San Diego Union-Tribune
By Cathryn Nacario
June 9, 2026
Every day in San Diego County, families face one of the most frightening moments imaginable: a loved one in the midst of a mental health crisis. In those moments, people need compassion, clinical expertise and a clear path to safety. Recognizing this reality, National Alliance on Mental Illness recently updated our “Navigating a Mental Health Crisis” guide to help families understand what to expect, how to advocate and how to keep their loved one safe during the most vulnerable moments of their lives. The guide makes one message unmistakably clear: A mental health crisis requires a mental health response.
Yet too often, our system fails to provide one.
Instead of specialized psychiatric care, people are taken to an emergency department that does not have the capacity to effectively manage our community’s needs for emergent behavioral health services. In the worst cases — cases we see far too often — individuals in crisis end up in jail cells, not because they committed a crime, but because their mental illness has gone untreated, a devastating outcome for people whose only “offense” is being sick.
The National Alliance guide outlines what the appropriate crisis pathway should look like: de-escalation, clinical assessment, safe transport and timely admission when medically necessary. For some in crisis, a psychiatric bed is the appropriate care. Without enough available treatment beds, even the best crisis teams cannot deliver the outcomes families deserve.
Unfortunately, that’s our current reality.
San Diego, like much of California, does not have enough psychiatric beds to meet the needs of our community. The RAND think tank and other researchers have documented statewide shortages across every level of care, from acute inpatient beds to residential treatment and crisis stabilization units. From a clinical perspective, these shortages have real consequences — long waits, days in an emergency room waiting for a psychiatric bed to open and conditions that worsen while people fall through the cracks. Making matters worse, this crisis is at risk of worsening rather than improving.
Recently proposed staffing regulations from the California Department of Public Health could force hundreds if not thousands of beds to come offline. Not only do these regulations not reflect current realities, but they also disproportionately impact for-profit psychiatric hospitals who play a critical role in this landscape. These facilities provide a significant share of the region’s inpatient psychiatric beds, accept complex patients, and operate 24/7 units that relieve pressure on emergency departments and law enforcement. When these beds close, mobile crisis teams have nowhere to transport patients, emergency departments become holding areas and law enforcement officers, lacking clinical alternatives, are forced into impossible decisions. This is not a failure of families or law enforcement – it is a failure of capacity.
The first step is ensuring there is sufficient capacity is making sure the operating psychiatric beds remain open, staffed and financially viable. Reimbursement rates must reflect the true cost of providing psychiatric care. Staffing requirements must respect the technicians who have committed their lives to this work and be paired with workforce investments so hospitals can recruit and retain the clinicians who make crisis care possible. And state and federal policymakers must recognize that psychiatric hospitals are essential partners in preventing the criminalization of mental illness.
At the same time, the region must continue strengthening the front end of the crisis system.
Investments in psychiatric emergency response teams, crisis stabilization units and hospital-based emergency psychiatric assessment, treatment and healing units have already transformed how San Diego responds to behavioral health emergencies, helping people get care earlier and closer to home. But these efforts cannot succeed if there is nowhere to take someone who exceeds short-term stabilization or divert someone from jail if every psychiatric bed is full.
San Diego has the opportunity and the responsibility to build a crisis system worthy of the people it serves. That means investing in mobile crisis teams, strengthening partnerships with law enforcement, expanding psychiatric bed capacity and sustaining access to outpatient and community-based services.
More beds. More clinicians. More capacity. More dignity.
Nacario is chief executive officer of the National Alliance on Mental Illness San Diego and Imperial Counties.