Governor Gavin Newsom used California\u2019s youth mental-health crisis to build a sprawling therapeutic bureaucracy rooted in the idea that white supremacy was driving children\u2019s distress\u2014and committed billions in taxpayer dollars to it.<\/p>\n
Beginning in 2021, the Newsom administration justified a major overhaul of the state\u2019s youth mental-health system by invoking<\/a>\u00a0\u201can escalating behavioral health crisis\u201d marked by \u201csevere outcomes,\u201d including a dramatic increase in hospital visits for self-harm and suicide<\/a> during the Covid pandemic. California was failing the children in greatest need, leaving them boarding in emergency rooms, traveling hundreds of miles for treatment, and cycling through short-term programs that failed to stabilize them. And this remains the case today.<\/p>\n Finally, a reason to check your email.<\/p>\n Sign up for our free newsletter today.<\/p>\n But the system that Newsom\u2019s effort has built over the past five years, with heavy input from progressive activists, did not focus primarily on those breakdowns in care. Instead, the Children and Youth Behavioral Health Initiative (CYBHI) was organized around \u201cbehavioral health,\u201d a legitimate term encompassing mental illness and substance abuse, but broad enough for activists to exploit in service of a statewide equity agenda. The effort centered on \u201cprevention\u201d\u2014the screening, surveillance, and medicalization of children who were not the ones driving the crisis<\/a>\u00a0in the first place.<\/p>\n Created through<\/a>\u00a0the 2021 Budget Act, the CYBHI was a five-year, multidepartment project with an initial $4.7 billion price tag and a mandate to \u201creimagine and transform\u201d the behavioral-health system. It became the centerpiece<\/a>\u00a0of Governor Newsom\u2019s Master Plan for Kids\u2019 Mental Health<\/a>. As part of a buildout costing more than $15 billion<\/a>, the state turned schools into sites of mental-health service delivery, expanded Medi-Cal to reimburse social services, and offered grants for \u201ccommunity-defined\u201d practices in place of evidence-based ones, making programs centered on progressive activism and \u201cgender-affirming\u201d services eligible for public funding.<\/p>\n Only a small share of the funds, by contrast, went toward securing psychiatric residential-treatment beds for the troubled kids at the heart of the state\u2019s mental-health crisis. Far too few facilities were planned; five years later, none has opened.<\/p>\n Children like J\u00e1zmin Pellegrini have paid the price. J\u00e1zmin\u2019s mental health began deteriorating<\/a>\u00a0at 12, leading to self-harm, suicide attempts, and repeated psychiatric hospitalizations. By 15, she had been admitted<\/a>\u00a0to ten different facilities on 40 separate occasions, trapped in the revolving door of short-term care options that state policy favored.<\/p>\n By 2024, three years after Newsom had promised to transform youth mental-health care, California still had no appropriate placement for J\u00e1zmin. Instead, the state sent her to an unlocked facility, from which she ran away. She was briefly hospitalized again. Finally, three days after being discharged, she was found dead on the streets of San Francisco from a suspected fentanyl overdose.<\/p>\n The public learned of\u00a0her story only because her mother is suing<\/a>\u00a0the state<\/a>. But many more children like J\u00e1zmin are out there. Their plight reveals the grotesque mismatch between the crisis state officials described in 2021 and the system they created. The sickest young people remain underserved, while far healthier children have been turned into mental-health patients.<\/p>\n California has long been more responsive<\/a>\u00a0to activists<\/a>\u00a0and media<\/a> panics<\/a>\u00a0than to the people<\/a>\u00a0who actually work<\/a>\u00a0with young people with severe emotional and behavioral challenges. The state has repeatedly curtailed intensive treatment options for youth in response to outside pressure without replacing the capacity it eliminated.<\/p>\n CYBHI followed the same pattern. Through the program, the California Health and Human Services Agency (CalHHS<\/a>) spent millions<\/a>\u00a0of dollars on stakeholder engagement and consulting, giving social-justice advisers a major role, while largely sidelining the people best positioned to understand what these children need.<\/p>\n One major beneficiary was The Social Changery<\/a>, a social-justice consultancy that received $4.4 million in state consulting contracts between 2021 and 2025. Its work included preparation of the \u201cYouth at the Center\u201d report, to serve as CYBHI\u2019s \u201cguiding principles<\/a>.