Addressing Chronic Vacancies in Prison Mental Health Care

analysis full AN LAO REPORT Addressing Chronic Vacancies In Prison Mental Health Care GABRIEL PETEK | LEGISLATIVE ANALYST FEBRUARY 2026 www.lao.ca.gov 1 analysis full AN LAO REPORT 2 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Executive Summary Prisons Have Struggled to Provide Mental Health Care and Address Chronic Mental Health Staff Vacancies. For over three decades, the California Department of Corrections and Rehabilitation (CDCR) has faced litigation for providing unconstitutional levels of prison mental health care, in part due to chronic vacancies among mental health staff. As a result, a series of federal court orders—in the case now known as Coleman v. Newsom—have directed the state to make various changes, including reducing vacancy rates below 10 percent in certain key mental health classifications. However, CDCR has struggled to meet this standard for various reasons, including the challenging working conditions at prisons and the limited pool of providers where prisons are located. In September 2025, the court—citing, in part, the ongoing failures to reduce vacancies—established a mental health Receivership “to take control of the delivery of mental health services.” This will result in a significant loss of autonomy for the state in the delivery of prison mental health care. Continued State Effort to Address Vacancies Is Critical. Despite the Receivership, the Legislature will retain the ability to approve, reject, or modify the Receiver’s budget proposals, pass legislation mandating CDCR to take specific actions, and conduct oversight of the system. Additionally, chronic mental health vacancies likely affect mental health outcomes and addressing them will be essential to returning authority back to the state. Accordingly, it is critical for the state to continue to take action to reduce mental health vacancies. Recommend Legislature Take Various Steps to Reduce Chronic Vacancies. To address chronic mental health staffing vacancies, we recommend the Legislature take the following the steps: • Assess Effectiveness of Other Steps Before Considering Across-the-Board Pay Increases. For various reasons, including that current CDCR compensation appears to meet or exceed market rates and factors outside of compensation likely play a major role in the state’s ability to staff mental health positions, we recommend the Legislature not provide significant across-the-board compensation increases in the near term, though more targeted increases could be appropriate. • Eliminate the Requirement for Licensed Out-of-State Providers to Get California Licenses. This would allow CDCR to benefit from recruiting from a wider pool of applicants. We also recommend directing CDCR to recruit more from out of state. • Increase Use of CDCR Tele-Mental Health to Maximum Court-Approved Levels. The Coleman court allows up to half of providers to patients not in inpatient beds to provide services through tele-mental health. Even under a proposed expansion, however, only about 30 percent of providers will be remote. Further expanding tele-mental health could attract qualified professionals who might not otherwise want to work in a prison setting, as well as allow the state to recruit from areas where there are more providers available. • Ask Court to Allow Tele-Mental Health Providers to Work From Out of State. This would open up a potentially large pool of new applicants who are interested in working for CDCR but would prefer not to move from their current location. www.lao.ca.gov 3 analysis full AN LAO REPORT • Require CDCR Report on the Feasibility of Concentrating Mental Health Population in Prisons That Are Easier to Staff. Concentrating the mental health population could have various benefits, such as making it easier to recruit staff located in areas with a wider pool of applicants and reducing the need for staff at locations with large vacancies. However, this could prove logistically difficult. Having a report that explores the feasibility and costs of this option would better position the state and the Legislature to know what the challenges of such an approach are. • Direct CDCR to Align Inpatient Capacity With Actual Need. CDCR is operating hundreds more inpatient beds than the amount projected to be necessary. This increases costs and the number of positions it needs to fill unnecessarily. We recommend directing CDCR to request the Receiver to allow it to operate only the inpatient beds projected to be necessary. Taken together, these steps will help the state better recruit and retain mental health staff, reduce the state’s reliance on expensive contracted staff, meet its constitutional requirements, lead to more effective care, and help return the mental health system to state control. 4 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT INTRODUCTION For many years, the California Department the system is through addressing its deficiencies, of Corrections and Rehabilitation’s (CDCR’s) which includes hiring and retaining qualified mental mental health system has struggled to employ an health care staff. The purpose of this report is adequate number of qualified staff. As a result of to provide an overview of CDCR’s mental health this chronic deficiency and others, CDCR has faced system, assess ongoing efforts to address mental litigation for over three decades contending that health vacancies as well as additional steps that it has not provided adequate mental health care. could be taken to reduce vacancies, and make This culminated in a federal court appointing a recommendations aimed at bolstering the state’s mental health Receiver to take direct control over ability to recruit and retain sufficient mental the prison mental health care system. The only health staff. way the state will be able to regain full control of OVERVIEW OF CDCR PRISON MENTAL HEALTH CARE Prevalence of Mental Health health need or the difficulty people with mental health needs have in earning credits (which allow Need in Prison people to be released earlier) based on behavior. About Two Out of Five People in Prison Furthermore, it is possible that CDCR’s ability to Receive Mental Health Services. Nearly identify people who have a mental health need 35,000 people in prison have a diagnosed mental has improved due in part to changes mandated health need. Compared to a few decades ago, by the federal court in a case now known as this represents significant growth. For example, Coleman v. Newsom, which we describe next. Figure 1 shows that in 1997 there were about 14,500 people in prison Figure 1 with a mental health need which represented about 10 percent Share of Prison Population With a of the overall prison population. Mental Health Need Continues to Increase However, in more recent years, the prison mental health population 45,000 45% has generally decreased and is Percentage of Population With a Mental Health Need 40,000 40 projected to continue to decline. This is due to the significant 35,000 35 reduction in the overall number 30,000 30 of people in prison. However, the mental health population has 25,000 25 not declined as quickly as the 20,000 20 overall population. As a result, the Mental Health Population share of people in prison with a 15,000 15 mental health need has increased. Although there is no conclusive 10,000 10 explanation for what is causing 5,000 5 this trend, CDCR has suggested that contributing factors could 1997 2007 2017 2027 include an increase in the length of (projected) prison stay for those with a mental www.lao.ca.gov 5 analysis full AN LAO REPORT Coleman Court Monitoring Prison prison mental health system. As we discuss later Mental Health Care Since 1990 in this report, the Special Master was recently replaced by a mental health Receiver (see the Federal Court Found State Provided nearby box for more on Receiverships). In contrast Inadequate Prison Mental Health Care. The to the Special Master, the Receiver has direct Coleman court case, filed in 1990 and certified authority over day-to-day operations of CDCR’s as a class action lawsuit in 1991, involves mental health care system. allegations that the state prison system provides constitutionally inadequate mental health care for Mental Health Classifications and people in prison. Through this litigation, the federal Treatment court found the state to be in violation of the Eighth Mental Health Needs Identified in Various Amendment of the U.S. Constitution—prohibiting Ways. CDCR is responsible for identifying cruel and unusual punishment—for providing and providing treatment to people with mental inadequate prison mental health care. Since then, health needs in prisons. When people enter the the Coleman court has been involved in bringing the prison system, they are routed to prisons with state into compliance with constitutional standards. reception centers where they undergo various Federal Court Appointed Special Master in evaluations, including mental health evaluations. 