The number of Californians with untreated mental health conditions is increasing and state leaders should be paying attention.

Overall, California ranks an unimpressive 17th in meeting the population’s need for access to mental health care in a recent State of Mental Health in America report. According to the report, over 21 percent of the population experienced a mental health condition in the past year. In addition, over 20 percent of Californians reported 14 or more mentally unhealthy days a month but were unable to see a provider because of the cost of care. Most worrisome, 62 percent of young people who have experienced a major depressive episode in the past year did not receive mental health services. 

Untreated mental health and substance use conditions can lead to loss of employment, reduced productivity, missed educational opportunities and dysfunction in families. They also create a significant cost to the community when those untreated conditions lead to hospitalization, incarceration or homelessness, and increase rates of hypertension, heart disease and stroke.  Californians want state policymakers to focus on increasing access to mental health care in 2025, surveys show.

At its root, the lack of access and insufficient treatment for mental health conditions is driven by declining insurance coverage and low reimbursement rates to providers.

The largest health insurer in California is the state’s Medi-Cal program, a comprehensive insurance program that covers approximately 40 percent of all Californians. Recent changes to Medi-Cal, driven by a large reform effort called CalAIM, hold promise for improving care, but also restrict care for people who receive Medi-Cal benefits. CalAIM has overhauled how it sets rates for providers, intending to incentivize the right care while slowing cost growth. However, the new rates do not cover the costs of engaging difficult-to-reach clients and bringing care directly to them in shelters, on the street or in their homes — a critical component of care management for people with severe mental illness. Some of these new rates are not enough to cover the cost of providing care, leading to program closures.

The first couple of years of CalAIM’s rate implementation has led to concerning reductions in the treatment available for mental health and substance use conditions. In multiple counties around the Bay Area, for example, providers are having to cap the number of individuals they can serve. Some providers have dropped Medi-Cal contracts altogether because the reimbursement rates didn’t cover their costs.  

But we can solve this. Policymakers must listen to community advocates and start carefully monitoring reimbursement rates so that they do not limit necessary care. If this issue is not addressed, the consequences will be far-reaching: More Californians will be left without access to life-saving mental health and substance use treatment, further exacerbating the state’s growing mental health crisis. Untreated conditions will continue to burden families, communities and the state’s economy, with escalating rates of homelessness, incarceration and preventable health complications. For California to thrive, it is essential to ensure that everyone has access to adequate and affordable mental health care.

We can’t afford not to.

Mark Cloutier is the CEO of Caminar, a behavioral health organization that serves more than 41,000 people in the San Francisco Bay Area and Northern California annually.