\u201d The report identifies<\/a>\u00a0\u201cracism, white supremacy, settler colonialism, poverty, and other forms of systemic oppression and violence\u201d as root causes of mental-health and substance-use problems. It calls for \u201cdecriminaliz[ing] mental health\u2014including substance use\u201d and building a \u201crepresentative\u201d workforce so that youth are spared the \u201cemotional labor\u201d of explaining themselves.<\/p>\n The same premise appears in the materials<\/a>\u00a0of the Equity Working Group, which CalHHS assembled to embed equity measures across CYBHI. The group said<\/a>\u00a0that it wanted to \u201c[a]void overly-clinical definitions of behavioral health\u201d and instead focus on the \u201csociopolitical determinants of health.\u201d Once the state let activists define mental illness and substance abuse primarily as the product of political and social forces rather than individual factors, the solutions followed from that premise. More than $3.5 billion<\/a>\u00a0of CYBHI\u2019s funding went to \u201cprevention and promotion\u201d under a population-wide strategy aimed at all children, rather than a targeted approach for those youth who need more support. \u201cEquity\u201d became<\/a>\u00a0the organizing principle.<\/p>\n One way that CYBHI pursued an equity agenda was through \u201ccommunity-defined evidence practices,\u201d or CDEPs, promoted<\/a>\u00a0by the California Pan-Ethnic Health Network for \u201cBIPOC and LGBTQ+ communities.\u201d Examples<\/a>\u00a0of CDEPs include<\/a>\u00a0Sweat Lodge ceremonies, Traditional Healer ceremonies, dance and drum circles, \u201csmudging\u201d rituals, Powwows, and \u201cradical inclusivity.\u201d In a 2021 concept paper<\/a>, the group argued that these practices should not have to meet conventional standards of empirical validation and urged California to fund them based solely on community acceptance. It also said that the CDEPS did not need to be delivered by licensed clinicians and suggested that a doctor or psychologist \u201cfrom the dominant culture\u201d could even represent \u201ca deficit.\u201d<\/p>\n CYBHI helped turn this vision into state spending. Across five grant programs, California set aside $381 million<\/a>\u00a0for \u201cevidence-based and community-defined\u201d practices, placing CDEPs in the same statewide funding stream as clinically validated treatment models but applying a lower evidentiary standard to them, allowing<\/a>\u00a0participant testimony to replace empirical support. While some grants are arguably of value, others are harder to defend, such as Drum-Assisted Recovery Therapy for Native Americans (DARTNA<\/a>).<\/p>\n City Journal\u2019s review of California\u2019s fourth grant round<\/a>, which awarded about $50 million for youth programs and community centers, found that at least half the grantees had a social-justice or identity-based orientation. Some explicitly aimed\u00a0to channel students into activism. For example, the state awarded $750,000 to Merced County to develop a clubhouse with the Youth Leadership Institute<\/a>, a progressive group whose Healing Generation Center<\/a>\u00a0introduces students to a \u201cdifferent justice platform\u201d each week.<\/p>\n Another beneficiary was On the Margins, which received about $370,000 for \u00a1DALE! for Health and Wellness<\/a>, a program designed to introduce high school students<\/a>\u00a0to progressive causes. The group envisions<\/a>\u00a0a \u201cworld without prisons and borders; that centers racial, gender, economic, ecological, and disability justice; that is pro Queer + Black, Indigenous Womxn of Color; and that cherishes pleasure and radical imagination.\u201d<\/p>\n At least $5.6 million went to eight LGBT-focused programs or community centers. Among them was Positive Images, which received nearly $400,000 for an LGBTQ drop-in center<\/a>\u00a0that hosts \u201caffirming and confidential\u201d support groups<\/a>\u00a0for youth. The group runs a \u201cQueer Library,\u201d a \u201cgender-affirming\u201d clothing closet, and holds an annual \u201cQueer Magic GAYla<\/a>.\u201d St. John\u2019s Community Health received $750,000 for a project titled \u201cAffirming LGBTQ+ Youth to Improve Mental Health and Well-being in San Bernardino County.\u201d Its transgender health program<\/a>\u00a0also provides hormones and surgical referrals.