California needs public health responses to behavioral health needs

in summary

Our government can do better to promote public safety by prioritizing resources to expand treatment and housing, not prisons, for people with unaddressed behavioral health needs.

by Sidney Kamlager

Sydney Kamlager represents District 30 in Los Angeles County in the State Senate,

Chesa Bowden, for CalMatters

Chiesa Bowden is a San Francisco District Attorney, District Attorney for

From San Francisco to Los Angeles, there’s a crisis on the streets of California. Our state’s failure to adequately treat and house people with behavioral health needs has led to high rates of overdose deaths, overflowing of tents on our streets, and concerns about public safety. We believe our government can do better to enhance public safety by prioritizing resources for expanding treatment and housing.

As we emerge from the pandemic, it’s time for a change. And we have reason to hope. Voters in San Francisco and Los Angeles supported increasing funds for housing the homeless. Both counties closed prisons and diverted resources to treatment. Assembly Bill 369 and Senate Bill 679, both of which are making their way through the legislative process, would expand Medi-Cal’s access to people experiencing homelessness and provide state support for creating affordable housing in Los Angeles. However, we still have a lot to go.

Crime prevention requires adequate investments in treatment and housing. However, rather than treating those with behavioral health issues, our government has focused almost exclusively on punishing people with untreated needs. We spend billions of dollars on prisons and prisons but we lack adequate treatment beds.

In San Francisco, of the 18,000 uninhabited people, nearly 4,000 have mental illness or a substance use disorder — often leading them to local hospitals. However, of those discharged from San Francisco General Hospital’s emergency psychiatric services during fiscal year 2017, 40% were not connected to required services upon release, putting vulnerable people at risk of rapid decompensation. A city review that year identified a severe shortage of case managers, insufficient hours for people to receive emergency services, and insufficient outpatient options. One statistic that particularly tells us: In 2019, San Francisco had only 394 beds for mental health and substance abuse treatment. So last week the city’s announcement of an additional 400 new treatment beds in the coming years was good news, but with ten times more people needing these treatment beds, this is only a small step.

In Los Angeles County, there were more than 66,000 homeless people as of January 2020. Nearly a quarter of those had mental illness. The Los Angeles County Jail houses 5,000 inmates with mental illness, making it the largest treatment facility in the country. This is as inhumane as it is ineffective. Mentally ill persons imprisoned for nonviolent crimes were kept naked and handcuffed to immobilizer tables, and received no treatment other than psychiatric medication. Research from the Los Angeles County Board of Supervisors in 2018 estimated that up to 68% of prison mental health inmates could be diverted out of prison, if there was housing or treatment beds available.

Criminalizing mental illness has a price: In Los Angeles County, jailing people with behavioral health needs costs five times the cost of providing inpatient treatment.

Seeing people with behavioral health needs on our streets leads to a sense – not without reason – of a fundamental breakdown in the social order, making people feel insecure. In the worst case, a person with an untreated mental illness harms someone. There is no real safety for those forced to live on the streets with unaddressed health needs.

No city in California is immune to this crisis — nor is it responding adequately to it.

We must adequately fund non-law enforcement crisis response teams, so that social workers — not the police — are available to respond to cases arising from mental illness or substance use disorders. We must expand the hours and availability of treatment facilities. Every agency must work to connect people to health solutions that can improve their lives and build safer communities.

Public safety is public health – for everyone.


Chesa Boudin meets with experts from 9 a.m. to 1:30 p.m. on Wednesday, July 28, to discuss the need for public health responses to behavioral health needs. Sydney Kamlager is the keynote speaker. Watch here:


Sydney Camlager has previously written about Sharing Abortion Costs.

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