A dangerous and detrimental staffing ratio mandate for freestanding psychiatric hospitals that would make it harder for Californians to get treatment for mental health disorders is careening toward approval.
Over the past month, since the initial proposal landed just before Christmas, CHA has pulled out every stop to try to secure amendments, including a differential ratio for overnight hours, but more importantly an extension for the implementation deadline — currently Jan. 31, just nine days from now.
Without a reasonable timeline and ratio regulations that balance safety enhancements with psychiatric care capacity, Californians will see an immediate disruption in care — reduced access to inpatient psychiatric care for people living with mental health disorders, and even more emergency department crowding.
CHA has been engaged with the highest levels of the Newsom administration and has executed a coordinated media strategy with aligned organizations to bring the issue to the attention of policymakers and the public.
From CHA’s media statement: “In the past, Gov. Newsom has been a champion for improving mental health and substance use care — just recently touting hundreds of new beds his investments are building — but this new policy does the opposite, reducing access to care for those in need,” said Carmela Coyle, President & CEO of the California Hospital Association. “We call on Gov. Newsom to be pragmatic — to support the dedicated caregivers of those who face great personal challenges — by allowing the time needed to make changes without forcing caregivers to STOP the good work they do.”
Still, the California Department of Public Health appears dug in to mandate implementation in less than two weeks, an impossible task for hospitals that will force them to take beds offline — at a minimum, 10% of the staffed beds statewide, but likely far more. Given that each staffed bed serves almost 20 patients annually, these closures would mean a loss of capacity to serve more than 16,000 psychiatric patients annually, or 1,360 fewer patients each month.
Recruiting, hiring, and safely onboarding licensed psychiatric nurses typically takes three to six months or longer — at a time when California’s psychiatric nursing workforce is already severely constrained, particularly for specialized inpatient settings.
And the ripple effect on communities would be disastrous — absent appropriate care sites, patients in behavioral health crisis often experience prolonged boarding in emergency rooms, sometimes for days — limiting or delaying access for other patients who need care for heart attacks, strokes, and injuries, as well as children requiring emergency services.
Collaborating with CHA, more than a dozen other organizations have submitted letters to the state with their concerns about the problems with an unachievable implementation deadline: the California Medical Association, the County Behavioral Health Association, the County Behavioral Health Directors Association, the California Police Chiefs Association, and more.
We’ll keep fighting for an achievable timeline to implement these new regulations and will hold the administration to account for the impacts should no extension be granted.
