based program to compel treatment for some of the most severely mentally ill residents. The Democrat also championed the passage of Proposition 1, a key part of his efforts to address the state’s homelessness and drug crises, stating it would add 10,000 treatment beds and housing units and improve access, Mai-Duc explained.
Let’s not forget, Mai-Duc wrote, that one of the biggest remaining bottlenecks is the severe shortage of psychiatrists — licensed medical doctors who can prescribe medications like antidepressants, antianxiety drugs, and antipsychotic medications. Although the state has expanded training slots in recent years, it can cost up to $250,000 annually and requires 12 years of post-secondary education.
In 2025, 239 first-year residents enrolled in California psychiatry programs, setting an all-time high and increasing from 152 seven years earlier. However, this number remains well below the 527 first-year psychiatry residents the workforce commission estimates are needed each year from 2025 to 2029, Mai-Duc noted.
To address these issues, the state has expanded the roles of other providers, such as nurse practitioners trained to prescribe behavioral health medications and certified peer counselors who may meet with patients more frequently.
Mark Ghaly, former Secretary of the State Health and Human Services Agency (HHS) and one of the architects of Newsom’s behavioral health overhaul, said it’s better to distribute responsibilities among various providers, including some with shorter training timelines, to increase capacity more quickly, Mai-Duc reported.
Furthermore, Mai-Duc said, along with the state’s investments, California is utilizing $1.9 billion in Medicaid funds to train, recruit, and retain behavioral health workers, offering scholarships and loan repayments to attract them, and supporting schools in funding new residencies and fellowships. However, the program only recently took effect in January, and there is a looming risk that the Trump administration could rescind the funds at any moment.
Health advocates, Mai-Duc wrote, warned that California is so far behind that any reduction in behavioral health workforce funding could be harmful. HHS Secretary Robert F. Kennedy Jr.’s decision to merge the nation’s mental health agency into a new department focused on chronic care and disease prevention, national advocates say, could jeopardize overall program funding.