<\/p>\n The grants did more than fund one-off projects. They helped move CDEPs toward continuous reimbursement<\/a>\u00a0through Medi-Cal, California\u2019s public insurance program, which covers<\/a>\u00a0nearly 38 percent of the state. That shift took shape under California Advancing and Innovating Medi-Cal (CalAIM), the roughly $5 billion<\/a>\u00a02021 overhaul that expanded<\/a>\u00a0Medi-Cal\u2019s scope<\/a>\u00a0far beyond medical care to include<\/a>\u00a0rent, utility set-up, security deposits, meal delivery, grocery boxes, and up to $7,500<\/a>\u00a0for housing transition expenses. By shifting these services onto the Medi-Cal tab, California could draw federal matching funds to cover about half the cost, meaning taxpayers nationwide now subsidize<\/a>\u00a0the state\u2019s social-service spending.<\/p>\n Under CYBHI, California\u2019s public schools were transformed into sites of mental-health\u00a0service delivery. Today, the state\u2019s schools are no longer just places of academic instruction that can act as a referral point to outside systems of care for struggling students. All California students are now eligible<\/a>\u00a0to receive therapy and a psychiatric diagnosis during school hours.<\/p>\n That change was facilitated by the 2024 rollout of the CYBHI Fee Schedule Program<\/a>, through which the state poured $400 million into schools<\/a>\u00a0to hire staff, install billing and medical-record systems, and contract with vendors to create<\/a>\u00a0a \u201csustainable reimbursement pathway\u201d for school-based mental-health services. California also gave $389 million<\/a>\u00a0to Medi-Cal managed-care plans so the insurance side could support the same system.<\/p>\n The stated goal is \u201cprevention\u201d through early identification and intervention. But the ubiquity of the program has lowered the threshold for what counts as\u00a0clinically concerning, covering the needs of what some call \u201cthe worried well.\u201d The state\u2019s hypothetical examples include students feeling anxious<\/a>\u00a0about college admissions or frustrated<\/a> about missing several days of school\u2014ordinary stressors that can now be treated as \u201cmedically necessary\u201d and thus eligible for reimbursement.<\/p>\n Parents have cause for concern, especially because this programming is not ideologically neutral, and they cannot always opt out. Some participating districts make providing insurance information mandatory<\/a>. If parents don\u2019t provide it, the California Department of Health Care Services (DHCS) requires<\/a>\u00a0the school to find another funding source.<\/p>\n Universal<\/a>\u00a0mental-health screenings<\/a>\u00a0are now widespread<\/a>\u00a0in California schools. Through the fee schedule, schools bill insurers for those screenings<\/a>, collect data<\/a>\u00a0on the results, sort students into a tiered<\/a> system<\/a>, and direct those deemed in need of more \u201csupport\u201d to additional billable screenings and services.<\/p>\n One prominent<\/a> tool<\/a>\u00a0is the Adverse Childhood Experiences (ACEs) survey, a crude<\/a>\u00a0ten-question measure used to assign a numerical score to childhood adversity and assess risk for \u201ctoxic stress<\/a>\u201d (based on the idea that adversity becomes \u201cbiologically embedded<\/a>\u201d in the body). Robert Anda, one of the ACEs survey\u2019s original authors, has warned<\/a>\u00a0that the ACEs score is being misused as an individual screening tool and was never designed for that purpose. California has nevertheless poured at least $167 million into promoting<\/a>\u00a0and expanding<\/a>\u00a0ACEs screening<\/a>.<\/p>\n Under the CYBHI fee schedule, schools bill $29<\/a>\u00a0for ACEs screenings, use separate billing codes depending on a student\u2019s ACEs score, and can flag students as \u201chigh risk\u201d not only because of a higher score but also because of \u201cACE-associated health conditions<\/a>,\u201d which include headaches, sleep problems, anxiety, not completing homework, or \u201cearly sexual debut.\u201d<\/p>\n Once a child is flagged, reimbursable next steps may include<\/a>\u00a0psychotherapy, psychiatric diagnostic evaluation, case management, neuropsychological testing, and medication support. A child may also be prescribed medication<\/a>\u00a0with parental consent, but many of these services can occur without parents being informed<\/a>. Under a new law, minors 12 and older can consent<\/a>\u00a0to outpatient mental-health treatment if a mental-health professional deems them \u201cmature\u201d enough; \u201cparents are not to be contacted,\u201d state guidance says. Minors can also get a separate Medi-Cal billing card not linked to a parent.<\/p>\n Much as outside of school, many of the CYBHI-funded services delivered in California schools are hyper-ideological. Many of these services are delivered through school-based health and wellness centers<\/a>\u00a0as part of the state\u2019s partnership<\/a>\u00a0with the California School-Based Health Alliance, which describes<\/a>\u00a0its model as \u201cactively anti-racist\u201d and committed<\/a>\u00a0to creating \u201ctruly affirming and equitable spaces where LGBTQIA+ youth can thrive.