Behavioral Health Transformation

Introduction to Behavioral Health Transformation

Behavioral Health Transformation is part of California’s Mental Health for All — a plan to build a stronger and more equitable behavioral health system. This work is supported by major investments, new policies and partnerships with local governments, health plans, care providers, people with lived experience, and community organizations. The state is also focused on prevention and early support — so individuals can get help before problems start.

Behavioral Health Transformation is the effort that will implement the ballot initiative known as Proposition 1 to modernize the behavioral health delivery system, improve accountability and increase transparency, and expand the capacity of behavioral health care facilities for Californians. Behavioral Health Transformation complements and builds on California’s other major behavioral health initiatives including, but not limited to, California Advancing and Innovating Medi-Cal (CalAIM) initiative, the California Behavioral Health Community-Based Organization Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration proposal, the Children and Youth Behavioral Health Initiative (CYBHI), Medi-Cal Mobile Crisis, 988 expansion, and the Behavioral Health Continuum Infrastructure Program (BHCIP).

Proposition 1, passed by California voters in March 2024, is a two-bill package that drives the statewide reform and expansion of California’s behavioral health system. It includes:

Together, the BHSA and the Bond Act build on California’s broader efforts to reimagine and strengthen the entire behavioral health system — connecting services, expanding access, and improving outcomes for all Californians.

As part of the BHSA, the California Department of Public Health (CDPH) has been allocated dedicated funding to address behavioral health prevention including, but not limited to:

Priority Populations¹

BHSA focuses on reaching and serving populations with the highest need and at greatest risk for negative outcomes along the care continuum. By focusing on these priority populations, the BHSA aims to improve behavioral health outcomes, reduce disparities, and ensure that the most vulnerable individuals receive the support they need.

BHSA prioritizes the following populations listed below:

Eligible children and youth who satisfy one of the following:

• Are chronically homeless or experiencing homelessness or at risk of homelessness
• Are in, or at risk of being in, the juvenile justice system
• Are reentering the community from a youth correctional facility
• Are in the child welfare system pursuant to W&I Code sections 300, 601, or 602
• Are at risk of institutionalization

Statewide Population Behavioral Health Goals

While BHSA priority populations have high needs, behavioral health transformation as part of California’s Mental Health for ALL is making sure every Californian—especially people who have had the hardest time getting help—can get high-quality mental health and substance use treatment when and where they need it. To achieve this, California has established 14 statewide behavioral health goals under the leadership of DHCS, in consultation with stakeholders and subject matter experts (see DHCS BHSA Policy Manual, section C.2). These goals lay out the vision that the state, counties, managed care plans, and other key partners will work toward improving the overall well-being and behavioral health outcomes of Californians. As statewide goals, it is not expected that BHSA funding alone will move the needle on these indicators, but rather, will take strong cross-service delivery system collaboration and partnership to achieve improved outcomes for all Californians. These behavioral health goals will also be used to inform state and local planning and prioritization of BHSA resources.

Health equity is foundational to the public health approach and central to each goal.

Population measures associated with each goal for monitoring and accountability are forthcoming. The Department of Healthcare Services (DHCS) and CDPH, in consultation with behavioral health stakeholders, subject matters experts, and implementation partners will work together to define specific population measures for statewide behavioral health goals and participate in a cycle of continuous improvement to drive progress on the statewide behavioral health goals. CDPH-led efforts for population-based prevention under the BHSA will contribute to achieving these goals. 

Alignment Across the Behavioral Health System

It is expected that BHSA population-based prevention (led by CDPH) and early intervention programming (led by DHCS) will work in tandem across the entire spectrum of prevention and early intervention to create a stronger and more equitable behavioral health system that supports individual needs.

Below are definitions of each area led by CDPH and DHCS, with the goal that the coordinated and integrated work between CDPH and DHCS along the prevention continuum will promote protective factors, prevent exposure to risk factors, and provide services and supports to address the behavioral health impacts affecting Californians.

Population Prevention – Led by CDPH

Early Intervention – Led by DHCS

• Early Intervention is the proactive approach of identifying and addressing behavioral health concerns in their early stages before they escalate into more severe, disabling or chronic conditions. Under the adapted Institute of Medicine’s Continuum of Care Model, Early Intervention includes indicated prevention and case identification.

• Indicated prevention interventions focus on BHSA eligible at-risk individuals who are at risk of and experiencing early signs of a mental health or substance use disorder or who have experienced known risk factors for poor behavioral health outcomes, such as trauma, Adverse Childhood Experiences, or involvement with child welfare or corrections system. This at-risk individual may not yet meet the criteria of a diagnosable mental health or substance use disorder. Examples of indicated prevention interventions include outreach, training, and education for high-risk individuals and/or families who are at risk and experiencing early signs of a mental health or substance use disorder.

• Case identification includes assessment, diagnoses, brief interventions, and activities needed to create access and linkages to care that connect individuals to appropriate care.

Under the specific context for BHSA, both CDPH and DHCS are working in concert to each provide guidance — the CDPH Population-Based Prevention Program Guide and the DHCS Behavioral Health Services Act County Policy Manual​. While the two guidance documents may be distinct, it is recognized that overlap in certain areas may exist, and both CDPH and DHCS have closely related roles along the spectrum of population prevention and early intervention. For example, many counties may be funding population prevention services through other sources (e.g., Substance Abuse and Mental Health Administration (SAMHSA) Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG), opioid settlement, Realignment, etc.) that will be captured as part of the county three-year Integrated Planning process. So, while BHSA funds for population prevention programs are directed to CDPH, it is critical that alignment and understanding of state-level policy work and local planning efforts^2​ happens on an ongoing basis to ensure that healthcare systems, behavioral health, local public health, and community-based organizations across the systems are complementary and unified in approach.

The figure below (adapted by DHCS) from the Institute of Medicine’s Continuum of Care Model illustrates the spectrum of approaches within BHSA population-based prevention and early intervention that include several levels of prevention on a continuum with treatment and recovery.