By Ana B. Ibarra, CalMatters
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On an early spring evening in Glendale, a 37-year-old woman is withdrawn and weak from refusing food and water for several days. Her mother calls for help. She tells a crisis counselor her daughter has been hearing voices, and has expressed needing to “kill” those voices. She will not go to a doctor.
That’s when James Gonzalez and Katerina Cabello pull up. They’re in casual clothes – khakis and jeans, paired with sweatshirts. They sound no sirens in an unmarked white minivan.
Gonzalez and Cabello are one of 75 mobile crisis response teams Los Angeles County runs around the clock. Licensed and trained as first responders for behavioral health crises, these teams of two respond – in person, with backpacks and clipboards – to calls from 988, the crisis lifeline, or the county’s mental health helpline. Gonzalez and Cabello work for Sycamores, a nonprofit agency that contracts with the county.
Across California, demand for these teams – an alternative to badges and sirens for people in their darkest moments – is surging. But just as they’re proving their worth, federal funding that supercharged their growth is set to end. Lacking that boost, Gov. Gavin Newsom’s budget blueprint proposes changing the service from a required benefit to an optional one, meaning the state does not have to cover the funding gap.
Counties that choose to keep this service will have to pay for it themselves at a price tag of $150 million to $200 million a year. Where counties cannot afford it, crisis teams could decrease or disappear entirely, if the Legislature approves the governor’s budget proposal.
A boost in mobile crisis services
Convincing a person in crisis to accept help is a skill. You have minutes, sometimes less, to earn trust.
When Gonzalez walks into the living room of a client in crisis, he’ll quickly scan the room, looking for family photos, religious artifacts, trophies, anything that can help him connect. He has seen people in various stages of vulnerability: a woman who feels the world on her shoulders after leaving an abusive relationship; a teenage boy feeling so much anger he attacks his father.
Knowing when to be gentle and when to be stern is a skill, too. After more than an hour in Glendale, Gonzalez and Cabello got their client to drink some water and convinced her to go to a nearby hospital for IV fluids – once there she finally agreed to a psychiatric evaluation.
“Mental health can be kind of cruel,” Gonzalez said. “I’ve dealt with it as a parent. I don’t want our consumers to feel that. I want them to feel like we actually did something for them.”
Two days later, he and Cabello followed up on the Glendale call. The adult daughter did not meet the criteria to be placed on a psychiatric hold, but after the team shared treatment options and resources, the mother reported that she was eating and doing better.
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When in-person help is necessary, teams meet people where they are – homes, schools, and workplaces – and serve everyone regardless of income or insurance status. Though the program started as a Medi-Cal benefit for low-income residents, teams also respond to the uninsured and those with private insurance – counties can bill private insurers for behavioral health emergencies.
In 2023, California made mobile crisis response a statewide benefit when a federal law offered a financial incentive to do so: the federal government would temporarily cover 85% of the costs, up from the usual 50%. At the time, people with mental health and substance use disorder made up one-fifth of all emergency department visits in California – a pressure point the state said mobile behavioral health teams could help address.
Mental health advocates and counties knew the extra federal money was temporary. What caught them off guard is what came next: Rather than cover the gap when the enhanced rate fell, the state plans to make the service optional, funding it only through March 2027 before shifting the burden to counties. “It did come as a surprise to us that this program was on the chopping block given kind of unanimous support,” said Tara Gamboa-Eastman, director of Government Affairs at the Steinberg Institute.
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State officials say the timing is unavoidable. The expiration of the enhanced federal match coincides with a projected state budget shortfall of nearly $3 billion for the upcoming fiscal year, and $22 billion the following year.
“The Administration has proposed redesigning this as an optional benefit, to be offered at counties’ discretion, as the most sustainable path for the program going forward,” said H.D. Palmer, spokesman for the California Department of Finance.
State lawmakers who support preserving this service challenged the department in a recent hearing. “We’ve invested so much money into creating and uplifting an infrastructure to not fully continue with it,” Sen. Caroline Menjivar, a San Fernando Democrat said. “Is that a waste of our money?”
Counties weighing options
In San Joaquin County, when a young woman was in mental distress because she couldn’t afford her rent, the local crisis team visited her multiple times to stabilize her. They also helped her find affordable housing. “No other team can be as persistent as a mobile crisis team,” said Fay Vieira, San Joaquin County’s behavioral health services director.
The funding changes could force San Joaquin to revert to fewer teams available only from 8 a.m to 5 p.m. Her biggest concern is losing credibility with a community the county has spent the last two years courting.
“We made vehicle purchases and put money into advertising,” Vieira said. “You can tell from our referral numbers that people are using this.” Crisis calls in the county have increased 15% this year compared to last, she said.
In Monterey County, the story is similar. The county started limited mobile crisis services in 2015 but struggled to grow them until the federal boost. “We had been trying to look at expanding for years because we saw the value,” said Melanie Rhodes, the county’s behavioral health director. “We saw the people we were helping.” Without continued funding, she said, the county could be forced to scale back.
Rural San Benito County rolled out its mobile crisis program just last year – it took officials there months to find an outside provider who could come in and offer the service. The program there is just starting to gain steam.
“We know that we cannot afford it without the federal dollars,” said Rachel White, San Benito County’s behavioral health director.
The pressure is hitting counties that are already absorbing other rising healthcare costs. Starting in July, counties will have to direct a third of their mental health budget toward housing chronically homeless people. In the coming year, they will also have to restart health programs for people who will lose their Medi-Cal coverage under rules related to the federal spending law President Trump signed in 2025.
Even for the state’s biggest county this is a pinch. Since the state mandate took effect just over two years ago, Los Angeles County has doubled its mobile crisis teams.
Officials at the Los Angeles County Department of Mental Health said they do not know yet if they’ll have to make cuts, but having to absorb the additional costs will stifle their plans to expand and better meet demand.
“It’s definitely going to hurt,” said Reuben Wilson, head of alternative crisis response at Los Angeles County Department of Mental Health. “We’ve been trying to reduce our response time so we can get there quicker; law enforcement becomes more and more reliant on us. We’re really in a growth period, and it seems really premature to be pulling the support.”
A promising alternative for help
National research has shown that behavioral health professionals responding without police – like county crisis teams – do a better job than law enforcement of keeping people out of emergency rooms and connecting them to mental health care.
“Involving clinical teams in the community can prevent expensive emergency department care and get people connected to mental healthcare after the crisis incident is resolved,” one small-scale study of crisis response teams in Michigan found. A separate California analysis found that alternative crisis response programs reduced the number of unnecessary psychiatric holds.
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California’s own data is incomplete. Since January 2024 the Department of Health Care Services has approved more than 73,000 claims for in-person mobile crisis encounters through Medi-Cal alone – and because of typical claims lag, actual use is likely higher. Counties collect volume and some demographics data, but no statewide analysis of outcomes exists. That won’t be possible until the state begins collecting results data, something expected to start later this year.
As counties await the Governor’s final budget, the calls keep coming in.
Gonzalez and Cabello had not heard of the proposed funding change. They’re not sure what it would mean for Sycamores, or teams like theirs. What they do know is that people are hurting.
At one recent call, Gonzalez and Cabello found a dad and uncle restraining a 19-year-old man who had been experiencing outbursts of rage. Police responded first, but couldn’t resolve it. The situation called for help like Gonzalez and Cabello. They talked the young man down.
“Dad called and thanked us,” Gonzalez said. “He said no one has been able to help him like that.”
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.