San Diego County's public behavioral health system publishes a detailed annual accounting of who it serves and how. Read closely, the FY 2023-24 adult...
Jump to a section
If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or call San Diego County's Access & Crisis Line at (888) 724-7240, available 24/7.
San Diego County's public behavioral health system publishes a detailed annual accounting of who it serves and how. Read closely, the FY 2023-24 adult report tells one story five different ways: the system's front door is the emergency room, and without a middle level of care, too many people cycle back through it.
51%: crisis is the front door
For the plurality of the 45,129 adults served in FY 2023-24, the most common first service was an emergency or crisis service. 51%. Half the system's clients meet it for the first time on their worst day, rather than through a referral, a screening, or a scheduled intake.
65,014, the volume of crisis contact
17,442 clients (39% of all adult mental health clients), used a combined 65,014 emergency/crisis services during the year. That averages nearly four crisis contacts per crisis-involved client: the same people, returning.
4,775: hospitalizations
4,775 adult mental health clients were psychiatrically hospitalized during the year. A hospitalization is the system's most restrictive and most expensive intervention (part 3 of this series prices it against the alternatives, using the state's own rate schedule).
1,310. The 27% who came back
Of those 4,775, 1,310 clients (27%), were hospitalized at least once more within the same fiscal year. The county notes this was the lowest multiple-hospitalization percentage of the past five years, which is genuine progress; it is also still more than a quarter of every hospitalized cohort returning within twelve months, which puts the weight on what follows a psychiatric hospital stay.
159, five or more times
Among the 1,310 rehospitalized clients, 56% were hospitalized twice, 21% three times, 10% four times: and 12%, or 159 people, five or more times in a single year. For this group the hospital is not an intervention; it is a recurring address. High-frequency utilizers are precisely the population step-down levels of care (partial hospitalization and intensive outpatient. See part 1) exist to catch.
What the report says is improving
The same report is not all bad news, and honest accounting includes it: average wait times for psychiatric assessment fell from roughly 11 days in FY 2021-22 to a little over 4 days in FY 2023-24, and the multiple-hospitalization rate is at a five-year low. The system is getting faster at the front end. The gap this series documents is at the back end, in what comes after a psychiatric hospital stay, where people go after stabilization.
One more number: 57%
57% of adult mental health clients carried a co-occurring substance use disorder. Any step-down capacity that treats mental health in isolation will miss more than half of the population that needs it: a design constraint, not a footnote, for the county's new PHP/IOP programs (part 1).
Sources
- UCSD Health Services Research Center, Adult Behavioral Health Services Annual System of Care Report FY 2023-24 (County of San Diego TRL, Section 6).
Reviewed by
Matthew Beck, LMFTProgram Director & Clinical Director
Matthew Beck, LMFT, is Program Director and Clinical Director at Golden Coast Rehab. A licensed Marriage and Family Therapist with more than a decade in substance use and mental health treatment, he oversees clinical delivery, supports staff, and holds the standard of care across programs. He has spent over ten years working directly with individuals and families affected by addiction and co-occurring mental health conditions. His therapeutic approach draws on person-centered, cognitive behavioral, and solution-focused work, meeting clients where they are while building practical tools for the long term. Matthew is open about his own recovery, and that experience informs how he runs a program: accountable, unsentimental about what the work requires, and unwilling to treat people as cases.
Written by the Golden Coast Rehab Editorial Team and reviewed for clinical accuracy before publication.