1995 to Monitor State Prison Mental Health After completing the reception process, people Care. To monitor the state’s efforts towards are sent to prisons that can accommodate their remedying the problems identified in the mental designated security level and identified needs. health system, the court appointed a Special Mental health needs can be identified after the Master in 1995. The Coleman court Special Master reception center process as well. For example, has audited and tracked CDCR’s progress in while at their assigned prison, people may alert addressing issues. The Special Master has also staff of their mental health needs. Mental health provided recommendations to mitigate problems concerns may also be flagged through referrals or identify new issues for the court, which has from healthcare staff, correctional staff, or fellow led to court orders that CDCR must comply with. incarcerated people. However, under the Special Master’s monitoring, CDCR maintained direct authority over the state’s Receiverships Are a Court’s Last Resort to Reform Prisons and Jails The appointment of a Receiver is a legal remedy in lawsuits seeking to reform prisons and jails that is typically used as a last resort by courts. Courts appoint a Receiver in order to place a neutral expert in control of some aspect of prison or jail operations. To establish a prison or jail Receivership, the court must make various determinations, including that there is grave and immediate harm to the plaintiffs, that the use of less extreme remedies has been exhausted, and that a Receiver is able to provide a quick remedy to the constitutional violations. Receivers are appointed and provided with various powers and authority necessary to bring prisons or jails into compliance. Receiverships last until the deficiencies have been rectified and defendants can show that they can sustain the remedies. The court has discretion on how a Receivership ends based on the circumstances that led to the establishment. Two Receiverships have been established to oversee aspects of California’s prison system. The first was established in 2006 to oversee the prison medical system. For more details on the medical Receiver please see our brief Overview and Update on the Prison Receivership. The second was established in 2025 to oversee the prison mental health system. More details on the mental health Receivership are provided later in this report. 6 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Outpatient Level of Care Offered to People • Enhanced Outpatient Program (EOP). With Less Acute Needs. To address mental Those that have additional needs are placed health needs, CDCR provides a range of services in EOP, where they receive additional services throughout the prison system, including outpatient such as weekly group therapy. CDCR seeks to care for lower acuity cases and inpatient treatment place these people in separate housing units for more severe conditions, at no direct cost to the with attached medicine distribution rooms patient. In outpatient settings, people typically live to facilitate their ability to receive psychiatric in a prison housing unit and receive regular mental medications. CDCR projected there would health treatment but do not require 24-hour care. be an average daily population of about This level of care is provided at most prisons and is 7,700 EOP patients in 2026-27. further divided into the following categories. Inpatient Level of Care Offered to People • Correctional Clinical Case Management With More Acute Needs. If a patient’s mental System (CCCMS). People who require regular health condition is not stable, the patient may outpatient mental health services at the lowest be referred to an inpatient level of care designed levels are placed in CCCMS programming to treat higher acuity cases. Once stabilized, where each person is assigned a clinician patients may be transitioned to outpatient services. and receives individual therapy at least every In inpatient beds, people receive 24-hour care and 90 days. As can be seen in Figure 2, CDCR more intensive treatment beyond what is provided projected in January 2026 there would be an in outpatient programs. These beds are offered average daily population of 25,200 people with only at select locations and are divided into the a CCCMS designation in 2026-27. following types based on the nature of the care they provide—some of which are staffed in a manner that allows them to flex between the types: Figure 2 • Mental Health Crisis Beds (MHCBs). MHCBs provide short-term housing and Most People With a Mental Health 24-hour care. Due to their immediate need Need in CDCR Receive Outpatient Services for treatment—often suicide prevention— 2026-27 Projections people referred to MHCBs are supposed to be transferred to these beds within 24 hours. APP/ICF Inpatient When an MHCB is unavailable at a specific MHCB 887 Outpatient 298 prison, CDCR typically transports people to another prison with an available MHCB. Under CDCR regulations, people are not supposed to stay in MHCBs for more than ten days—but EOP 7,731 may stay longer in the same bed if it is flexed into a different inpatient bed type. Currently, CDCR is budgeted to operate 455 MHCBs— CCCMS 25,190 including a new 50-bed crisis facility at the California Institution for Men in Chino. As can be seen in Figure 2, CDCR projected that an average of 298 (65 percent) of these beds would be filled on a daily basis in 2026-27. The annual cost of operating each MHCB— CDCR = California Department of Corrections and Rehabilitation, whether filled or not—is around $400,000. MHCB = Mental Health Crisis Bed, APP/ICF = Acute Psychiatric Program/Intermediate Care Facilities, EOP = Enhanced Outpatient Program, and CCCMS = Correctional Clinical Case Management System. • Acute Psychiatric Programs (APPs). APPs provide short-term, intensive treatment for people who show signs of a major mental www.lao.ca.gov 7 analysis full AN LAO REPORT illness or higher-level symptoms of a chronic Staffing Model Funds CDCR Based on Size and mental illness. Patients are supposed to be Composition of Mental Health Population… transferred to an APP within 72 hours of the The annual budget for prison mental health staffing referral, but no more than ten days after the is based on a budgeting methodology that utilizes referral and can generally stay up to 45 days. specific, court-ordered staffing ratios that factor Currently, CDCR is budgeted to operate in the size and composition of the mental health 480 APP beds, of which CDCR projected population. Accordingly, an increase in the mental 206 (43 percent) would be filled in 2026-27. health population requires additional positions The annual cost of operating one of these and funding, and a decline results in a reduction beds—whether filled or not—is $300,000. compared to the previous year. For example, as • Intermediate Care Facilities (ICFs). ICFs shown in Figure 3, if the number of EOP patients provide care beyond what is provided in is estimated to increase by 97, the staffing ratios CDCR outpatient programs but are available would indicate that one additional psychiatrist for longer time periods than MHCBs or APPs. will be needed. The staffing model includes People with lower security concerns are placed various other ratios—not listed in Figure 3—for in low-custody ICFs, which are in dorms, different subpopulations. while those with higher security concerns are …And the Number of Inpatient Beds. placed in high-custody ICFs, which are in cells. Additionally, the number of active inpatient mental Currently, the state has budgeted 714 ICF health beds, which require specialized prison beds in state prisons and 306 low-custody infrastructure, affect the level of funding and ICF beds in state hospitals which CDCR