Governor Gavin Newsom used California’s youth mental-health crisis to build a sprawling therapeutic bureaucracy rooted in the idea that white supremacy was driving children’s distress—and committed billions in taxpayer dollars to it.
Beginning in 2021, the Newsom administration justified a major overhaul of the state’s youth mental-health system by invoking “an escalating behavioral health crisis” marked by “severe outcomes,” including a dramatic increase in hospital visits for self-harm and suicide 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.
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But the system that Newsom’s 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 “behavioral health,” 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 “prevention”—the screening, surveillance, and medicalization of children who were not the ones driving the crisis in the first place.
Created through the 2021 Budget Act, the CYBHI was a five-year, multidepartment project with an initial $4.7 billion price tag and a mandate to “reimagine and transform” the behavioral-health system. It became the centerpiece of Governor Newsom’s Master Plan for Kids’ Mental Health. As part of a buildout costing more than $15 billion, the state turned schools into sites of mental-health service delivery, expanded Medi-Cal to reimburse social services, and offered grants for “community-defined” practices in place of evidence-based ones, making programs centered on progressive activism and “gender-affirming” services eligible for public funding.
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’s mental-health crisis. Far too few facilities were planned; five years later, none has opened.
Children like Jázmin Pellegrini have paid the price. Jázmin’s mental health began deteriorating at 12, leading to self-harm, suicide attempts, and repeated psychiatric hospitalizations. By 15, she had been admitted to ten different facilities on 40 separate occasions, trapped in the revolving door of short-term care options that state policy favored.
By 2024, three years after Newsom had promised to transform youth mental-health care, California still had no appropriate placement for Jázmin. 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.
The public learned of her story only because her mother is suing the state. But many more children like Jázmin 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.
California has long been more responsive to activists and media panics than to the people who actually work with 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.
CYBHI followed the same pattern. Through the program, the California Health and Human Services Agency (CalHHS) spent millions of 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.
One major beneficiary was The Social Changery, a social-justice consultancy that received $4.4 million in state consulting contracts between 2021 and 2025. Its work included preparation of the “Youth at the Center” report, to serve as CYBHI’s “guiding principles.” The report identifies “racism, white supremacy, settler colonialism, poverty, and other forms of systemic oppression and violence” as root causes of mental-health and substance-use problems. It calls for “decriminaliz[ing] mental health—including substance use” and building a “representative” workforce so that youth are spared the “emotional labor” of explaining themselves.
The same premise appears in the materials of the Equity Working Group, which CalHHS assembled to embed equity measures across CYBHI. The group said that it wanted to “[a]void overly-clinical definitions of behavioral health” and instead focus on the “sociopolitical determinants of health.” 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 of CYBHI’s funding went to “prevention and promotion” under a population-wide strategy aimed at all children, rather than a targeted approach for those youth who need more support. “Equity” became the organizing principle.
One way that CYBHI pursued an equity agenda was through “community-defined evidence practices,” or CDEPs, promoted by the California Pan-Ethnic Health Network for “BIPOC and LGBTQ+ communities.” Examples of CDEPs include Sweat Lodge ceremonies, Traditional Healer ceremonies, dance and drum circles, “smudging” rituals, Powwows, and “radical inclusivity.” In a 2021 concept paper, 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 “from the dominant culture” could even represent “a deficit.”
CYBHI helped turn this vision into state spending. Across five grant programs, California set aside $381 million for “evidence-based and community-defined” practices, placing CDEPs in the same statewide funding stream as clinically validated treatment models but applying a lower evidentiary standard to them, allowing participant 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).
City Journal’s review of California’s fourth grant round, 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 to channel students into activism. For example, the state awarded $750,000 to Merced County to develop a clubhouse with the Youth Leadership Institute, a progressive group whose Healing Generation Center introduces students to a “different justice platform” each week.
Another beneficiary was On the Margins, which received about $370,000 for ¡DALE! for Health and Wellness, a program designed to introduce high school students to progressive causes. The group envisions a “world 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.”
