California Must Do More to Support Infant and Early Childhood Mental Health and Its Workforce

Infants, toddlers, and young children have unique mental health needs compared to their older counterparts.

While adolescent and teen mental health typically revolves around their day-to-day experiences and life events, the mental health needs of infants, toddlers, and young children center around the relationships they form in their earliest days. The ability of infants, toddlers, and young children to form healthy relationships is crucial for setting up how they will experience, manage, and express their emotions. It is one of the most critical factors determining their overall mental wellbeing in their first few years.

However, because their mental health needs look different, it is easy for their mental and behavioral health challenges to be overlooked. According to the American Academy of Pediatrics, approximately 16 percent of children under the age of six have clinically significant mental problems requiring clinical care early in life. Moreover, the burden of need for mental and behavioral health support is not shared equally amongst all children. CDC data shows that the percentage of children who had received any mental health treatment is highest among non-Hispanic White children. The CDC's data also found that non-Hispanic White children are almost twice as likely to receive mental health services in comparison to their Hispanic and non-Hispanic Black counterparts.

Children from birth to age five require a strong infant and early childhood (IECMH) mental health workforce. IECMH providers play a crucial role in assessing the mental and behavioral health needs of infants, toddlers, and young children. They also provide much-needed support when challenges are identified to ensure healthy emotional, social, and cognitive development during the most formative years of a child's life.

Without a strong IECMH workforce, even when the mental and behavioral health needs of their children are identified, they can go untreated. California is facing an IECMH workforce provider shortage. A report by researchers at the University of California, San Francisco, found that 23 of 58 California counties had fewer than one psychiatrist per 10,000 residents, and 6 counties had no psychiatrist at all. Data from the American Academy of Child and Adolescent Psychiatry found that only two California counties had a mostly sufficient supply of child and adolescent psychiatrists. Meanwhile, most counties suffer from a high to severe shortage of child and adolescent psychiatrists. This data only tells one side of the story.

Most young children who need mental health support would likely seek care from different types of mental health providers like psychologists or licensed clinical social workers. Data exists on the availability of this workforce in California however it is not stratified by the population being served, making it difficult to get a true count of the landscape of infant and early childhood serving mental health providers. More inclusive data must be collected to understand the current provider shortage better, especially as it relates to early childhood.

California has implemented several programs, like the Children and Youth Behavioral Health Initiative (CYBHI), and introduced new Medi-Cal benefits, like the dyadic care benefit, to support the IECMH workforce shortage and better address the mental and behavioral health needs of infants, toddlers, and young children. Yet, the state still has a long way to go if it wants to truly prioritize the mental health needs of California's youngest. In 2024, Children Now ranked California 51st among states for parents reporting it was not possible to obtain mental health care for their child.

Many of the state's new investments focus on children older than age five, and recent changes in mental and behavioral health funding through Proposition 1 and the Mental Health Services Act may impact the availability of community-based prevention and early intervention for young children. Moreover, due to the '23-'24 state budget shortfall, the CYBHI saw its $4.7 billion funding cut by $426 million for the next three years, further exacerbating existing health disparities and challenges families face in accessing much-needed mental health services.

California must be doing more to prioritize the mental wellbeing of our state's infants, toddlers, and young children. Investing in and growing the workforce that can provide crucial support for this group is essential to this effort. Our brief, "The Impact of California's Mental Health Service Provider Shortage: Inequitable Access to Infant and Early Childhood Mental Health Services," details the current provider workforce shortage and presents four actionable policy recommendations the state could take to improve access to mental health services and reduce the inequitable impacts of our current system. The success of California's mental health investments for infants and young children, especially new benefits like dyadic care, rests on having a culturally relevant workforce that can meet this population's needs.