can distribution of mental health staff throughout refer patients to. Of the 1,020 total ICF beds, the prisons. This is because some mental health CDCR projected 632 (62 percent) would be staffing positions are tied to the number of active filled in 2026-27. There are also 75 additional inpatient beds as opposed to being tied directly to beds that can flex between ICF and APP levels the mental health population. For example, CDCR of care of which 49 (65 percent) are projected receives about $400,000 and the associated to be filled in 2026-27. Each ICF bed in a state positions annually for each active MHCB, prison costs—whether filled or not—around irrespective of whether the bed is occupied for $246,000 annually to operate, while those in most of the year. In practice, CDCR can move the Department of State Hospitals (DSH) cost staff around the prison as needed, especially if an around $393,000 annually. inpatient bed is not occupied. As such, the number of active beds contribute to the number of positions Mental Health Staffing at a given prison. Court Ordered Specific Staffing Levels and Current Staffing Model. A series of Coleman court Figure 3 orders since 2002 have dictated the levels of staffing Size of Mental Health Population required to operate the mental health system in the Drives Need for Certain Positions state’s prisons. Specifically, the court has ordered Ratios of Clinicians to Patients for General that CDCR must (1) establish the mental health Outpatient Populations staffing positions and budget using agreed upon ratios, (2) maintain enough mental health beds to Classification CCCMS EOP meet the needs of the population in a timely manner, Supervising Psychologist 1:1,200 1:150 (3) maintain a 10 percent or less vacancy rate in Supervising Social Worker 1:1,200 — five key mental health classifications (psychiatrists, Staff Psychiatrist 1:225 1:97 Clinical Psychologist 1:157 1:30 psychologists, social workers, medical assistants, Social Worker 1:157 1:70 and recreational therapists), and (4) pay Recreational Therapist — 1:37 court-ordered fines when vacancy rates exceed CCCMS = Correctional Clinical Case Management System and 10 percent (as we discuss in greater detail later). EOP = Enhanced Outpatient Program. 8 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Some Mental Health Staff Work Remotely. at 43 percent. The growth in vacancy rates seen in In addition to the on-site staff, CDCR uses 2022 were likely a result of a combination of factors tele-mental health services to deliver mental that include staff turnover, several changes in the health care. Staff who deliver tele-mental health 2021-22 Budget Act that added new mental health services use teleconferencing technology to meet positions, and subsequent changes in the mental with patients. These staff have the option to either health population. commute to offices, some of which are outside Court Levied Fines on State for Contempt of prisons, or work from home if they are able to of Court-Ordered Staffing Levels. Due to not ensure patient privacy. Generally, patients are adequately filling mental health vacancies, in escorted to a medical room within the prison where June 2024, CDCR was found to be in contempt they communicate via audio and video with the of the court’s orders to keep vacancy rates below mental health professional over a secure network. 10 percent. The court began levying monthly Other Mental Health Staff Are Contractors. fines for vacancies in the five key classifications When CDCR lacks sufficient onsite staff to fill its (psychiatrists, psychologists, clinical social workers, positions, it hires contractors known as registry recreational therapists, and medical assistants). staff. Registry staff can supplement the number In establishing the fines, the Coleman court said that of mental health care staff in order to provide CDCR’s strategies to reduce vacancies lack urgency, treatment and reduce delays in services. have been insufficient to fill needs, and indicate that the state “is continuing to operate business as Inability to Fill Mental Health Vacancies usual.” However, further collection of the fines has Resulted in Fines and Contributed been paused due to the establishment of the mental to Appointment of a Mental Health health Receivership, discussed below. For further Receiver details on the fines, see the box on the next page. Court Has Established Mental Health State Has Struggled to Comply With Receivership to Address Vacancies and Improve Court-Ordered Staffing Levels. Since the Care More Broadly. Effective September 1, 2025, Coleman staffing court orders were established, the court established a Receivership “to take mental health vacancy rates have generally been control of the delivery of mental health services.” above the court-ordered 10 percent maximum and As a result, the Receiver—rather than CDCR continue to remain high. Specifically, according leadership—is responsible for the day-to-day to court records, vacancy rates in the five key operations of the CDCR mental health system. classifications between April 2023 and April 2024 ranged from: • 6 percent and 15 percent for Figure 4 psychiatrists. CDCR Has Notable Mental Health Vacancy Ratesª • 35 percent and 41 percent for Vacancy Rate in June of Each Year psychologists. • 17 percent and 29 percent for 50% social workers. 45 • 8 percent and 32 percent for 40 35 medical assistants. 30 • 8 percent and 49 percent for 25 recreational therapists. 20 15 Figure 4 highlights the vacancy 10 trends for these five classifications 5 taken together (after accounting 2017 2018 2019 2020 2021 2022 2023 2024 2025 for registry staff) over the past nine years and shows that the ª Vacancy rates for psychiatrists, psychologists, social workers, medical assistants, and recreational therapists taken together and adjusted to account for registry staff. vacancy rate as of June 2025 was CDCR = California Department of Corrections and Rehabilitation. www.lao.ca.gov 9 analysis full AN LAO REPORT Coleman Court Found State in Contempt and Levied Fines In June 2024, the Coleman court found the California Department of Corrections and Rehabilitation (CDCR) to be in contempt of the court’s orders and began levying fines related to mental health staffing vacancies. Beginning retroactively in April 2023, fines accrued for each of the five key classifications (psychiatrists, psychologists, clinical social workers, recreational therapists, and medical assistants) that did not achieve a 90 percent fill rate—after accounting for tele-mental health and registry staff. As of January 2026, the court has collected $155 million in fines which were deposited into a special deposit fund called the Mental Health Staffing Deposit Fund. The court also ordered CDCR and the plaintiffs to develop a plan as to how these fines would be used. The plan developed specified that the fines would support various one-time efforts to address vacancies, most notably by funding retention bonuses for the five classifications the state was fined for. However, additional fines have been paused due to the establishment of the mental health Receivership in September 2025. About $33 million of the fines already collected have been spent in accordance with court-approved plans and the remainder is expected to stay in the special deposit fund to be used by the Receiver. Along with the establishment of the Receivership, $41 million annually to implement the plan and it the Coleman court has adopted the Receiver’s will take between five and seven years to bring action plan. The plan outlines the Receiver’s the state into compliance. The plan’s primary cost strategy and efforts intended to bring the state drivers are salary increases for mental health staff into compliance, address court-ordered remedies, ($25.3 million) and additional staff—known as and “achieve and retain a qualified mental health resource teams—at inpatient units ($6.6 million). workforce.” As shown in Figure 5, the plan includes In addition, the plan outlines that it would cost six goals—each goal accompanied by a set of about $9 million annually to establish and operate actions. The Receiver estimates it will cost about the Office of the Receiver. Figure 5 Receiver’s Action Plan Outlines Goals and Actions to Improve Mental Health Care Goal 1 Improve Mental Health Care Delivery Through Culture Change and Effective Management Selected Actions • Implement a comprehensive communications strategy. • Centralize and streamline mental health reporting structure under the Receiver. Goal 2 Achieve and Retain a Qualified Mental Health Workforce Selected Actions • Enhance recruitment of clinicians by expanding use of mental health internship programs. • Assess factors contributing to clinician fear and identify strategies for addressing them. • Evaluate compensation concerns. Goal 3 Provide Adequate Care at Every Level and Treat Each Patient at the Appropriate Level of Care Selected Actions • Evaluate the use of Resource Teams to enhance patients’ ability and willingness to step down. • Increase compliance with existing policies regarding use of force. Goal 4 Fully Implement a Suicide Prevention Program Selected Actions • Establish implementation goals and plans to resolve outstanding suicide prevention recommendations. • Complete transition of annual suicide reporting to CDCR. Goal 5 Complete Development and Implementation of a Quality Assurance Program Selected Actions • Recommend final indicators and compliance thresholds to the court. • Complete development of user-friendly dashboards to monitor compliance. • Seek court approval for a process to recommend that CDCR has fully implemented a remedy. Goal 6 Create Mechanisms to Demonstrate Remedies Selected Actions • Partner with external expert to assess feasibility of seeking accreditation. CDCR = California Department of Corrections and Rehabilitation. 10 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT CURRENT EFFORTS TO ADDRESS CHRONIC MENTAL HEALTH VACANCIES Hiring sufficient mental health staff is not a Receiver—have undertaken additional efforts to unique challenge to CDCR. Other employers, reduce vacancies. We summarize some of these including correctional facilities in other states, recent efforts below. struggle to hire sufficient mental health care staff. State Was Pursuing Various Steps A 2018 survey from the University of Michigan of 20 correctional facility representatives across six to Address Vacancies Prior to states found that most respondents (85 percent) Establishment of Mental Health agreed that they had difficulty filling open Receivership behavioral health positions and had high turnover of In recent years, CDCR has taken various behavioral health staff. A wide variety of factors can steps to maintain court-ordered staffing levels. make it difficult to hire and retain mental health staff For example, in 2024, CDCR expanded its at prisons, including: tele-mental health policy by allowing social workers • Challenging Working Conditions. Based on and psychologists (who also deliver mental health discussions with CDCR staff, mental health care) to work remotely in addition to psychiatrists professionals may not want to work at a prison who were previously authorized to provide such for various reasons. Staff cited concerns services. CDCR indicates that this has allowed about safety, air conditioning and heat, lack them to improve recruitment and retention of these of privacy, dilapidated or limited offices and staff. Additionally, in 2025, CDCR partnered with treatment space, as well as a rigorous work the California Department of Human Resources schedule with few flexibilities. Finding similar (CalHR) to establish new classifications that can concerns, the Receiver’s action plan indicates provide mental health services at the prisons. The that mental health staff have an elevated fear classifications consist of both line and supervisory of being assaulted in prisons. staff of marriage and family counselors as well as • Limited Pool of Providers. The California clinical counselors. CDCR plans to use these staff in Department of Health Care Access and lieu of psychiatrists and psychologists in outpatient Information in 2022 estimated for the overall settings, as they expect the new classifications will California population that there is a shortage be easier to fill. This will allow CDCR to prioritize the of psychiatrists and behavioral health psychiatrists and psychologists it is able to recruit providers in all 58 counties, with several for inpatient settings. Absent any changes from counties experiencing severe shortages. the Receiver, these various steps will continue to Further, this report projected that in 2025, be implemented. 16 of the state’s prisons would be in counties Mental Health Receiver Plans to facing a severe shortage of mental health professionals and 11 prisons in counties facing Address Vacancies in Various Ways a high shortage. The Receiver’s action plan involves various additional efforts to reduce mental health Over the last few decades, the state has taken a vacancies, as outlined in Figure 6 on the next page, variety of actions aimed at addressing the chronic including a specific set of actions aiming to achieve vacancies, including bargaining salary increases, and retain a qualified mental health workforce. expanding the use of registry staff, and centralizing For example, building the pipeline of providers by recruitment efforts. These efforts, however, have expanding the number of internships available at not been sufficient to reach sustained court CDCR would help increase the number of providers compliance. More recently, the state—and now the that can work at CDCR directly—by bringing in www.lao.ca.gov 11 analysis full AN LAO REPORT Figure 6 Receiver’s Action Plan to Address Mental Health Vacancies 9 Communicate to staff the high priority of filling vacancies. 9 Implement procedures that ensure newly opened or reopened EOP, MHCB, or inpatient units have sufficient staff prior to opening. 9 Improve onboarding process for new staff. 9 Assess need for more staff dedicated to recruitment, hiring, and retention. 9 Hire an internship coordinator to centralize and expand clinical internship programs. 9 Identify strategies to reduce safety concerns among mental health staff. 9 Maintain retention bonuses and assess whether further pay increases are needed in hard-to-fill locations and positions. 9 Approve a hybrid work policy that would allow clinicians to work remotely and in person and assess whether other workplace flexibilities are possible. 9 Decrease clinician time spent on nonclinical tasks. 9 Complete applicant tracking system to make improvements to recruitment process. 9 Eliminate triage plans, which have the effect of reducing treatment hours for those at the lowest levels of care. 9 Conduct a space needs assessment at each prison and develop a plan to address those needs. EOP = Enhanced Outpatient Program and MHCB = Mental Health Crisis Beds. interns—and could help CDCR’s ability to recruit some vacancies. Finally, assessing to what degree them on a permanent basis. Furthermore, efforts compensation increases are necessary could be to address concerns among mental health staff fruitful to understanding what compensation levels related to the safety of the prison environment could would induce mental health providers to work be useful. To the extent, CDCR can mitigate these at the prisons. The other Receiver’s goals, while concerns, people may be more open to working not directly related to staffing, depend heavily on at a prison and staying there once employed. having enough qualified mental health staff, which Moreover, increasing compensation by making the is why the Receiver has indicated recruitment and bonuses permanent may have the effect of reducing retention will be a key focus of the Receivership. CONTINUED STATE EFFORT TO ADDRESS VACANCIES IS CRITICAL Legislature Retains Significant Role Despite health system budget proposals, pass legislation Appointment of Mental Health Receiver. The mandating CDCR to take specific actions, and establishment of the Receivership will result in a conduct oversight of the system. While the Receiver significant loss of autonomy for the state in the has the authority to ask the court to overrule such delivery of prison mental health care. Despite legislative actions, the Coleman court has directed this, the Legislature will still retain the ability to the Receiver to work in a manner consistent with approve, reject, or modify the Receiver’s mental California state laws, regulations, and contracts. 