CHCF report shows significant unmet need for mental health services among California youth and adults


Soraya Marashi


A new California Health Care Foundation (CHCF) report that compiles the most recent state data available shows that in recent years, many adults and children with mental health issues or major depressive episodes did not receive treatment despite significant need in the state and increased funding.


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According to the report, 3.9% of adults in California experienced a serious mental illness (SMI) that “resulted in difficulty carrying out major life activities,” and 14.4% of adults in California experienced any type of mental illness, including a mental, behavioral, or emotional disorder. 7.3% of children in California experienced a serious emotional disturbance (SED) that “could interfere with functioning in family, learning, or getting along with people.”

The following chart shows California adults with an SMI and children with an SED in 2019 by region.


The Northern and Sierra region and the San Joaquin Valley region had the highest prevalence of SMI among adults, while the Greater Bay Area had the lowest prevalence. For children, the prevalence of SED across the state did not vary much, staying consistently around 7% among all regions.

The percentage of California adults with an unmet need for mental health treatment is almost equal to the percentage of all adults in the US with an unmet need for mental health treatment, with both at nearly 6% between 2018 and 2019. 36% of these adults in California and 39% in the US reported not receiving treatment due to high costs.

Between 2017 and 2019, about 36.8% of California adults with any mental illness reported receiving mental health treatment, counseling, or prescription medication in the past year, which was lower than the national rate of 43.6%. Similarly, between 2016 and 2019, only about 36.4% of children in California who reported having a major depressive episode received treatment, which was lower than the national rate of 41.8%.

The following chart shows funding for California’s county-based mental health system between Fiscal Years 2010 and 2020. 


According to the report, county funding was projected to increase by 81% within this time frame, with federal reimbursement for providing specialty mental health treatment to Medi‐Cal enrollees nearly doubling.

The report also notes that the use of Medi-Cal mental health services through managed care plans significantly increased between FY 2017 and FY 2020, with visit rates for children increasing from 8.2% to 12.9% in 2020.

The chart below shows Medi-Cal mental health visits for California adults in FY 2020 by delivery system and region.


Adults in the Northern and Sierra region had the highest percentages of mental health visits in both managed care and specialty mental health services Medi-Cal delivery systems. According to the report, “adults in Los Angeles County had the lowest rate of mental health visits in the Medi-Cal managed care system, while adults in Orange County had the lowest rate of mental health visits delivered in the specialty mental health services system.”