NOVEMBER 25, 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.
New research from the Steinberg Institute 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. The research was developed in partnership with Master’s of Public Policy candidates from UCLA Luskin School of Public Affairs.
Through a combination of quantitative data analysis and qualitative interviews with county officials, this research estimates the prevalence and treatment rate of SMI throughout the state and examines the variation in how eight different 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
- Major inconsistencies in assessment processes, contributing to uneven placement and challenges stepping people up/down the continuum
- Statewide SMI prevalence and treatment gaps, including counties where fewer than 30% of adults with SMI receive care
- County perspectives on strengths and challenges, based on interviews with eight diverse counties
- Data and infrastructure limitations that impede accurate tracking, care coordination, and equity
- Policy recommendations to strengthen assessment training, standardization, and statewide data systems
→ Download the report here.
Our companion Infographic, Rebuilding the Continuum of Care, distills the main findings and recommendations of our analysis. View the infographic here.
Together, this analysis and its recommendations provide a much-needed examination of how decisions are being made today and what it will take to ensure that Californians with SMI receive timely, appropriate, and equitable care at every point in the system.
About the Steinberg Institute Research Fellowship
This report was prepared under the mentorship of the Steinberg Institute by five UCLA Luskin School of Public Affairs MPP students — Gustavo Medrano, Kelsey McGillis, Dominique Taylor, Gianna Radeljic, and Cameron Manning. Their work supports the Institute’s Vision 2030 initiative to reduce hospitalization, incarceration, and homelessness for Californians with the most complex behavioral health needs.