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Your (Unofficial) Guide to State-Sponsored Therapy in California

There’s a way to get affordable mental health care that you might not know about. That’s California’s mental health system.

If you qualify, you can get mental health care at your county program for a small co-pay or a low sliding-scale fee. But even if you don’t qualify for services at a state-funded provider, California’s system can still give you information, local referrals to affordable providers, and other essential help for free.

If you’re in a hurry and want to get the most essential information about what’s available at your county program and who it’s for, you can read our quick start guide below.

Quick Start Guide

Quick facts about California’s mental health system:

  •     California’s mental health system helps more than a million people every year.
  •     All California county mental health programs accept Medi-Cal and offer low sliding-scale fees to people without insurance coverage.

What services are available?

  •     California’s mental health system offers specialty and intensive mental health services that can be hard to find anywhere else, like case management, day treatment, and wraparound care.
  •     Outpatient mental health services including psychiatric evaluation, medication management, and group and individual therapy are also available in most county mental health programs.

Who’s eligible?

  •     Some services, such as county crisis and information lines, are available to any California resident without exception.
  •     Most outpatient services have income requirements and generally accept people who make 200 percent of the federal poverty level or less.
  •     Some services are only available to people with severe conditions like major depression or schizophrenia. However, more people have one of these conditions than realize it! In fact, 1 in 10 Americans experience major depression each year.

Where can you get started?

  •    You can reach local mental health crisis and information services from anywhere in California by dialing 988.
  •     You can find your county’s non-emergency mental health access line (as well as your local crisis line) by scrolling to your county in the directory below.

To learn more about public mental health services in California, keep reading. We’ve done the research to uncover essential facts about who’s eligible, what services you can get, when to go, where to call, and how it works so you can decide if California’s mental health system might be right for you.

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Who Is Eligible?

You should consider looking into your county program if you (or a loved one) are having a mental health crisis, have a severe mental health condition, have Medi-Cal, or have a limited income.

Everyone in California can use the state-funded mental health emergency response system. If you or someone you love is in crisis, you can call your local crisis line to get the help you need, quickly.

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Use the State System When You're in Crisis

Public mental health services are usually the best option if you’re having a mental health crisis and need help right away.

State mental health programs are required to provide mental health crisis response services and are one of the fastest ways to get care when you’re having a mental health emergency.

The people who answer your county’s crisis line can provide caring attention and support as they help you determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

Even if you’re not in crisis, you can call your local mental health hotline for information about affordable mental health services in your area. When you call, you can find out whether you might qualify for state-funded mental health services, schedule an assessment or intake appointment, or get free information about other affordable local providers.

Other parts of the system have stricter eligibility requirements. You need to have a serious mental health condition (a diagnosable condition that affects your daily functioning) to qualify for public outpatient mental health care in many California counties. However, more people have a qualifying condition than realize it. Don’t assume you’re not eligible!

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Fast Facts About Eligibility in California

Consider reaching out to your county mental health program if you:

  •     Are having a mental health emergency
  •     Have Medi-Cal or don’t have insurance
  •     Need to get information about affordable providers in your area
  •     Have a significantly limited income (200 percent of the federal poverty level or less)
  •     Have a serious mental health condition like major depression, bipolar disorder, or schizophrenia
  •     Need specialty mental health care like day treatment, case management, wrap-around care, or home-based services

Eligibility criteria depend on the service you want and can vary from county to county, so it’s worth calling to confirm. To get started, you can call your county’s mental health access and information line. To find your local number, scroll to the directory below.

One of the most important requirements you need to meet to get services at a county mental health program in California is to be a resident of the county it serves.

It’s a great option if you’re a county resident with a public insurance plan. If you qualify for Medi-Cal, you’re probably also eligible for your county’s mental health program. All state-funded providers in California accept Medi-Cal, and it can be hard to find other providers who do.

You can also qualify if you have no insurance and have a limited income. Community mental health programs in California focus on serving people whose income is 200 percent of the federal poverty level or less. If you qualify, you can usually get services for the cost of a low sliding-scale fee.