\u201d Though California K\u201312 schools are not yet prescribing puberty blockers and cross-sex hormones, school-based health advocates elsewhere, including in Seattle, have pushed<\/a>\u00a0for it.<\/p>\n California also spent $278 million launching Certified Wellness Coaches, a new nonclinical workforce<\/a>\u00a0that can enter schools and gain direct access to students for billable \u201ccoaching<\/a>\u201d sessions. Coaches are required<\/a>\u00a0to have only<\/a>\u00a0two years of community college education and several weeks of supervised field experience. Their code of conduct commits<\/a>\u00a0them to advancing \u201csocial, economic, and environmental justice\u201d and opposing \u201coppression, racism, discrimination, and inequities.\u201d<\/p>\n Students are also pushed<\/a>\u00a0toward the state\u2019s digital mental-health platforms<\/a>, another major CYBHI expense<\/a>\u00a0totaling $607.7 million<\/a>. The virtual services platform Soluna, for ages 13\u201325, emphasizes that one-on-one chats and video sessions are not shared with parents. Both Soluna and BrightLife Kids, for ages 0\u201312, rely on similarly nonclinical staff trained<\/a>\u00a0in \u201cculturally responsive care\u201d tailored to \u201cLGBTQ+\u201d and \u201cBIPOC\u201d identities.<\/p>\n California also used CYBHI funds to expand<\/a>\u00a0social-emotional learning (SEL) during instructional time, spending<\/a> $120 million<\/a>\u00a0to bring Transformative SEL<\/a>, with its \u201cexplicit equity and social justice lens,\u201d to students<\/a>\u00a0in public schools in every county. This expansion was part of the California Department of Education\u2019s more expansive \u201cwhole child\u201d framework,<\/a>\u00a0which treats schools as responsible not just for academics but also for students\u2019 emotional and social development. It is the same framework<\/a>\u00a0behind the department\u2019s $4.1 billion California Community Schools Partnership Program (CCSPP<\/a>) for under-resourced schools.<\/p>\n The state justified all this spending as part of its response to a youth mental-health crisis. But its primary effect has been to expand the state\u2019s role in children\u2019s lives, weaken parental authority, and shift schools further from their academic mission at a time when students are already falling<\/a> behind<\/a>\u00a0in core subjects.<\/p>\n This approach may not only be a distraction from academics; it could also be harming kids. Teaching children to look for the \u201cearly signs and symptoms of distress,\u201d as CYBHI\u2019s $100 million public-awareness campaign aims<\/a>\u00a0to do, risks pathologizing<\/a>\u00a0ordinary experience in ways that can result in unnecessary medicalization and even contribute to the development<\/a>\u00a0of mental-health disorders. Research has found no clear benefit\u2014and in some cases evidence of harm\u2014from universal school-based mental-health initiatives<\/a>\u00a0and screenings<\/a>. Yet California embraced the model so fully that it awarded $56 million<\/a>\u00a0for \u201cEarly Childhood Wraparound Services,\u201d extending behavioral health screening<\/a>\u00a0and intervention even to babies, toddlers, and preschoolers.<\/p>\n While the state poured billions into broad-brush, ideologically charged programs, California\u2019s investments were paltry when it came to young people in genuine crisis. In 2021, CYBHI allocated slightly more than $480 million to the children and youth round of the Behavioral Health Continuum Infrastructure Program (BHCIP). It prioritized<\/a>\u00a0placing children in the \u201cleast restrictive settings,\u201d despite warnings<\/a>\u00a0from county officials that short-term care was often ill-equipped<\/a>\u00a0to safely manage the youths most in need. The awards were skewed<\/a>\u00a0toward outpatient programs rather than inpatient or residential care, with nearly all of the latter being short-term. Just two projects were Psychiatric Residential Treatment Facilities (PRTFs)\u2014the only funded setting<\/a>\u00a0able to lock its doors and keep a child longer based on individualized medical need.<\/p>\n By 2024, California realized that it had not devoted\u00a0enough funding<\/a>\u00a0to treatment<\/a>\u00a0beds. It put before voters<\/a> Proposition 1<\/a>, a roughly $6.4 billion<\/a>\u00a0ballot initiative. But a substantial share<\/a>\u00a0of that funding still went to homeless housing under a Housing First model that requires<\/a>\u00a0neither sobriety nor participation in treatment. Even after the passage of Prop. 1, the state plans<\/a>\u00a0only eight PRTFs statewide, or 158 beds total, according to DHCS. None are open, and many are still years out from completion.