Preventing Behavioral Health Crises

California is facing a behavioral health crisis that affects communities across the state. Too many families watch loved ones with serious mental illness cycle through emergency rooms, psychiatric holds, jails and homelessness while the system intervenes only after a crisis has escalated.

This is not a compassionate approach, and it is not effective.

This year, I am excited to be introducing legislation, in partnership with San Francisco Mayor Daniel Lurie and Supervisor Rafael Mandelman, to strengthen California’s behavioral health system by ensuring outpatient treatment actually stabilizes people with serious mental illness.

For many people, psychotropic medication is essential. These medications can dramatically improve functioning and help people stay connected to treatment, housing and their families. Yet for some, the very nature of their illness prevents them from recognizing their need for medication or accepting it voluntarily.

I have spoken with parents who know exactly what their adult child needs to stay well, and yet they are powerless to make it happen. One mother told me she could see the warning signs every time her son stopped taking his medication. She begged providers to intervene earlier, but the answer was always the same: Until he posed a danger to himself or others, there was nothing they could do. Eventually, the call came in the middle of the night. Her son was on a psychiatric hold. He received medication, stabilized and returned home.

But everyone involved knew what would happen next. Within weeks or months, the cycle would repeat – medication would stop, symptoms would escalate and another crisis would become the only way back into care.

This gap in care also has real consequences for public safety. When people with untreated serious mental illness cycle in and out of crises, the risk of harm to themselves, first responders, family members and the broader community increases. Emergency rooms, jails and law enforcement are left to manage situations that should never have reached a breaking point. This legislation helps reduce emergency calls, hospitalizations and encounters with the criminal justice system by intervening earlier and ensuring treatment is effective.

California’s Assisted Outpatient Treatment (AOT) program was created to help address this challenge. AOT allows courts to order individuals with serious mental illness to participate in structured treatment rather than cycling through hospitalization after hospitalization. However, there is a critical gap in the law: Courts cannot currently require medication as part of an outpatient treatment plan, even when clinicians agree it is essential for stabilization.

The result is tragic and predictable. People begin outpatient treatment without the tools they need to help them succeed. Their condition deteriorates. Eventually, they end up in crisis again, requiring a psychiatric hold or hospitalization. Only then, when someone is at their most vulnerable and unstable, does the system allow for involuntary medication.

My legislation is designed to intervene earlier and more thoughtfully. This bill would allow counties to include involuntary medication as part of an assisted outpatient treatment plan when it is clinically necessary. Judges would review each case individually, relying on medical evidence and the person’s specific circumstances.

Today, involuntary medication is largely reserved for people on time-limited psychiatric holds or under conservatorships, meaning we wait until someone is in severe crisis before acting. This legislation shifts our approach toward prevention. It recognizes that supporting people earlier can reduce hospitalizations, improve health outcomes and enhance public safety.

By strengthening assisted outpatient treatment, we can spare families endless cycles of crisis and finally give people the care they need before their lives unravel. Treatment works only when it is real, consistent and complete. And that includes medication. This bill is about ending preventable crises by giving families and courts the tools to act before someone’s life falls apart.

Assemblymember Catherine Stefani represents California’s 19th Assembly District, which includes the west side of San Francisco and northern San Mateo County. She can be reached at 415-557-2312 or Assemblymember.Stefani@assembly.ca.gov.