You can also qualify if you have a severe mental health condition that affects your functioning or safety on a day-to-day basis. You may also qualify for services if you belong to a special eligibility group.

DEEP DIVE

Special Eligibility Groups

While there is some variation from county to county, the basic eligibility requirements for county mental health services in California are that you need to be a resident of the county the program serves and:

  •     Have a limited income
  •     Have or be eligible for Medi-Cal
  •     Have a serious mental health condition

Even if you don’t meet other eligibility requirements, you may still qualify for services if you:

  •     Are or were recently homeless (or at risk of homelessness)
  •     Have co-occurring mental health and substance use disorders
  •     Have recently been discharged from an inpatient psychiatric facility
  •     Are involved in the criminal justice system or are on probation or parole

This doesn’t mean you can’t get services at your county’s mental health program if you’re not a member of one of these groups. New funding sources can add new programs or expand access to existing ones, so it’s a good idea to call before you assume you’re not eligible.

In general, community mental health programs aren’t the best place to go if you have mild mental health issues and are covered by a private insurance plan.

However, if you’ve recently been hospitalized for mental health reasons or are unemployed or homeless because of a mental health condition, you should definitely call your county program. Their specialized services are designed to help you address these challenges and get the support you need to regain stability while living at home in your local community.

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Check Out the State System If You Need Specialized Services

County mental health programs in California are great places to find specialized and intensive mental health services like case management and day treatment that can be hard to find anywhere else. These specialty programs can give you extra help when you’re dealing with severe symptoms.

You can also usually find affordable therapy and other basic outpatient mental health services like medication management at California’s county mental health programs. You may not need to have a serious mental health condition to qualify if you meet income eligibility requirements. If you’re eligible, you can usually get the care you need for a very low co-pay or sliding-scale fee.

You can find the number for your county’s program in the directory below. We encourage you to call even if you think you might not be eligible.

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Check with Your County for Accurate Local Eligibility Information

One of the most important things to know about the California public mental health system is that programs vary from county to county. While California funds mental health programs using state revenue, each county in California administers its own program separately.

This means that which services you can get through the state system and whether you’re eligible depends on the county you live in. So, it’s important to check with your county to find out what’s available where you live.

Even if you’re not eligible, or if the program doesn’t offer the service you want, they can probably still help you. County mental health workers are knowledgeable about local resources and will often give you free information or even referrals to other affordable providers nearby, including local non-profits that provide free or low-cost counseling.

Where Do You Call to Get Started?

The easiest way to learn more about state mental healthcare in California is to call your county’s mental health hotline. Each county administers its own program separately, so which services are available and who’s eligible depends on where you live. To find your local number, scroll to the directory below.

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Important Numbers in California

The statewide California mental health crisis hotline is 988.

The Crisis Text Line for the state of California is 741741.

The number for the California Peer-Run Mental Health Warmline is (855) 845-7415.

You can reach the California National Alliance on Mental Illness (NAMI) Helpline by calling 1-800-950-NAMI (6264).

The number for the Mental Health Office of the Ombudsman for Medi-Cal mental health services is (888) ​452-8609.

Public mental health services in California are managed on the state level by the Mental Health Services Division of California’s Department of Health Care Services. For general information about California’s system, you can contact the Office of the Mental Health Ombudsman at (888) 452-8609.

However, you’ll probably get the best results by calling your county’s program directly. You can find the number for your county in the directory below.

County-by-County Directory

There are 58 counties in California and 57 county mental health programs that serve those counties. (Sutter and Yuba Counties have a shared program.) Each county has a phone number you can call to get information about mental health services or to get help in a crisis.

Some counties have separate crisis and information lines, while others have a single mental health hotline you can call for either purpose.

You can find the website and contact numbers for your county’s program in the directory below.

County Contact Information

Some counties have access lines that are staffed 24 hours a day, while others have access lines with limited hours.

