Too many Californians with serious mental illness or substance use disorders are trapped in cycles of incarceration, hospitalization, and homelessness instead of getting the treatment they need.
Before we can build real solutions, we have to understand what’s driving this crisis.
Two new Steinberg Institute reports—developed through our Graduate Research Fellowship Program—help answer that question. Together, they evaluate the barriers that prevent people with serious mental illness (SMI) and substance use disorders (SUD) from accessing timely, appropriate care across California’s behavioral health system. Each report offers a comprehensive, data-driven evaluation across two elements of our system:
- The state of crisis care capacity across California’s continuum
- The processes counties use to assess and place people with serious mental illness (SMI) into appropriate levels of care
The findings reveal critical system gaps in capacity, assessment, and placement that must be addressed to build a pathway to recovery rooted in dignity, access, and accountability.
The findings directly support our Vision 2030 initiative to reduce hospitalization, incarceration, and homelessness for people with serious mental illness or substance use disorder.
Report One: Assessing Level of Care Gaps in California’s Behavioral Health Crisis Continuum
November 2025
The research was developed under the mentorship of the Steinberg Institute by Andrea Elser, a Doctor of Medicine/Master of Public Health (MD/MPH) graduate student from the University of Southern California Keck School of Medicine.
Today, too many people experiencing behavioral health crises are sent to traditional destinations such as Emergency Departments (EDs), where they wait without receiving appropriate care. Even with new statewide investments, California still faces serious gaps in its crisis care infrastructure—gaps that leave far too many people routed to emergency departments, jails, and homelessness instead of treatment.
To help policymakers, providers, and stakeholders better understand the state of crisis care in California, this report assesses crisis care capacity across the state, highlighting:
- How crisis capacity varies across every level of care in California
- The workforce and implementation barriers that prevent crisis teams and facilities from operating at needed capacity
- The structural gaps in our crisis system that push people toward hospitalization, incarceration, or homelessness instead of treatment
- Recommendations for targeted investment to build a more equitable, person-centered system of care
Report Two: Assessing How California Counties Determine Levels of Care for Serious Mental Illness
June 2025
California is facing a mental health crisis, with serious mental illness (SMI) affecting over 1.7 million adults annually. Despite various policy initiatives, significant treatment gaps remain.
This research takes an in-depth look at how California counties assess which level of care individuals diagnosed with SMI are placed in—a foundational step that determines whether someone receives outpatient support, intensive community care, or higher-acuity services.
Through a combination of quantitative data analysis and qualitative interviews with county officials, this research estimates the prevalence and treatment rate of SMI across and examines how eight California counties–whose adult population represents 50% of its overall population–assess and place adults diagnosed with a SMI. The report highlights:
- How counties assess and assign levels of care for adults with SMI — including use of tools like LOCUS, ANSA, LIST, and county-developed frameworks
- Inconsistencies in assessment processes, contributing to uneven placement and challenges stepping people up/down the continuum
- SMI prevalence and treatment gaps across California’s 58 counties
- Data and infrastructure limitations that impede accurate tracking, care coordination, and equity
- Policy recommendations to strengthen assessment training, standardization, and statewide data systems for SMI level of care systems
The research was developed under the mentorship of the Steinberg Institute by five Master’s of Public Policy candidates from UCLA Luskin School of Public Affairs.
These reports were prepared under the mentorship of the Steinberg Institute by our Graduate Research Fellows from USC and UCLA as part of our Research Fellowship Program, which cultivates the next generation of behavioral health policy leaders through applied, systems-level research.
We are grateful to our Fellows for their rigorous analysis and meaningful contributions to advancing behavioral health reform in California.
About the Steinberg Institute Graduate Research Fellowship
The Steinberg Institute’s graduate research fellowship program, launched in 2024, is designed to give future leaders in mental health and public policy hands-on experience turning research into actionable policy. The program will bring together students from multiple academic disciplines, including public policy, public health, psychology, human development, and mental health.