<\/p>\n In response to questions about delayed PRTF projects and the lack of secure youth treatment beds, a DHCS spokesperson offered a broader defense of the state\u2019s approach, saying California is \u201crepairing a mental health system that was decimated by the Reagan Administration 40 years ago\u201d and pointing to planned treatment beds and expanded outpatient services.<\/p>\n Despite Governor Newsom\u2019s claims of success<\/a>, the promised expansion of treatment-bed capacity has fallen badly behind<\/a>\u00a0schedule. Children still travel<\/a>\u00a0hundreds of miles across the state just to secure a psychiatric hospital bed. Yet California is once again bowing to outside<\/a> pressure<\/a>\u00a0rather than working with hospital operators as it rushes<\/a>\u00a0to enforce new regulations that could sideline<\/a>\u00a0hundreds of already-scarce psychiatric hospital beds.<\/p>\n Asked whether the Newsom administration stands by CYBHI\u2019s approach to children experiencing severe mental-health crises, a spokesperson for the governor noted that \u201cthe state will continue to support families and kids through effective strategies to prevent those outcomes. We\u2019re expanding school-based services, building out the full continuum of care, and investing billions to meet young people where they are before they reach a crisis point.\u201d<\/p>\n For some youths, mobile crisis teams and short-term treatment may be enough. But for a growing number of children, mental-health crises form a chronic pattern<\/a>\u00a0reinforced by repeated short-term interventions. These are often kids<\/a>\u00a0with histories of trauma, aggression, self-harm, running away, and emotional and behavioral instability that can put themselves or others<\/a>\u00a0at serious risk<\/a>. Even with follow-up care, about one in four children return<\/a>\u00a0to crisis care within six months.<\/p>\n High-quality residential treatment can provide<\/a>\u00a0a live-in setting where youths receive the structure, accountability, and time they need to change their behavior before returning home or to the community. For some, it is the only thing that can break the cycle of crisis. Yet 94 percent<\/a>\u00a0of states have lost youth residential psychiatric capacity.<\/p>\n This form of treatment is disappearing<\/a>, but the children who need it are not. A recent bipartisan Senate investigation<\/a>\u00a0found that in 25 states, children were waiting for mental-health treatment in juvenile detention because there was nowhere<\/a>\u00a0safe for them to go. Others end up stranded<\/a>\u00a0for long periods<\/a>\u00a0in psychiatric hospitals and emergency rooms, warehoused in hotels<\/a>, left homeless<\/a>, or \u201ctreated and streeted<\/a>\u201d back into the same failed cycle of outpatient care, as J\u00e1zmin Pellegrini was.<\/p>\n As J\u00e1zmin\u2019s mental health deteriorated, California repeatedly offered her \u201ccommunity-based treatment\u201d instead of the psychiatric residential care she needed. The state has long been reluctant<\/a>\u00a0to invest in residential care. PRTFs did not become a licensed category in California until 2022<\/a>. For years, children had to travel<\/a>\u00a0out of state to access PRTFs and other secure settings. But in 2021, amid a media-driven backlash<\/a> against\u00a0this form of care, California barred foster youth from those placements and brought<\/a>\u00a0133 of them back into the state without adequate alternatives. The state<\/a>\u00a0lost track of some, and some ended<\/a>\u00a0up in juvenile detention.<\/p>\n Today, the state has just two<\/a>\u00a0operating facilities in Los Angeles County capable<\/a>\u00a0of locking their doors and keeping children longer term, both with limited beds and, at times, long waiting lists<\/a>. In a desperate effort to help her daughter access one of them, J\u00e1zmin\u2019s mother relinquished custody<\/a>. The girl died while awaiting placement. There are many children like her, but state privacy laws keep most of their stories from public\u00a0view.<\/p>\n Governor Newsom invoked children like J\u00e1zmin when he declared a youth \u201cmental health crisis<\/a>\u201d in 2022. Yet they are among those most neglected by the system he has built. Instead, the state spent billions of dollars on a bureaucratic expansion that treats every child as a patient\u00a0but no child as a priority. In Newsom\u2019s California, children<\/a>\u00a0like J\u00e1zmin are left to cycle through a revolving door of short-term care until it finally closes on\u00a0them for good.<\/p>\n Editor\u2019s note: This piece has been updated to include a comment from Governor Newsom\u2019s office submitted after deadline.<\/p>\n