Santa Clara County is struggling to retain its behavioral health workforce.
A recent report from the University of California, San Francisco examines the gaps in the county’s Behavioral Health and Services Department. It shows that between February 2024 and February 2025, 28% of behavioral health workers employed by the department and contracted agencies are no longer working for the county. The reports points out that patients are struggling to get appointments due to a shortage of psychiatrists. In addition, workers are dealing with burnout due to staffing shortages. But the county has made improvements since it declared a mental health crisis in 2022.
The report recommends the department focus on recruitment and retention, in addition to partnering with educational institutions to improve opportunities in mental health education. At the Nov. 4 Board of Supervisors meeting, District 4 Supervisor Susan Ellenberg directed staff to come back in September 2026 and provide responses to all recommendations from the report.
“I believe prioritizing culturally competent providers stands out as essential,” Ellenberg, who led the effort in directing county workers to tackle the mental health crisis, told San José Spotlight. “At the same time, we must ensure we have a strong, supported workforce that can meet the diverse needs of our clients.”
Ellenberg recognizes it’s not just a one way street and workforce needs can’t be ignored.
“The report’s call to improve mental health support for our own employees is vital because our workforce can only care for the community if they also have the tools and space to care for themselves,” she said.
Workforce shortage
There are about 12,000 behavioral health workers in Santa Clara County and 1,400 workers in the behavioral health department’s service network. The report shows there is an overall adequate number of mental health and substance use providers, but a shortage of psychiatrists. Only 21% of clients were able to book their first non-urgent appointment within 15 business days and only 33% were able to book an appointment within seven days of hospitalization.
A separate report from the California Future Health Workforce Commission warned of a “severe and growing” shortage across the behavioral health field, including psychiatrists, therapists, social workers and substance use counselors, according to KFF Health News. The workforce commission estimated the state will need 527 first-year psychiatry residents annually from 2025 to 2029. In 2025 the number of first-year enrollees was only 239, or about 45%.
The UCSF report estimates the county behavioral health department will need an additional 137 in-network mental health and substance use providers by 2030 if clients continue to grow at the same pace as previous years.
Out of the 22 recommendations in the report, the department has completed or is in the process of implementing 17. A department spokesperson said they are working to complete an implementation plan before publicly sharing details.
The department has been developing a pipeline of behavioral health care workers, starting with Andrew P. Hill High School students. The county also plans to hold a summer career institute in the next fiscal year.
Rather than hiring more psychiatrists to address the shortage, the department is focusing on maximizing available hours and matching patients to the appropriate level of care due to budget challenges, a county spokesperson said.
The behavioral health department has also implemented bonuses for 90 employees who signed on over the past three years. It has also implemented wellness programs aimed at reducing burnout, pay differentials for hard to recruit roles and career pathways for interns, the spokesperson said.
“(The county also promotes) the state’s BH-CONNECT program, which provides financial incentives to encourage long-term commitment to the public behavioral health sector,” the spokesperson told San José Spotlight.
In 2022, Ellenberg and Supervisor Otto Lee declared a mental health crisis in the county due to the lack of treatment beds and called for more investment and a coordinated response to the problem. Since then, the county has added 260 beds, including 53 acute inpatient psychiatric beds at for-profit San Jose Behavioral Health. This allows the county to serve nearly 2,850 more residents each year, according to officials.
“We really have focused for the last couple of years primarily on bed development, which is critical,” Ellenberg said at the Nov. 4 board of supervisors meeting. “But obviously, without a workforce to staff both inpatient beds and outpatient treatment, we can’t provide those services.”
Ellenberg said as the county continues to build capacity, workforce development will become increasingly challenging due to federal cuts that have strained the budget. In addition, the county will receive less money from the state due to changes to what is now known as the Behavioral Health Services Act, after the passage of Proposition 1 in 2024.
The prior proposition — the Mental Health Services Act, approved by voters in 2004 — created a 1% tax on people earning more than $1 million to pay for mental health services. The state normally raises between $2 billion to $3.5 billion each year from this tax, according to the Legislative Analyst’s Office.
However, with the passage of Proposition 1 last year, it shifted more money generated by this “millionaire’s tax” to state programs — from 5% to 10%. As a result, Santa Clara County will lose about $6.6 million each year.
Proposition 1 also changed the way money from this tax will be used, requiring 30% of funding to support housing, primarily for homeless people. This removed the flexibility counties had to spend funds on other mental health services, such as outreach and those in a crisis.
“Despite these financial constraints, we must stay focused on supporting our staff so they can avoid burnout and continue providing high-quality care,” Ellenberg told San José Spotlight.
Contact Joyce Chu at [email protected] or @joyce_speaks on X.