The Brief

Many of the stories LAist covered in 2023 focused on the tragic outcomes that can happen when the mental health care system fails the people who are sickest.

Several families whose stories were reported said they were exasperated from trying to get their loved ones the kind of mental health care they need.

This year, I hope to write more people-driven stories that illustrate where and how the system of care has broken down. In the new year, there will be more state and local resources than ever dedicated to mental health issues.

I’m interested to see if it will be enough to address some of the issues I reported on in 2023.

A look back

In March, I looked at a recent spike in suicides within the L.A. County jail system, and why families continue to decry what they see as a dismal situation for incarcerated people living with serious mental illness.

In April, I wrote about Oscar Leon Sanchez, whose family said he was struggling with his mental health and was in crisis when before he was fatally shot by L.A. police during a crisis.

And in August, I wrote about tagging along with a street medicine team whose leader said they need more help treating unhoused people with mental health conditions where they are.

And then there was the story of the Campos family, who lost their son in an accident on Interstate 5.

Frank Campos was 29 and an artist whose childhood bedroom in Duarte overflowed with charcoal drawings, sculptures he created. Campos also lived with schizophrenia and was on his way from a locked, in-patient facility to a lower level of care in 2021 when he jumped out of the car on the freeway and was hit by a truck.

Before Campos’ death, his family was actively involved in his care. His mother became his conservator so she could guide treatment and medications.

She said she wanted her son to remain in a locked facility so that he could recover, but he was discharged on Feb. 22, 2021 to a lower level of care and was en route when he died.

I talked with Enrico Castillo, a UCLA psychiatry professor, who said Los Angeles has about half the per capita mental health hospital beds than what is recommended by national medical consensus guidelines.

“So many places today are discharging patients with higher and more acute needs than they might have discharged in the past,” Castillo said.

He said hospitals are sometimes “financially disincentivized” to hold people in expensive levels of care. And I heard that the default is to discharge people quickly.

LA County supervisors say thousands more mental health beds are needed.

Looking ahead 

I’ll be interested to see if any of the solutions state and county leaders have introduced will move the needle on how we care for the most vulnerable.

This year saw several pieces of legislation passed that were aimed at getting people help. The new CARE Court program launched in December and will allow family members and others to petition a court to order a care plan for someone with mental health needs. Many families are hopeful it will give them leverage to get a loved one into lifesaving care.

The law says the program is voluntary, but there are still concerns from civil liberties groups who argue the program is too coercive and could strip individual rights.

As always, my goal is to focus on individuals and families struggling to make the mental health care infrastructure work for them in the hopes that it can make a seemingly intractable system easier to navigate.

The Supreme Court ruled Wednesday that the Trump administration must continue providing gender-affirming care to transgender inmates in federal prisons.

The decision, in an emergency appeal, maintains a lower court's injunction on a federal Bureau of Prisons' policy that would terminate hormone therapy and other treatments for trans inmates.

The order offered no explanation behind the decision. It simply read, "The application for stay presented to The Chief Justice and by him referred to the Court is denied."

It also said Justices Clarence Thomas and Samuel Alito would side with the Trump administration and would grant the application for stay.

A federal district judge barred the BOP from implementing its policy this summer.

A second court, the U.S. Court of Appeals for the District of Columbia Circuit, also rejected the administration's request to pause U.S. District Judge Royce Lamberth's order.

That's when U.S. Solicitor General D. John Sauer asked the Supreme Court to intervene.

As the federal judge's injunction remains in place, the legal battle over the policy continues.

Li Nowlin-Sohl, senior staff attorney at the American Civil Liberties Union and a lawyer involved in this case, said the organization believes there are more than 2,000 people in BOP custody who identify as transgender. (The BOP stopped publishing data reflecting transgender inmates after Trump took office in 2025. It only records male or female individuals incarcerated in the federal system.)

Kingdom v. Trump represents 1,000 inmates who have a gender dysphoria diagnosis, Nowlin-Sohl explained. Of those, the ACLU believes there are about 800 who have been prescribed hormone therapy and many who are also receiving social transition accommodations, Nowlin-Sohl said.

In its request for an emergency stay on the earlier rulings, the Trump administration argued that providing this care poses several risks, including for recipients of this specialized care, who it argued would become "targets for attacks." They also said that it raises "fairness concerns" as it would "breed resentment" with other inmates.

Access to gender-affirming care is considered medically necessary to treat gender dysphoria, a medical term used to describe the deep discomfort caused by a mismatch between a person's assigned sex at birth and their gender identity. Without it, individuals can struggle severely with mental health issues such as heightened anxiety and depression, with some turning to self-harm and suicide.

Gender-affirming care can include "...hormone therapy, and gender-affirming surgeries among others," according to the World Professional Association for Transgender Health. (In its filings, the Trump administration questioned WPATH's standards of care, which were developed by experts in transgender health and used by organizations across the world.)

Some people who are transgender may require hormone therapy and gender-affirming surgeries; others may not require any of these interventions.

The BOP has treated people diagnosed with gender dysphoria since at least 1992, the ACLU said in response to the government's filings to the Supreme Court.

"Had BOP's doctors found this treatment unhelpful or harmful to patients or had the agency found that the treatment compromised security, surely BOP would have mentioned it in the administrative record," the ACLU wrote.