12 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Notably, the medical Receiver appointed to oversee returning authority back to the state. Recognizing CDCR medical care in the Plata v. Newsom case this importance, the Receiver’s action plan “places has worked collaboratively with the state and has significant emphasis on building and retaining a involved the Legislature in the decision-making mental health workforce because it is a foundational process, especially when developing the medical element to providing constitutionally adequate care budget. mental health care.” Moreover, prisons that do not Vacancies Likely Affecting Mental Health struggle to fill positions appear to provide care Outcomes. When an adequate number of mental much more effectively and have received positive health staff are not available, patients might have feedback from the court in the past. For example, appointments delayed or canceled. Based on CDCR indicates that San Quentin Rehabilitation data from CDCR, 56 percent of mental health Center (SQRC) performed well in court audits appointments were not completed as scheduled prior to the appointment of the Receiver because in 2024—35 percent were refused by the patient, it was more fully staffed and was able to better 2 percent for custody reasons such as lockdowns, meet the needs of its mental health population than and 19 percent for other reasons such as other prisons. vacancies. In addition, 47 percent of the outpatient Relying on Registry Staff Is Costly to population did not receive the necessary number the State. To the extent the state can recruit a of treatment hours. When patients do not receive sufficient number of mental health staff, it could not timely treatment, it could lead to deteriorating only reduce vacancies, but also its use of costly mental health and result in self-harm—including registry staff. In December 2025, the state Auditor suicide. For example, a recent research study found released a report that compared vacancy rates at that among veterans seeking mental health care in three state facilities that employ mental health staff veterans’ medical centers across the country, lower along with a comparison of hourly costs between mental health staffing increased the likelihood of mental health registry staff and state employees. a suicide-related event. The results were largest The Auditor’s report focused on Salinas Valley among facilities that had the fewest mental health State Prison (SVSP), Porterville Developmental staff. While the study is not in a correctional Center, and Atascadero State Hospital. Based on setting, it provides a benchmark of what outcomes the Auditor’s calculations, registry staff cost the could result for a population with mental health state more at these facilities on an hourly basis needs seeking services at facilities with high than state employees, even after accounting for vacancy rates. staff benefits, such as healthcare coverage. This To Achieve Overall Compliance, Addressing difference ranges from 14 percent to 115 percent Vacancies Will Likely Be Essential. The state’s higher, depending on the position. For example, inability to fill vacancies was a strong contributor registry psychiatrists appear to cost the state to the appointment of a mental health Receiver. about $113 (46 percent) more per hour and registry As a result, addressing mental health vacancies psychologists $105 (115 percent) more per hour at will be essential to ending the Receivership and SVSP, after accounting for state employee benefits. ASSESSMENT OF ADDITIONAL STEPS TO ADDRESS CHRONIC VACANCIES Based on discussions with CDCR providers (1) increasing compensation, (2) extending licensing and union representatives—as well as a review of exemptions to providers with out-of-state licenses, court documents and research—we identified five (3) expanding the use of tele-mental health, different strategies the Legislature could consider (4) clustering patients in easier-to-staff prisons as the state continues to address the chronic and (5) reducing excess inpatient capacity. In the mental health vacancies in the prison system: subsequent sections, we describe and assess each option. www.lao.ca.gov 13 analysis full AN LAO REPORT Increasing Compensation Bonuses for Psychiatrists May Largely Eliminate Pay Gap With Other Employers. Increased Compensation Is a Common The most recent compensation study for Bargaining Strategy to Improve Recruitment and Retention. Unit 16, which represents state psychiatrists, When employers increase compensation—either evaluated state psychiatrist pay and found it below in the form of higher pay or augmentations to other market (6 percent below market when comparing employer-funded benefits (for example, higher total compensation and 1 percent below market employer contributions toward health premiums)— when comparing wages alone). The findings from they typically receive more qualified applicants the compensation study suggest that lagging for a given job and people already employed are wages could be a contributing factor to the high less likely to leave. Thus, it stands to reason that vacancy rates among psychiatrists. However, increasing compensation—especially if it is lagging the most recent contract with Unit 16 increased other employers—could be one strategy to improve state psychiatrist pay by 3 percent across all state CDCR’s recruitment and retention of mental departments. For more on the Unit 16 agreement, health staff. please see MOU Fiscal Analysis: Bargaining Compensation Study Shows Pay for Most Unit 16 (Physicians, Dentists, and Podiatrists). Mental Health Staff Leading Other Employers. Additionally, the Coleman court’s pay bonuses To inform the collective bargaining process, CalHR increased the pay by roughly 3 percent as well conducts compensation studies to determine how for those working in prisons. These two changes state pay rates compare to the market rate for may largely eliminate the gap for state employees various classifications. Although the methodology compared to other employers, though this could for comparing the state’s total compensation has be eroded if other employers also increase their notable limitations, it is often the best information salaries at similar or larger rates. available to the state. CalHR produced the most Factors Outside of Compensation Likely recent compensation study of Unit 19 (Health Play a Major Role in Ability to Hire and Retain and Social Services/Professional) in 2023, which Staff. Although changes in compensation likely can includes three of the five key mental health affect the state’s ability to hire and retain staff, our classifications working at state prisons. CalHR’s analysis of vacancy rates at California prisons— study found that the state’s compensation was across different classifications and between higher than the market for: recreational therapists different prisons—suggests that other factors play (found to lead the market by 14 percent in total an outsized role in vacancy rates at many prisons. compensation and 11 percent above market in First, many of the classifications with relatively wages alone); clinical, counseling, and school high compensation rates also have high vacancy psychologists (found to lead the market by rates. For example, although the compensation 10 percent in total compensation and 5 percent in study shows that in 2023 state social workers led wages ); and healthcare social workers (found to the market, CDCR social workers had a vacancy lead the market by 14 percent in total compensation rate of about 27 percent in 2023—higher than the and 8 percent in wages). Since the 2023 statewide average. Second, despite pay being compensation study, these classifications have largely similar between prisons, some prisons have also had general salary increases and pay bonuses much lower vacancy rates—including a couple with resulting from Coleman court actions. While more rates that comply with Coleman court requirements. recent data is not yet available, it seems plausible, As shown in Figure 7, vacancy rates at prisons based on the magnitude of the gap between state range from 6 percent to 70 percent. This suggests pay and other employers and the recent bonuses that factors unrelated to pay—such as challenging extended to these classifications, that the state still working conditions and a limited pool of providers maintains a lead in these occupations. available—very likely affect the state’s ability to fill mental health vacancies at most prisons. 