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 that hosts “affirming and confidential” support groups for youth. The group runs a “Queer Library,” a “gender-affirming” clothing closet, and holds an annual “Queer Magic GAYla.” St. John’s Community Health received $750,000 for a project titled “Affirming LGBTQ+ Youth to Improve Mental Health and Well-being in San Bernardino County.” Its transgender health program also provides hormones and surgical referrals.
The grants did more than fund one-off projects. They helped move CDEPs toward continuous reimbursement through Medi-Cal, California’s public insurance program, which covers nearly 38 percent of the state. That shift took shape under California Advancing and Innovating Medi-Cal (CalAIM), the roughly $5 billion 2021 overhaul that expanded Medi-Cal’s scope far beyond medical care to include rent, utility set-up, security deposits, meal delivery, grocery boxes, and up to $7,500 for 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 the state’s social-service spending.
Under CYBHI, California’s public schools were transformed into sites of mental-health service delivery. Today, the state’s 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 to receive therapy and a psychiatric diagnosis during school hours.
That change was facilitated by the 2024 rollout of the CYBHI Fee Schedule Program, through which the state poured $400 million into schools to hire staff, install billing and medical-record systems, and contract with vendors to create a “sustainable reimbursement pathway” for school-based mental-health services. California also gave $389 million to Medi-Cal managed-care plans so the insurance side could support the same system.
The stated goal is “prevention” through early identification and intervention. But the ubiquity of the program has lowered the threshold for what counts as clinically concerning, covering the needs of what some call “the worried well.” The state’s hypothetical examples include students feeling anxious about college admissions or frustrated about missing several days of school—ordinary stressors that can now be treated as “medically necessary” and thus eligible for reimbursement.
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. If parents don’t provide it, the California Department of Health Care Services (DHCS) requires the school to find another funding source.
Universal mental-health screenings are now widespread in California schools. Through the fee schedule, schools bill insurers for those screenings, collect data on the results, sort students into a tiered system, and direct those deemed in need of more “support” to additional billable screenings and services.
One prominent tool is the Adverse Childhood Experiences (ACEs) survey, a crude ten-question measure used to assign a numerical score to childhood adversity and assess risk for “toxic stress” (based on the idea that adversity becomes “biologically embedded” in the body). Robert Anda, one of the ACEs survey’s original authors, has warned that 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 and expanding ACEs screening.
Under the CYBHI fee schedule, schools bill $29 for ACEs screenings, use separate billing codes depending on a student’s ACEs score, and can flag students as “high risk” not only because of a higher score but also because of “ACE-associated health conditions,” which include headaches, sleep problems, anxiety, not completing homework, or “early sexual debut.”
Once a child is flagged, reimbursable next steps may include psychotherapy, psychiatric diagnostic evaluation, case management, neuropsychological testing, and medication support. A child may also be prescribed medication with parental consent, but many of these services can occur without parents being informed. Under a new law, minors 12 and older can consent to outpatient mental-health treatment if a mental-health professional deems them “mature” enough; “parents are not to be contacted,” state guidance says. Minors can also get a separate Medi-Cal billing card not linked to a parent.
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 as part of the state’s partnership with the California School-Based Health Alliance, which describes its model as “actively anti-racist” and committed to creating “truly affirming and equitable spaces where LGBTQIA+ youth can thrive.” Though California K–12 schools are not yet prescribing puberty blockers and cross-sex hormones, school-based health advocates elsewhere, including in Seattle, have pushed for it.
California also spent $278 million launching Certified Wellness Coaches, a new nonclinical workforce that can enter schools and gain direct access to students for billable “coaching” sessions. Coaches are required to have only two years of community college education and several weeks of supervised field experience. Their code of conduct commits them to advancing “social, economic, and environmental justice” and opposing “oppression, racism, discrimination, and inequities.”
Students are also pushed toward the state’s digital mental-health platforms, another major CYBHI expense totaling $607.7 million. The virtual services platform Soluna, for ages 13–25, emphasizes that one-on-one chats and video sessions are not shared with parents. Both Soluna and BrightLife Kids, for ages 0–12, rely on similarly nonclinical staff trained in “culturally responsive care” tailored to “LGBTQ+” and “BIPOC” identities.