This is a "glaring omission" and appears to indicate that the government's arguments now are simply "contrived," the ACLU continued.

NPR previously covered the impact of the loss of hormone treatments on people who are incarcerated. One woman said she experienced severe physical and mental anguish when she lost access to hormone treatments.

The Supreme Court's decision is at odds with other rulings that support the Trump administration's anti-trans policy agenda.

Last June, the court ruled that states can ban transgender girls from participating in sports at publicly funded schools. And in 2025, the court upheld state laws that make it illegal for doctors and other health professionals to provide gender-affirming care for minors.

In one of his first executive orders of his second term, President Trump targeted the trans community with a declaration that his administration recognizes just two sexes, male and female. This order has been the basis for a host of anti-trans policies throughout the administration.

Copyright 2026 NPR

If Proposition 3 looks familiar, it’s because this is the third time the income tax measure has appeared on California ballots. But this time might be the last.

Prop. 3 would permanently extend an income tax on the wealthy to fund schools, healthcare and other state services. It first appeared on the ballot as a temporary tax in 2012 to help schools through the Great Recession, and voters renewed it in 2016. Now, its supporters are asking voters to make it permanent before it expires in 2031.

“I can’t overstate how important this is,” said David Goldberg, president of the California Teachers Association, the state’s largest teachers union and a primary supporter of the measure. “It’s only a tax on the wealthiest Californians, but it’s vital for our schools.”

Prop. 3 would extend a tax on individuals who earn more than $371,000 or couples who earn more than $743,000 annually. It generated between $5 billion and $15 billion a year, fluctuating with the stock market, interest rates and other factors that affect the income of the state’s top earners.

Top earners would continue paying an income tax rate of 12.3% if the measure passes. Tack on the state’s additional 1% tax on income over $1 million for mental health services and California’s highest-earners wind up with an income tax rate of 13.3%, the highest in the nation.

The bulk of the money would be funnelled through the state’s Proposition 98 funding mechanism, which guarantees 40% of the state budget be set aside for K-12 schools and community colleges. If the money surpasses a certain level, the extra would go toward a budget rainy day fund.

Prop. 3 would also pay for healthcare and other services because it frees up money the state would ordinarily spend on schools for other services, according to the Legislative Analyst’s Office. Of the Prop. 98 money, 89% goes to K-12 schools and 11% goes to community colleges.

In flush years, the income tax makes up about 15% of the state’s overall K-12 education budget. If it doesn’t pass, school districts will be forced to lay off up to 50,000 teachers and make other cuts, Goldberg said.

Union’s big push

The teachers union is aggressively supporting the measure. It collected thousands of signatures to win a spot on the ballot and sent members to knock on more than 200,000 doors throughout the state. Goldberg described the campaign as “one of our biggest, most ambitious efforts yet.”

The powerful union as well as other groups have raised more than $40 million to pass Prop. 3. Opponents, which include taxpayer associations, have raised $5,500.

The measure appears to have an edge with voters. According to a Public Policy Institute of California poll conducted in September, 58% of likely voters said they planned to vote yes on the measure. Among Democrats, 82% said they favored it, while 18% of Republicans said they did.

Prop. 3 is not the only tax-the-rich measure on the Nov. 3 ballot. Proposition 40 would levy a 5% tax on Californians with assets of more than $1 billion, with 90% of the money going toward healthcare and the rest divided between schools, food assistance programs and other services. The teachers union opposes Prop. 40 because it argues schools wouldn’t receive enough of the money, Goldberg said.

“We’re not campaigning against Prop. 40. We’re just prioritizing Prop. 3,” Goldberg said.

The union decided to put the measure on the ballot now, more than four years before the current tax expires, because schools typically plan their budgets many years in advance and need plenty of advance warning of significant changes in revenues, Goldberg said.

‘Not sustainable’

Susan Shelley, vice president of the Howard Jarvis Taxpayer Association, questioned whether schools need more money, considering the state’s recent investments and declining enrollment.

“We have fewer and fewer students. Does this mean we need fewer teachers? Maybe it does,” Shelley said. “It’s time to revisit some of these costs. Some districts have unaffordable labor contracts, fewer students … It’s not sustainable.”

In addition, she said, California already has the highest personal income tax rate – 13.3% – in the country. Adding more will only drive the wealthiest residents – and their money – from the state, which will have a disproportionate impact on state revenues, she said. According to the Legislative Analyst’s Office, the state’s top 2% of earners pay about half the state’s income taxes.

California’s K-12 enrollment has declined steadily for at least a decade, with schools losing more than 500,000 students since the mid-2010s. Families are having fewer children, immigration is down and many families have left California because of the high cost of living.

Still, California has among the country’s highest student-to-teacher ratios. In 2022-23, California had one teacher for every 22 students, according to the National Center for Education Statistics. The national average was 1:15. In New York, it was just over 1:11.

That’s why California schools need more money, said Rob Manwaring, senior policy and fiscal adviser at the advocacy group Children Now.

“Those ratios mean that students who need extra help aren’t getting it, which is why we have such a large achievement gap in California,” Manwaring said. “It’s dire.”

He also noted that federal budget cuts will continue affecting California, including its schools, and the state will need revenue to backfill those costs. The chance of an economic downturn in the next few years will also imperil school funding.

“No one wants to project out too far, but schools might see some very tight budgets,” Manwaring said.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.