Listening to Californians with Complex Needs: Behavioral Health

As the CalAIM (California Advancing and Innovating Medi-Cal) program’s Enhanced Care Management and Community Supports reach their fourth year since statewide launch in 2022, how are these programs  being experienced by the people they are intended to support? In a major research project supported by CHCF, Los Angeles research firm EVITARUS interviewed 99 people with complex needs and eight focus groups with caregivers across Alameda, Fresno, Humboldt, and Los Angeles Counties.

In the full report, In Their Own Words: What Californians with Multiple Health and Social Needs Say About Their Care, published in June 2025, participants described their experiences with the health care system. This fact sheet reveals how Californians with behavioral health conditions navigate the health care system. Los Angeles research firm EVITARUS conducted in-depth interviews with 99 people with complex needs and facilitated eight focus groups with caregivers across Alameda, Fresno, Humboldt, and Los Angeles Counties.

A Story That Illustrates the Challenge

Consider this participant’s experience: A 31-year-old man in Humboldt County has been homeless and unable to work since a 2019 roofing accident caused traumatic brain injury and severe crush injuries. The brain injury left him with short-term memory loss, while the trauma triggered a relapse into opioid use, unraveling years of sobriety and worsening his posttraumatic stress disorder and depression.

With no stable support system and over nine years of incarceration behind him, he now lives in a tent and travels two hours daily for methadone treatment while experiencing chronic pain, legal uncertainty, and fragmented care. His mental health challenges and substance use history are deeply intertwined.

What he wants most is someone who can help him piece together the health care and services he needs. “I know what I need, I need housing and things like . . . helping me figure out what’s the best route to take in order to get where I’m trying to go.”

Promising Approaches to Better Care

The fact sheet highlights three innovative strategies organizations are using to enhance patient experiences and advance behavioral health care.

• Lay Counselors Bridge Care Gaps. Health care organizations are deploying lay counselors to help deliver integrated care despite ongoing workforce shortages, bringing services directly to people who need them most.

• One-Stop Care. Certified community behavioral health clinics are combining physical and mental health services in single locations, making it easier for patients to access treatment.

• Low-Barrier Entry Points. Some communities are developing systems that prioritize easy access to care. In Santa Cruz County, the sheriff partnered with a local substance use treatment provider to offer sobering services and treatment connections instead of booking people into jail for substance-related arrests.

These patient voices and innovative approaches demonstrate that improving behavioral health care requires both systemic changes and deep understanding of individual experiences. When the actual needs of people are listened to, a system can be built that truly serves California’s most vulnerable residents.