If you need information after hours or aren’t sure whether you’re experiencing a mental health crisis, it’s okay to call a crisis line for help. The staff who answer are trained to quickly figure out what you need and can tell you what steps you need to take to connect with the right services.

Also Consider: Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are another great way to get affordable publicly-funded mental health services in California.

These federally-funded programs provide cutting-edge care in places where good primary healthcare was once hard to find. Most provide integrated care, meaning you can get primary medical and mental health services at the same location.

Each FQHC accepts Medicaid and Medicare and offers low sliding-scale fees if you don’t have insurance. Their eligibility requirements are generally less strict than the requirements for the state-funded system.

You can search for FQHCs near you by using the online search tool on the U.S. Health Resources and Services Administration website.

Troubleshooting Guide

The state mental health system is complicated and can be confusing to navigate. If you’re having any issues, we’re here to help. Here are some of our solutions to common problems you might experience.

Problems and Solutions

 1.   You can’t get through to someone on the phone.

Except in extremely rare circumstances, someone should answer your county’s crisis line any time you call. But if you’re not in crisis, the person you talked to gave you another number to call, and you’re having a hard time getting through, you can try going to a walk-in clinic instead.

Many county mental health programs in California run walk-in centers where you can be seen during regular business hours on Monday through Friday. Some let you walk in and wait without an appointment. You can often be seen the same day. If the wait is long or they don’t have availability, you can schedule an appointment and come back.

We recommend checking your county program’s website for clinic locations and hours.

2.    There’s a long waiting list.

State-funded services are often in high demand. California is working to shorten waiting times and make sure you can get seen for essential services right away. However, if you’re not in crisis, you may still have to wait before you can be seen by a therapist or other mental health provider.

Sometimes, it’s worth it to wait if you’ve found a good therapist or service. You can read our article on what to do before your first therapy session for tips on how to maintain your mental health while you wait.

If your symptoms are getting worse and you’re worried you can’t wait, you should call a crisis line. The caring people who answer can help you figure out if you need help right away and tell you where and how to get the level of care you need.

If you’re not in crisis but don’t want to wait, you can call an access line, an intake worker, the main number, or your contact person at the agency to ask if there are other options. There may be another affordable local program they could tell you about that could meet your needs but has a shorter waiting list.

3.    You’re not eligible for state-funded services.

If you’re not eligible for state mental health services in California, the people at your county program should still be able to help you.

Intake workers usually keep lists of affordable local mental health resources for people who aren’t eligible or would prefer to go somewhere else. Ask for information, resources, or even a direct referral to another provider.

4.   Your state system doesn’t offer the service you want.

State mental health programs sometimes have to change or limit the services they offer based on their current funding. If you’re admitted to your county program but it doesn’t offer the service you need, you have two options.

One is to try an alternative service that they do offer. The other is to ask if they can recommend an affordable alternative provider who does offer that service.

If they do offer the service you want, but it’s limited, stand up for yourself if they try to get you to do something else. Don’t accept getting pushed into something you don’t want just because it’s easier for them or because they can get you in faster.

If you’re willing and able to wait, tell them you would prefer to wait for the service you want, whether that’s therapy, medication, or something else.

5.    You don’t like your therapist.

You should never accept bad therapy—or bad mental healthcare of any kind—for any reason. This is just as true in the public system as it is anywhere else. If you have a bad therapist, ask for a new one. Tell your main contact person at the agency, an intake worker, or a manager that you want to try a different therapist.

If you’re not sure whether you have a bad therapist, you can read our articles on how to spot an unethical therapist and how to do a background check on a therapist. If you don’t like your therapist but wonder if it the problem might be fixable, you can read our articles, “What If I Don’t Like My Therapist?” and “How to Fix Problems with Your Therapist.”

If you don’t like the first therapist you’re assigned, ask someone at the agency if they have a webpage or list of therapists you can review. You can read their bios and see if you think one might be a better match. Not all agencies do this, but it doesn’t hurt to ask. You can read our article on how to choose a therapist for information on what to look for.

