Rosa Rivas was unaware of Santa Rosa’s location. She’d never needed to. Her world, including her job, her family, and her daughter’s medical history, was in Salinas, on the Central Coast of California. However, Natividad Medical Center did not have any beds available when her 35-year-old daughter, who suffers from schizophrenia, required hospitalization four years ago. No options in the area. A facility located more than 150 miles north was discovered by hospital staff. Since there is only one possible response, Rivas responded in the affirmative. When she could, she went every other day. There, she observed shackled inmates whose mental health requirements had surpassed those of the county jail. She observed what occurs when a system continues to lack both space and a plan.
Supervisors in Monterey County unanimously decided to stop developing a multimillion-dollar Mental Health Rehabilitation Center in Salinas in late March 2026. It was a devastating, uncontested, and clean decision. Rivas, a family advocate in the city where the center was to be constructed, said she felt physically ill and deceived. “Give me another solution,” she remarked later. “Just saying no is not enough.” She is correct. However, there was no other option provided, so the families who are currently riding through a crisis without a nearby facility will continue to do so. Currently, about 100 patients from Monterey County are kept outside the county in state hospitals, locked treatment programs, and board-and-care facilities that are difficult for their families to access. Some of these patients are sent to Santa Rosa, while others are sent more than 300 miles south to Long Beach.
| Category | Details |
|---|---|
| Recent flashpoint | Monterey County, March 2026 — supervisors voted unanimously to halt planning for a multimillion-dollar Mental Health Rehabilitation Center in Salinas, stranding patients and families already lacking local psychiatric bed access |
| Affected patients (Monterey) | Nearly 100 Monterey County patients currently housed outside the county — some as far north as Santa Rosa (150+ miles), others over 300 miles south in Long Beach — in state hospitals, locked intensive treatment programs, and board-and-care facilities |
| Rosa Rivas case | Salinas family advocate; daughter (age 35) diagnosed with schizophrenia 15 years ago; when hospitalization was needed, no local beds were available; daughter placed in Santa Rosa — over 150 miles away; Rivas could visit only every other day |
| Foundational legislation | Lanterman-Petris-Short Act of 1967 — signed by Gov. Reagan; authored by Assemblyman Frank Lanterman and Sen. Nicholas Petris; intended to close state hospitals and replace them with community-based care; the second half was never adequately funded |
| State hospital decline | California state hospital census fell from 37,489 in 1959 to 6,431 by 1975; community mental health infrastructure to absorb those patients was never built at comparable scale |
| Current prison mental health data | 38.2% of California’s 92,000 prison inmates currently diagnosed with a mental illness — approximately 35,157 people, roughly equal to the state hospital census at its 1950s peak |
| Homelessness overlap | California leads all states in homelessness — 180,000 people in shelters or on streets; 47% of the nation’s chronically homeless individuals with a disability live in California, per HUD data |
| RAND finding (2022) | RAND researchers identified severe shortfall in community residential mental health programs — particularly severe in the Inland Empire, Southern San Joaquin Valley, and Central Coast regions |
| For-profit facility expansion | California is increasingly sending people in mental health crises to locked facilities run by for-profit companies — raising serious questions about quality, oversight, and incentive structures for vulnerable patients |
| Lanterman’s own verdict | In 1978, his final year in office, Frank Lanterman reflected: “I have devoted my life to taking care of the mentally ill, the handicapped, the developmentally disabled. And apparently it is coming to a rather sad and confused conclusion.” |
| Current state hospital population | Virtually all 5,800 patients in California’s five remaining state hospitals — plus 3,800 in related facilities — have been committed after committing crimes; original civilian psychiatric patients have no equivalent institutional option |
| What counties cite as resistance | Community opposition (NIMBY concerns), cost, staffing shortages, and political risk — no mechanism currently compels counties to site or open mental health residential facilities even when state funding is available |
Monterey is not the only place with this pattern. It’s a California phenomenon that keeps happening in counties that oppose the construction of new mental health facilities as the populations they would serve become more apparent and desperate. The structural causes are well-known and include staffing shortages, cost pressures, community opposition, and the political calculation that constructing a mental health facility close to a neighborhood is a quicker way to lose votes than to gain them. Less attention is paid to the actual results of the resistance, which include patients being housed far from their homes, families being split apart by distance, and a system that functionally outsources its failures to facilities that no one selected and that no one keeps a close enough eye on.
This has deeper roots than most people realize, and it is worthwhile to consider the past because it makes the current situation seem more like a design flaw that was apparent from the start rather than a policy failure. California passed the groundbreaking Lanterman-Petris-Short Act in 1967, which expedited the closure of state hospitals and guaranteed fundamental rights to individuals suffering from severe mental illness. The goal was to transfer patients from overcrowded, frequently abusive facilities to community-based care. There was never a full commitment of funds to establish that community care. The Republican assemblyman whose name appears at the top of the bill’s title, Frank Lanterman, observed what transpired in the ensuing years and, prior to his departure from office in 1978, described it as reaching “a rather sad and confused conclusion.” He was correct.
The state hospital census dropped from approximately 37,500 in 1959 to about 6,400 by 1975. The infrastructure for community mental health never grew to accommodate those patients. The beds vanished, and there were no substitutes. Over many years, the criminal justice system filled the void. Approximately 35,000 of California’s 92,000 prison inmates, or 38.2% of them, have a diagnosed mental illness. This figure nearly exactly matches the state hospital population at its peak in the 1950s. The hospitals emptied into the streets and jails. With 47% of the country’s chronically homeless people with disabilities, California currently has the highest rate of homelessness of any state. These facts are not unrelated.
In this sense, what’s going on in Monterey County is more of a continuation of something that has been going on since 1967 than a local controversy. Counties oppose the construction of facilities. There is no practical way for the state to force them. Patients are forced to distance themselves from their communities, families, and any semblance of stability. Salinas is located on the Central Coast, which has one of the worst shortages of community residential mental health programs, according to a 2022 RAND study. A facility did not result from that discovery. After years of planning, the county decided to end it with a unanimous vote.
Some of this resistance may be due to actual logistical challenges, such as staffing shortages, high costs, and the need for ongoing operational investment in mental health facilities that county budgets may find difficult to sustain. However, the pattern of opposition in California does not appear to be primarily related to a budgetary issue. It appears to be a political one, with those most negatively impacted by the lack of facilities—those with severe mood disorders, schizophrenia, and psychotic illness requiring long-term supervised care—having the least political clout to protest. Planning hearings are not attended by them. Sometimes their families show up and talk. Nevertheless, the vote takes place.
Watching this play out in California county after county gives the impression that the state is still making the same deal it made in 1967: announce that it will provide care for its most critically ill citizens, create political support for the announcement, and then covertly let the infrastructure remain unbuilt. In his own life, Lanterman witnessed it. Today’s payers are the ones who never had a say in whether the agreement would be upheld.
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