14 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT vacancies. For example, the Figure 7 action plan estimates that it Mental Health Vacancy Rates Vary by Prison will cost $25 million ongoing to Mental increase pay by roughly 3 percent Health for mental health positions at Vacancy County Prison Ratea CDCR. Those salary costs would directly increase the state’s Lassen High Desert State Prison 69.9% costs for benefits where the Solano California Medical Facility 62.5 Monterey Salinas Valley State Prison 62.4 employer’s cost is determined as Kern North Kern State Prison 57.9 a percentage of pay (often referred San Joaquin California Health Care Facility 56.6 to as “salary-driven” benefits) like Kings California State Prison, Corcoran 54.1 employer contributions to pension Kern Wasco State Prison 53.8 Kings Substance Abuse Treatment Facility and State Prison 51.4 benefits. Although there might be Imperial Calipatria State Prison 48.8 ways to target compensation to the Amador Mule Creek State Prison 48.6 prisons or classifications with the Kern California Correctional Institution 47.6 greatest recruitment and retention Los Angeles California State Prison, Los Angeles County 46.4 Kern Kern Valley State Prison 45.5 challenges, the costs could still be Del Norte Pelican Bay State Prison 45.1 substantial. Furthermore, changes Fresno Pleasant Valley State Prison 39.0 in CDCR pay might have other Sacramento California State Prison, Sacramento 37.3 indirect effects on mental health San Diego Richard J. Donovan Correctional Facility 35.6 San Luis Obispo California Men’s Colony 33.4 care programs operated by other Kings Avenal State Prison 32.8 state agencies such as DSH. Those San Bernardino California Institution for Men 28.4 departments may seek increases in Monterey Correctional Training Facility 27.3 compensation to ensure their pay Madera Central California Women’s Facility 25.5 Sacramento Folsom State Prison 22.1 remains competitive with CDCR— Riverside California Institution for Women 21.3 potentially adding still more costs Imperial California State Prison, Centinela 21.1 to the state. Riverside Ironwood State Prison 21.1 Tuolumne Sierra Conservation Center 19.0 Extending Licensing Madera Valley State Prison 15.3 Solano California State Prison, Solano 13.3 Exemptions to Out-of-State Marin San Quentin Rehabilitation Center 8.5 Licensed Providers Riverside California Rehabilitation Center 5.6 a Average of all mental health vacancies between January 2025 and August 2025. State Licensing Policies Limit Pool of Potential Providers. Licensing restrictions limit the Receiver Examining Pay Increases as number of people that can work as mental health Part of Action Plan. Given the importance of providers in California prisons. Generally, to non-compensation factors in determining vacancy become a mental health provider in California, rates, it is unclear what level of pay increase would a person must obtain a California license. be needed to meaningfully improve recruitment For example, clinical social workers must obtain and retention for mental health positions. However, licensure from the California Board of Behavioral as discussed above, the Receiver will be studying Sciences. This requires meeting the necessary potential pay increases as part of the action plan. education requirements, completing exams, and Depending on the findings of that analysis, the having a sufficient number of hours in the field. Receiver may propose pay increases, which would People that are licensed in other states must apply give the Legislature an opportunity to evaluate for a California license through the appropriate whether they are necessary at that time. licensing board, meet certain requirements, and in Increasing Compensation Can Be a some cases complete further education or training High-Cost Strategy. In general, compensation to become licensed in California. increases can be a high-cost strategy for filling www.lao.ca.gov 15 analysis full AN LAO REPORT State Allows Some Limited Licensing air conditioning. Finally, offering more tele-mental Exemptions for People Working in Prisons. health positions could allow CDCR to recruit staff Under existing law, the Board of Behavioral from areas of the state where there is a larger pool Sciences, which oversees licenses for clinical social of providers available. workers and marriage and family therapists, as State Has Room to Utilize More Tele-Mental well as the Board of Psychology, which oversees Health. Despite these potential benefits, CDCR licenses for psychologists, allow limited exemptions does not appear to be taking full advantage of to licensing for those working in special settings, this option. While CDCR is not allowed to use such as a correctional facility. For example, state tele-mental health services in inpatient settings, law generally allows out-of-state mental health the Coleman court allows up to 50 percent of providers to work at prisons. However, those outpatient providers—those working with the providers must obtain a California license within a CCCMS or EOP populations—to be remote. As of set amount of time of working at CDCR and these September 2025, only 23 percent of outpatient exemptions do not apply to psychiatrists, which are providers are remote. Notably, the Governor’s licensed through the Medical Board of California. proposed 2026-27 budget requests $8.9 million Additional Licensing Exemptions Could General Fund growing to $12.8 million by 2028-29 Expand the Pool of Providers. CDCR could and ongoing to expand tele-mental health services. benefit from recruiting from a wider pool of Under the proposal, 100 existing on-site clinicians applicants, particularly those from out of state would be redirected to tele-mental health. that already hold licenses in their respective The additional resources would fund supervisory states. Removing the requirement that people and support staff (such as the on-site medical with out-of-state licenses obtain a California license assistants that help clinicians during tele-mental could help with these recruiting efforts. Notably, health appointments) and equipment. While this CDCR and CalHR would retain their current roles proposed expansion is laudable, it would increase in identifying qualified recruits and providing the the rate of remote providers roughly to 30 percent— necessary training and supervision to ensure still 20 percentage points below the court allowed people are performing their duties adequately. limit. (For more on this proposal, including some This would help to ensure that the quality of care concerns we have with the amount of resources is maintained. requested, please see the “Tele-Mental Health” section in our brief The 2026-27 Budget: California Expanding Use of Tele-Mental Health Department of Corrections and Rehabilitation.) Expanding Tele-Mental Health Could Help Allowing Tele-Mental Health Staff to Work Address Prison Environment Concerns. Outside of California Could Attract More Tele-mental health could be a particularly useful Providers. Currently, the Coleman court requires tool for providing services at hard-to-staff prisons. tele-mental health staff to provide services Indeed, CDCR has stated that tele-mental health from California. This requirement from the court positions have been easier to hire since it started unnecessarily limits the pool of potential applicants expanding tele-mental health. Because providers to people living or willing to relocate to California. delivering tele-mental health services do not have If the state—working with the court—allowed to be physically present at a prison, this means tele-mental health providers to work outside of that some of the concerns that accompany being California, it could likely attract a much larger pool on-site are addressed. For example, people of qualified professionals. Moreover, California working remotely likely do not face the same often pays mental health professionals more than level of safety concerns that workers on site may other states. For example, CDCR psychologists, experience when walking through a prison and according to the state Auditor, earn between $56 interacting with various incarcerated people. and $85 per hour—well above the average hourly Additionally, they can have more privacy and do not rate paid in other states. According to 2023 data need to work in dilapidated facilities that may lack from the Bureau of Labor Statistics, California is 16 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT the highest paying state for psychologists with the resulting in fewer vacancies. In July and August average hourly wage at $64 per hour, whereas 2025, SQRC’s vacancy rate was 0 percent—well psychologists nationwide earned a median of under the court-ordered 10 percent vacancy rate. $53 per hour (21 percent less). If people in other During a site visit in July 2025, SQRC staff noted states were allowed to provide tele-mental health that retention was high at the prison, and that new services in California prisons, the state might applicants have had to be placed on the waitlist be able to attract qualified candidates living in because of how well staffed the prison is. Staff lower-cost-of-living areas with higher pay, while at the prison have indicated that this improves still allowing them to maintain their residency in the prison’s ability to deliver care, increases other states. This would be further facilitated if morale, and makes the prison a more desirable these candidates were also not required to obtain place to work. California licenses, as discussed previously. Eliminating Excess Clustering in Easier-to-Staff Prisons Inpatient Bed Capacity High Vacancy Rates Can Be a Excess Inpatient Capacity Means CDCR Self-Perpetuating Cycle. High vacancy rates Trying to Fill More Vacancies and Spending themselves might make working at a prison More Than Necessary. As discussed in the undesirable. This is because existing mental health “Inpatient Mental Health Beds” section in our staff typically have increased workload when brief The 2025-26 Budget: California Department there are many vacancies. They may also lack of Corrections and Rehabilitation and shown in the peer and supervisory support to maintain a Figure 8 on the next page, CDCR is operating positive morale. This can mean that vacancy rates 713 inpatient beds in excess of the amount that are already elevated due to the environment projected to be necessary. Operating excess inside prisons become exacerbated, making inpatient beds at this scale costs the state over recruitment and retention especially difficult. $200 million each year and requires that the state As discussed earlier, vacancy rates vary widely maintain many mental health positions more than by prison. This suggests that certain prisons are the projections show are necessary. Moreover, more challenging to staff than others. By continuing maintaining these unnecessary beds means that to place people with mental health needs at the state is required to staff them, regardless of hard-to-staff prisons, CDCR must recruit mental whether people are treated in them, artificially health staff where few are available or willing to inflating the vacancy rate. This makes it more work, contributing to chronic vacancies. difficult for the state to comply with the Coleman Placement of Mental Health Patients in court’s order to reduce mental health vacancies. Easier-to-Staff Prisons Could Help Reduce CDCR Taking Steps to Address Excess Vacancies. If CDCR moves patients from Capacity but Could Go Further. In court filings, hard-to-staff prisons to easier-to-staff prisons, CDCR indicated to the Coleman court that it it would help address the vacancy problem planned to deactivate 249 inpatient beds because in two ways. First, the positions added to the “from September 2024 to present, between easier-to-staff prisons would be more likely to be 40 percent and 48 percent of inpatient beds have filled. Second, reducing the number of patients been empty and unused.” CDCR informed the and vacant positions at the hard-to-staff facilities court that closing such beds would still provide a would mean the mental health staff remaining at sufficient buffer to accommodate fluctuations in those prisons would not be stretched as thin, which the inpatient mental health population in the near could improve retention and, possibly, recruitment term. These efforts to deactivate 249 inpatients at those prisons. The benefits of operating a beds are laudable. At the time of this publication, prison in easier-to-recruit areas can be seen at the mental health Receiver had approved CDCR’s SQRC in Marin. SQRC has had more success in request to close 100 excess inpatient beds and was hiring mental health staff than most other prisons, deliberating on whether to deactivate additional www.lao.ca.gov 17 analysis full AN LAO REPORT Figure 8 excess inpatient beds. However, based on the Department Has More most recent projections, even if the Receiver Inpatient Bed Capacity Than Needed allowed all 249 beds to be closed, it would still leave 464 excess inpatient beds in 2026-27. Therefore, it seems reasonable that the state could go further in deactivating additional excess beds. This option could result in about $200 million in less spending to support the 713 beds if these Excess Capacity beds were eliminated. In addition, this could reduce 713 the mental health vacancy rate. For example, Beds Needed in court documents, CDCR estimated that the 1,317 staff fill rate for ICF and APP beds in June would have been 98 percent for psychiatrists (instead of 81 percent), 73 percent for psychologists (instead of 52 percent), 105 percent for social workers (instead of 82 percent), and 127 percent for recreational therapists (instead of 101 percent) had all 249 inpatient beds been deactivated that month. RECOMMENDATIONS CDCR’s actions and the mental health Receiver’s influence vacancy rates, (3) the mental health proposed actions include promising efforts to Receiver plans to reassess whether further changes address vacancies. For example, the creation of in pay are necessary, (4) various other efforts are new classifications is a promising step as it would underway to improve recruitment and retention, and allow treatment to be provided by potentially (5) increasing compensation is a relatively costly easier-to-recruit, lower-cost positions. In addition, strategy compared to other options we assess. the Receiver’s plan would also increase the pool As a result, we recommend the Legislature not of people that can provide services to the mental provide significant across-the-board pay increases health population by expanding clinical internship for mental health staff at prisons in the near term. slots across the prisons. Not only will interns Instead, we recommend such pay increases be perform work while part of the program, but it considered only if the other recommendations is also possible that they will become employed described below and those initiated by CDCR and permanently by CDCR. However, the plans put the Receiver prove insufficient, or if the Receiver is forward by CDCR and the Receiver could go further able to demonstrate the need for and effectiveness in addressing the barriers to filling vacancies. of further increases to support recruitment and Below, we provide recommendations for the retention. However, smaller pay increases, such as Legislature—some of which need coordination with cost-of-living increases, or increases targeted at the Receiver and the Coleman court to implement— specific geographic regions, or providers working as it seeks to address the chronic mental health in specific settings, may still be appropriate in the vacancies facing CDCR. near term. Assess Effectiveness of Other Steps Before Eliminate the Requirement for Licensed Considering Across-the-Board Pay Increases. Out-of-State Providers to Get California We found that (1) most mental health classifications Licenses. We recommend expanding the licensing appear to be relatively well paid compared to exemptions so that all out-of-state mental health the broader market even before recent bonuses, providers already licensed in their respective state (2) other non-compensation factors appear to no longer need to acquire a California license to 18 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT work at CDCR. This exemption would eliminate Ask Court to Allow Tele-Mental Health the requirement for out-of-state mental health Providers to Work From Out-of-State. We providers to obtain California licenses within a set recommend the Legislature direct CDCR to request amount of time of working at CDCR. Extending that the Coleman court remove the requirement the exemption to all mental health providers would that tele-mental health staff work in California. also allow other out-of-state providers who do This would open up a potentially large