The COVID-19 pandemic, climate change and the cost of living have all impacted Californians’ mental health over the past decade—but there’s a shortage of professionals who can meet this growing health care need. How might new or existing frameworks help make mental health services more accessible?
As Pomona College prepares to host a California gubernatorial debate on April 28, Associate Professor of Psychological Science Sara Masland examines existing barriers to accessing mental health services, the risks associated with using AI as a therapist and the importance of early intervention in the state’s new Mental Health for All initiative. This interview has been edited for length and clarity.
More adults and teens in California report experiencing psychological distress than ten years ago. What factors might be contributing to this increase?
A combination of technological, social and economic forces are likely at play. Social media has fueled constant comparison and eroded sleep and face-to-face connection, while economic pressures have created chronic financial anxiety, especially for younger generations. These trends began before the COVID-19 pandemic but have only worsened since. Some factors are particularly relevant for California, including the high cost of living and housing crisis. Californians have also faced unique threats from climate change, including wildfire displacement, drought and extreme weather events. People of color, low-income Californians and those who identify as LGBTQ have been most impacted and have seen the greatest increase in psychological distress.
On a positive note, reduced stigma around mental health has reduced barriers to reporting distress, which means that the increases we see in reports of psychological distress are partly a reflection of greater awareness alongside genuine suffering.
What barriers do Californians face to accessing mental health resources?
California is a progressive state with strong rates of higher education and many training programs for mental health professionals. Still, the majority of Californians who try to make mental health appointments have difficulty finding providers who accept their insurance and may skip or postpone care due to cost. Additional barriers include stigma, lack of insurance, language barriers and fear of deportation for immigrants.
What barriers does California face to providing mental health services?
California has a significant shortage of mental health professionals, particularly licensed, non-prescribing clinicians. The California Department of Health Care Access and Information (HCAI) has reported that in 2025, all 58 California counties were projected to face a shortage across all behavioral health roles, with a statewide deficit of roughly 40%. We need more than 55,000 additional providers to meet the need. It is projected that this number will increase to over 170,000 by 2033. Shortages are not evenly distributed: the Northern & Sierra, Inland Empire and San Joaquin Valley CHIS (California Health Interview Survey) regions are most impacted.
California also has a funding problem across multiple sectors, including in county mental health systems. This limits the ability to hire more mental health professionals. At the same time, insurance companies do not treat mental health concerns with parity to physical health concerns, and federal legislation significantly undermined Medi-Cal coverage for mental health conditions in 2025.
More people are turning to AI for mental health care. What are the benefits and risks of using AI as a therapist?
If California has such significant financial barriers and shortages in mental health providers, then it is easy to understand why alternative services, including AI, may seem promising. However, it is hard to generate a true benefit of AI therapy other than access, and access is only useful if the services are effective and do not cause harm. Research in this area is growing, but we have no clear evidence that AI therapy is effective. We do have evidence that it can cause harm—AI may not recognize when someone is in crisis, may give users bad (and potentially deadly) advice and has embedded bias against some mental health conditions and marginalized groups.
California recently rolled out an initiative to improve overall wellbeing for residents. What role does early intervention play in successful mental health care outcomes?
Research robustly supports the importance of early intervention in mental health care. Early intervention is critical for better long-term outcomes. Without timely intervention, serious mental health conditions tend to worsen and contribute to cycles of crisis, hospitalization, homelessness and involvement with the criminal justice system. Evidence consistently shows that early, coordinated care can bring even serious disorders into remission and prevent them from becoming chronic and debilitating. California's Mental Health for All framework reflects this principle, prioritizing early action over reactive, crisis-driven care.
If you could advise policymakers on improving access to mental health resources, what would you suggest?
The single most urgent priority is ensuring that MediCal, the funding backbone of California’s mental health system, is not gutted by federal cuts.
Next, I would advise policymakers to prioritize prevention, not just early intervention. California's Mental Health for All framework rightly emphasizes early intervention, but it is critically important to address the upstream social, economic and environmental conditions that give rise to mental health challenges. This means treating housing instability, food insecurity, poverty and climate-related stress as mental health issues, not just social ones.
I would also encourage policymakers to treat the workforce crisis as the emergency it is. No amount of funding for facilities or programs matters if there are not enough clinicians to staff them. California should dramatically expand loan forgiveness and scholarship programs for mental health trainees, streamline licensing processes, invest in peer support and community health worker roles, and prioritize recruiting a workforce that reflects the racial, cultural and linguistic diversity of the people it serves.
Finally, regulation is essential in at least two areas: California can do more to regulate insurance companies to ensure that mental health conditions are treated with parity and can develop regulatory oversight for AI mental health tools to protect vulnerable Californians, particularly adolescents.