If you’ve run into a problem that we haven’t addressed, don’t give up. Call someone at the program (or the information line) and tell them what’s going on.

You’re much more likely to get the help you need when you advocate for yourself and are persistent. Tell the person you talk to what you need or what problem you’re having.

If they don’t help the first time, call them back and tell them. If you keep calling and keep calm and focused, you should eventually get through to someone who can help you.

Deep Dive: How Does the System Work?

To understand California’s mental health system, it helps to understand how it started and how it’s changed since then.

Public mental health services have been around for a surprisingly long time. But for over a hundred years in America, the only way to get them was in a psychiatric hospital.

DEEP DIVE

For More Information

To learn more about what the public mental health system was like in the early days—and how psychiatric inpatient care has evolved since then—you can read our article “Do Insane Asylums Still Exist? The Surprising Past and Present.”

To learn more about what inpatient mental health treatment is like now, and the differences between how it works in general hospitals and specialized psychiatric facilities, you can read our article “How Inpatient Mental Health Treatment Works.”

In the 1960s, Americans started thinking differently about mental health care. Conditions in psychiatric hospitals were getting worse and new medications made it possible to provide mental health treatment on an outpatient basis.

In response, new laws were passed that required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. The most important was the Community Mental Health Act, which President John F. Kennedy signed into law in 1963.

DEEP DIVE

What Is the Focus of the California Mental Heath System?

The California mental health system developed out of the need to provide services for people with severe mental health conditions and people experiencing mental health crises.

All county programs provide emergency and crisis intervention services. These typically include crisis hotlines, walk-in centers, and mobile assessment teams who evaluate people who have been placed on an involuntary psychiatric hold (commonly known as a “5150 hold”) to determine if they require involuntary inpatient treatment.

Many of the additional services that county mental health programs provide follow from the outcome of these crisis interventions.

Many state mental health programs trace their origins back to the 1960s when these important changes started to happen. California is no exception.

The 1957 Short-Doyle Act and 1968 Lanterman-Petris-Short Act laid the foundations for the state’s community mental health system. The purpose of these laws was to make it possible for people with serious mental health conditions to live in the least restrictive settings possible—in other words, to be able to live and receive treatment in their local communitiy instead of an institution.

A more recent law, the 2004 Mental Health Services Act, made many important updates that now define how public mental health services are delivered in the state of California. Community mental health programs in California now offer an expanded network of integrated mental health services that include clinical care and community and social supports.

DEEP DIVE

The Continuum of Care in the California Mental Health System

Some California programs offer therapy and other basic outpatient services to people with mild to moderate mental health conditions as long as they meet other eligibility criteria.

On the other hand, all of them offer intensive services for people recovering from a mental health crisis. Most county mental health programs provide case management for people who have been hospitalized or who are at risk of hospitalization.

Case managers help link their clients with all of the different services they need and monitor their progress. Full-service partnerships pair case management with other services including home-based services, psychiatric services, counseling, and a range of social and community services. All full-service partnerships provide therapy to clients who need it.

Many county mental health programs that aren’t full-service partnerships have counseling departments, but some do not. Whether they do depends on the budget for the program and the size of the county they serve.

Public mental health services in California are overseen on the state level by the Mental Health Services Division of California’s Department of Health Care Services.

Each county decides how its program works. Some county agencies provide services directly, while others contract with other community agencies to provide state-funded mental health services.

No matter how your county does it, you should start by calling your local mental health hotline. They know how the system works and will help you get where you need to go.

Conclusion

According to the Substance Abuse and Mental Health Services Administration, only 37 percent of people in California who have mental health conditions get treatment for them. Many of them qualify for public mental health services but don’t know about them.

You can make a difference by reaching out and connecting with local mental health resources to get the care you need. If you’re not sure whether you qualify for California state mental health services, call your county’s access and information line. You may find out you can get mental health services through your county’s program or that there’s another affordable option nearby.

The most important thing is to get started—the help you need may be only a call or click away.

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