pool of not already have exemptions under existing state new applicants who are interested in working for law—such as psychiatrists—to provide services if CDCR but would prefer not to move from their they are already licensed in another state. We also current location. Additionally, these applicants recommend directing CDCR to recruit more from could be particularly motivated to apply given that out of state. To the extent feasible, similar strategies CDCR pays more than many other out-of-state could be employed to recruit people qualified to jurisdictions. These factors, combined with our work from other countries in cases where those recommendation above to waive the need to countries’ licensing requirements are sufficiently obtain California licensure, would likely increase similar California’s or other U.S. states. The fiscal the pool of potential staff who could work at cost of these changes would be minimal and likely CDCR to provide mental health services. CDCR absorbable, depending on how CDCR pursues would have to explore strategies to effectively greater out-of-state recruitment. manage such remote workers. We expect the Increase Use of CDCR Tele-Mental Health cost of implementing this option would be largely to Maximum Court-Approved Levels. We covered by the cost of expanding tele-mental health recommend directing CDCR to increase the use discussed above. of tele-mental health up to the maximum levels Require CDCR Report on the Feasibility approved by the court. This could attract qualified of Concentrating Mental Health Population professionals who might not otherwise want in Prisons That Are Easier to Staff. Given that to work in a prison setting, as well as allow the it appears easier to recruit and retain mental state to recruit from areas where there are more health staff at some prisons relative to others, we providers available. One way to implement this recommend requiring CDCR report on the feasibility strategy would be to assign tele-mental health of concentrating—or clustering—the mental health staffing to as many CCCMS patients as possible population at the prisons where it is easiest to before moving to EOP patients, given EOP patients’ recruit and retain staff by January 10, 2027. In the greater acuity. Deploying such a strategy could also report, CDCR should consider whether the lower include identifying prisons that face the greatest vacancy rates at certain prisons are a result of staffing challenges and utilizing a greater share those prisons being easier-to-staff and not the of remote workers at those facilities. The cost of result of other factors that could be temporarily increasing tele-mental health to the maximum level affecting the vacancy rate. Clustering the mental allowed would be unlikely to exceed $30 million in health population together could help address annual ongoing costs in addition to funding for the various challenges. For example, it could (1) make it Governor’s proposed 2026-27 tele-mental health easier to recruit staff located in areas with a wider expansion. These costs would come primarily pool of applicants, (2) reduce the need for mental from buying equipment and having sufficient on health staff at locations with large vacancies, and site medical assistants. CDCR, in coordination (3) reduce the competition for mental health staff with CalHR, may need to use pay differentials among adjacent facilities. There could be various for those who work inside prisons so that such logistical difficulties with doing this on a large providers have an incentive to remain on site. This scale. For example, prison infrastructure could be a would result in an additional fiscal cost to the state. limiting factor, as some prisons in easier-to-recruit Given that CDCR reports having more success in areas may lack the appropriate space to house hiring tele-mental health providers, we expect this more mental health patients (such as sufficient expansion to reduce vacancies in the long run. housing units with medication distribution rooms www.lao.ca.gov 19 analysis full AN LAO REPORT to house the EOP population). Additionally, CDCR deactivations. We recommend that CDCR request places people in prison based on a host of factors 464 further deactivations so that capacity better beyond their need for mental health, such as aligns with the bed need study. This would allow the medical, rehabilitation, and security needs. Some state to reduce CDCR’s mental health funding by prisons in easier-to-recruit areas may not be able over $200 million if all 713 currently empty beds are to serve all of these other needs of some patients. deactivated without resulting in adverse effects to Moreover, it would be important to move patients actual staffing or mental health services available to and positions between prisons so that vacancies the incarcerated population. A reduction in inpatient and workload do not accumulate at prisons beds would also reduce the number of vacancies receiving patients in a manner that harms retention CDCR needs to fill to comply with the Coleman or recruitment at these prisons. Therefore, having court’s orders. Moreover, it would allow existing a report that explores the feasibility and costs of clinicians to be reassigned to fill vacancies at concentrating the mental health population in the other prisons. This would help to reduce the strain easiest to recruit prisons would better position vacancies create on the staff at those prisons— the state and the Legislature to know what the likely improving morale, recruitment and retention. challenges of such an approach are. The report Require CDCR to Regularly Adjust Inpatient should also consider how clustering could work Bed Capacity. To ensure excess capacity does with expanded tele-mental health strategies, such not accumulate in future years, we recommend as those discussed above. For example, the report directing CDCR to regularly seek adjustments to should consider the extent to which outpatient the inpatient mental health bed capacity based on populations could remain in hard-to-staff prisons the bed need study carried out biannually. To the but be serviced with tele-mental health to a extent the mental health Receiver denies a plan to greater degree. deactivate excess bed capacity, we recommend Direct CDCR to Continue to Seek Further the Legislature request from the Receiver what Alignment With Bed Need Study. The Coleman criteria, threshold, or buffer the state would have court has referred CDCR’s request to deactivate to achieve in order to deactivate some, if not all, a total of 249 inpatient beds to the mental of the excess capacity and direct CDCR to make health Receiver, who has so far approved the changes accordingly. deactivations of 100 beds and is deliberating further CONCLUSION Chronic vacancies among mental health staff health and reducing barriers created by licensing in the state’s prison system are a long-standing requirements. We also recommend directing CDCR challenge that pose a significant risk to the to further right size its inpatient capacity and wellbeing of the incarcerated population. As a develop plans to shift its mental health population result, the Coleman court has appointed a mental to locations that would facilitate filling mental health health Receiver to take control of the delivery of positions. Taken together, these steps will help the mental health services. However, the Legislature state better recruit and retain mental health staff. can continue to exercise oversight in this area This, in turn, could reduce the use of costly registry to ensure the state is progressing toward the staff and will allow the state to better meet its benchmarks specified by the courts. Accordingly, constitutional requirements, lead to more effective we provide a series of recommendations that would care, and help return the mental health system to further increase the pool of potential mental health state control. staff by expanding existing efforts in tele-mental 20 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT www.lao.ca.gov 21 analysis full AN LAO REPORT 22 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT www.lao.ca.gov 23 analysis full AN LAO REPORT LAO PUBLICATIONS This report was prepared by Orlando Sanchez Zavala, and reviewed by Drew Soderborg and Ross Brown. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, California 95814. 24 LEGISLATIVE ANALYST’S OFFICE