How California can continue to make strides on behavioral health | Opinion

When we consider California’s behavioral health system, two opposing things are true: We’ve made historic advances and more progress in acknowledging, uplifting and funding mental health and substance abuse issues than at any period in my lifetime. Yet we still have miles to go to create systems and laws that assure quality access and care for more people in a still-broken system.

Let’s start with the progress. We are in a period of unprecedented attention, investment and reform, with Gov. Gavin Newsom the first governor to make behavioral health a priority — and back it up with significant resources.

When I began working on the issue as a legislator more than three decades ago, behavioral health was not a focus. I was fortunate to be part of a shift that helped bring behavioral health to the center of state policy.

Early legislative efforts led to the Mental Health Services Act, which created a dedicated funding stream now amounting to $35 billion and counting. It expanded services to hundreds of thousands of Californians, fundamentally reshaping how our state invests in behavioral health.

Since then, I have watched as California has expanded its commitment. In 2011, there were nine bills focused on mental health and substance use systems, and roughly $7.5 billion was directed toward services. By 2024, that number had grown to more than 85 bills and approximately $17.8 billion in public investment.

But there’s still a long way to go. The age-old complaints — that our behavioral health systems are too fragmented, that we pay providers not nearly enough and that getting access to quality care is too difficult — still hold true for too many people who need help.

In every other field of medicine, there are understood protocols. But in our public and private behavioral health systems, there are no standards that clearly say that people are entitled to a level of care commensurate with the severity of their illnesses.

For tens of thousands of people with the most serious illnesses whose lives are at risk because of their conditions — combined with their lack of basic shelter and housing — there is no guarantee that they will ever get offered access to the intensive care and housing support they need.

The current and next generations of political and policy leaders must embrace this tension between celebrating progress and refusing to settle for “good enough.”

Throughout my career, eight core principles have guided my advocacy. As California enters another period of political transition, I recommit to them and urge the state to do the same:

• Every human being, especially those who are sick and vulnerable, matters.
• The question is not whether we can save everyone, it is whether we do everything in our power to try.
• We must celebrate success and replicate the interventions and treatment that work while remaining indignant about what’s still broken and demand change.
• Outcomes — not process — must drive investments and decisions. If a process does not help people who are unnecessarily suffering, the process must change. The governments and nonprofits that deliver better results person by person should get paid more for that success.
• Our kids are in crisis. Investments in early intervention must ultimately grow, not shrink, so fewer Californians reach the point of acute need.
• The workforce shortage is real. Employing those with lived experience through expanding peer support is our most powerful workforce strategy.
• If the nature of some behavioral issues is such that some people must be compelled to accept treatment, we must be vocal about society’s legal and moral obligation to offer meaningful care. You can’t refuse what isn’t truly offered in the first place.
• Leadership matters. Nothing changes unless leaders are willing to take chances and endure the criticism that comes with it. 

I urge policymakers and our next governor to use these principles to guide funding, legislation and implementation.

As we enter our state’s next turning point, I find myself returning to the questions that first drew me to behavioral health advocacy nearly 30 years ago: What will it take to make suffering from untreated mental illness the rare exception, rather than “that’s just the way it is?”

What will it take for brain illnesses to be treated with the same dignity and care as any other bodily illness? The answer is in our hands.

Darrell Steinberg is the former president pro tem of the California Senate, mayor of Sacramento and founder of the Steinberg Institute, a leading mental health advocacy organization in California.