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Sacramento Behavioral Healthcare Hospital in Sacramento on May 30, 2026. New staffing requirements are set to go into effect in psychiatric hospitals throughout California sparking concerns from unions and workers about layoffs.<\/p>\n
Andri Tambunan\/For the S.F. Chronicle<\/p>\n
Gov. Gavin Newsom\u2019s administration on Monday enacted historic staffing requirements for psychiatric hospitals in California aimed at keeping tens of thousands of people a year safe while they are being treated for emotional crises.<\/p>\n
The California Department of Public Health (CDPH) emergency regulations specify that the hospitals must assign 1 nurse for every 6 patients in adult psychiatric units, and 1 nurse for every 5 adolescent patients. Hospitals found in violation of this standard can be fined $15,000 to $30,000 per day.<\/p>\n
Major healthcare worker unions and frontline caregivers applauded the reforms as an essential step to improving treatment in locked facilities where patients are often held against their will, with California\u2019s largest nurses union celebrating the changes as \u201ca win.\u201d<\/p>\n
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\u201cCDPH is finally doing the right thing and fixing its emergency regulations for safe nurse-to-patient ratios in our acute psychiatric hospitals,\u201d according to a statement submitted by hundreds of nurses during the public comment period preceding the June 1 enactment.<\/p>\n
But labor organizations also raised significant concerns that hospital operators are already planning to undercut the reforms by firing droves of unlicensed staff, who have historically provided the bulk of direct patient care in psychiatric facilities, in order to meet the new requirements while still minimizing costs.<\/p>\n
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<\/p>\n Add Preferred Source<\/p>\n <\/a><\/p>\n \u201cLicensed nurses will be added on paper, unlicensed direct-care staff will be removed, and most patients will experience little or no improvement in care,\u201d\u00a0Sal Rosselli, president emeritus of the National Union of Healthcare Workers, wrote to the state health department last month, after union members at Sacramento Behavioral Healthcare Hospital received notice that the hospital would cut dozens of full time, unlicensed mental health worker positions.\u00a0<\/p>\n \u201cThe result is a shell game,\u201d\u00a0Rosselli said.<\/p>\n Article continues below this ad<\/p>\n Sal Rosselli, then-president of the National Union of Healthcare Workers, speaks at a rally for more hospital staffing outside of a Kaiser Permanente facility in San Francisco on Jan. 12, 2015. (AP Photo\/Jeff\u00a0Chiu)<\/p>\n Jeff Chiu\/AP<\/p>\n The new staffing standards are in response to the Chronicle\u2019s \u201cFailed to Death<\/a>\u201d investigative series<\/a> that uncovered widespread abuse and neglect<\/a> of patients in psychiatric hospitals operated by for-profit companies<\/a>, often due to inadequate staffing.<\/p>\n A 1999 state law mandated that California leaders set minimum nurse-to-patient ratios in psychiatric hospitals decades ago, but the Chronicle found that never happened.\u00a0<\/p>\n In the absence of these requirements, reporters uncovered hundreds of reported patient assaults<\/a> in for-profit psychiatric hospitals, and at least 18 deaths between 2019 and 2024 that state health inspectors had connected to deficient care.<\/p>\n CDPH originally unveiled a draft of the regulations in December with implementation planned on Jan. 31 for the state\u2019s 35 freestanding psychiatric hospitals, the majority of which are run by for-profit chains. However, after hearing from hospital administrators and workers, the agency decided to move the start date to June 1 to give facilities more time to ramp up staffing.\u00a0<\/p>\n Article continues below this ad<\/p>\n The emergency regulations will be in effect for about a year as the state develops permanent staffing requirements through the regular rulemaking process, which includes public hearings.\u00a0<\/p>\n \u201cThese updates clarify expectations on nursing services, establish required documentation and staffing policies, and set minimum staffing standards intended to support patient safety and quality of care,\u201d said\u00a0CDPH spokesperson Mark Smith.<\/p>\n Under the emergency regulations, registered nurses, who are among the highest paid and most well trained nurses, must make up at least 50% of the caretakers counted toward the ratios. Licensed vocational nurses and licensed psychiatric technicians are allowed to make up the rest. If patients need more intensive supervision, hospitals must employ additional staff, including unlicensed mental health workers.\u00a0<\/p>\n The rules mirror decades-old requirements for psychiatric units in general hospitals, which the Chronicle investigation found had been cited for far fewer serious safety violations than for-profit psychiatric hospitals.<\/p>\n Elsy Jimenez (left) and her husband Lionel Jimenez (right) with a photo of their son, Raymond, at what would have been his graduation ceremony at Oxnard High School in June 2024. Raymond died inside a psychiatric hospital in Ventura after staff members failed to monitor him.<\/p>\n Gabrielle Lurie\/S.F. Chronicle<\/p>\n Kirsten\u00a0Barlow, vice president of policy at the California Hospital Association, told the Chronicle in an interview that the state\u2019s psychiatric hospitals have hired hundreds of frontline workers in recent months, many of them new graduates from nursing school.<\/p>\n Article continues below this ad<\/p>\n As of late May, Barlow estimated that the facilities were 80% of the way to meeting the staffing requirements, but frequent turnover and time-intensive training had made full compliance challenging. The association has asked CDPH to allow hospitals to apply for an extension if they are unable to meet all the proposed requirements by June 1. On Monday, the agency said no extensions have been granted.<\/p>\n \u201cTo the extent any of these hospitals are unable to hit that June 1 deadline, they either are really forced with the choice of closing beds or face a very stiff penalty,\u201d Barlow said.\u00a0<\/p>\n The hospital association has also warned that without additional state financial support, the new staffing requirements would pose a heavy financial burden on hospitals, potentially resulting in hundreds of unlicensed workers being laid off. The entry-level caretakers are among the lowest paid patient care staff in for-profit psychiatric hospitals and typically make between $25-30-an-hour.<\/p>\n \u201cIt\u2019s not as though hospitals wouldn\u2019t want to retain mental health workers to do those tasks. They simply can\u2019t afford the cost,\u201d Barlow said. \u201cIn order to hit the ratio, they need to focus on nurses.\u201d<\/p>\n Dan Shearn at his office in Santa Rosa on Oct. 16, 2025.\u00a0 Shearn was the director of nursing at a Santa Rosa psychiatric hospital from 2022 to 2024 before resigning during a stretch of patient assaults tied to persistent understaffing.<\/p>\n Gabrielle Lurie\/S.F. Chronicle<\/p>\n The two publicly traded psychiatric hospital chains operating in California have raised financial concerns in investor meetings\u00a0\u2014 while also reporting massive earnings. \u00a0<\/p>\n Article continues below this ad<\/p>\n A Universal Health Services executive said in a February earnings call<\/a> that the new staffing regulations would cost the company\u2019s seven psychiatric hospitals in California an estimated $30 million per-year, mostly due to increased labor costs. Those same facilities reported a combined $120 million in profits in 2024, the most recent year with audited state financial data.<\/p>\n<\/p>\n
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