California also used CYBHI funds to expand social-emotional learning (SEL) during instructional time, spending $120 million to bring Transformative SEL, with its “explicit equity and social justice lens,” to students in public schools in every county. This expansion was part of the California Department of Education’s more expansive “whole child” framework, which treats schools as responsible not just for academics but also for students’ emotional and social development. It is the same framework behind the department’s $4.1 billion California Community Schools Partnership Program (CCSPP) for under-resourced schools.
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’s role in children’s lives, weaken parental authority, and shift schools further from their academic mission at a time when students are already falling behind in core subjects.
This approach may not only be a distraction from academics; it could also be harming kids. Teaching children to look for the “early signs and symptoms of distress,” as CYBHI’s $100 million public-awareness campaign aims to do, risks pathologizing ordinary experience in ways that can result in unnecessary medicalization and even contribute to the development of mental-health disorders. Research has found no clear benefit—and in some cases evidence of harm—from universal school-based mental-health initiatives and screenings. Yet California embraced the model so fully that it awarded $56 million for “Early Childhood Wraparound Services,” extending behavioral health screening and intervention even to babies, toddlers, and preschoolers.
While the state poured billions into broad-brush, ideologically charged programs, California’s 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 placing children in the “least restrictive settings,” despite warnings from county officials that short-term care was often ill-equipped to safely manage the youths most in need. The awards were skewed toward 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)—the only funded setting able to lock its doors and keep a child longer based on individualized medical need.
By 2024, California realized that it had not devoted enough funding to treatment beds. It put before voters Proposition 1, a roughly $6.4 billion ballot initiative. But a substantial share of that funding still went to homeless housing under a Housing First model that requires neither sobriety nor participation in treatment. Even after the passage of Prop. 1, the state plans only eight PRTFs statewide, or 158 beds total, according to DHCS. None are open, and many are still years out from completion.
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’s approach, saying California is “repairing a mental health system that was decimated by the Reagan Administration 40 years ago” and pointing to planned treatment beds and expanded outpatient services.
Despite Governor Newsom’s claims of success, the promised expansion of treatment-bed capacity has fallen badly behind schedule. Children still travel hundreds of miles across the state just to secure a psychiatric hospital bed. Yet California is once again bowing to outside pressure rather than working with hospital operators as it rushes to enforce new regulations that could sideline hundreds of already-scarce psychiatric hospital beds.
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 reinforced by repeated short-term interventions. These are often kids with histories of trauma, aggression, self-harm, running away, and emotional and behavioral instability that can put themselves or others at serious risk. Even with follow-up care, about one in four children return to crisis care within six months.
High-quality residential treatment can provide a 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 of states have lost youth residential psychiatric capacity.
This form of treatment is disappearing, but the children who need it are not. A recent bipartisan Senate investigation found that in 25 states, children were waiting for mental-health treatment in juvenile detention because there was nowhere safe for them to go. Others end up stranded for long periods in psychiatric hospitals and emergency rooms, warehoused in hotels, left homeless, or “treated and streeted” back into the same failed cycle of outpatient care, as Jázmin Pellegrini was.
As Jázmin’s mental health deteriorated, California repeatedly offered her “community-based treatment” instead of the psychiatric residential care she needed. The state has long been reluctant to invest in residential care. PRTFs did not become a licensed category in California until 2022. For years, children had to travel out of state to access PRTFs and other secure settings. But in 2021, amid a media-driven backlash against this form of care, California barred foster youth from those placements and brought 133 of them back into the state without adequate alternatives. The state lost track of some, and some ended up in juvenile detention.
Today, the state has just two operating facilities in Los Angeles County capable of locking their doors and keeping children longer term, both with limited beds and, at times, long waiting lists. In a desperate effort to help her daughter access one of them, Jázmin’s mother relinquished custody. The girl died while awaiting placement. There are many children like her, but state privacy laws keep most of their stories from public view.
Governor Newsom invoked children like Jázmin when he declared a youth “mental health crisis” 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 but no child as a priority. In Newsom’s California, children like Jázmin are left to cycle through a revolving door of short-term care until it finally closes on them for good.