More than two months after California’s new nurse-to-patient staffing ratios for freestanding acute psychiatric hospitals took effect, state lawmakers are pushing regulators to loosen a rule that hospital leaders said has closed beds and destabilized the nursing workforce.
Becker’s has been tracking the fallout from the emergency regulations since they took effect June 1, requiring at least one licensed nurse for every six adult patients and one for every five patients younger than 18 at the state’s 35 affected hospitals.
Here are five updates on where things stand:
1. State legislators are engaged. Sacramento-area Democratic Assemblywoman Maggy Krell gathered signatures from 19 other state legislators from both parties on a letter urging California’s health department to work with stakeholders on reforming the emergency regulations, said Kirsten Barlow, vice president of public policy for the California Hospital Association. The letter calls for changes aimed at reopening beds that have closed and stemming job losses among mental health technicians. “We are very much trying to ensure that our legislature and state leaders know they have an opportunity to direct the state to make some very common-sense changes to the emergency regulations,” Ms. Barlow said.
2. Nearly 70 psych beds remain closed, with none reopened. Becker’s reported in June that 65 beds — roughly half of them youth beds — closed across four California counties in the early days of the ratios’ implementation. As of the most recent data available, that number has remained at just under 70 beds, and Ms. Barlow said she isn’t aware of any hospital that has been able to reopen a unit it was forced to close. “I don’t think we need more time to see how many more hospitals will have to close beds,” she said, adding she doesn’t expect closures to stop soon without changes to the rule.
3. The hospital association is pushing three specific fixes. The CHA wants the state to adopt a 1-to-12 nurse ratio overnight. “Sleep is the most effective intervention you can have, even more than therapy or medication,” Ms. Barlow said. The group also wants RN-supervised mental health technicians and counselors to count toward the ratio. Lastly, it wants the state to drop language requiring the ratio be met “at all times,” even when patients are already under the supervision of other licensed staff, such as during group therapy or meals. Kristen Pace, RN, executive director of behavioral health at Walnut Creek, Calif.-based John Muir Health, said the “at all times” requirement means hospitals must staff extra nurses solely to cover six-hour group treatment, even when nurses have no patients to attend to because those patients are already with other staff. At a 1-to-6 ratio, she said, three additional nurses required just for break coverage translates to 18 fewer patients a hospital can admit.
4. The state has stood up a dedicated inspection unit for psychiatric hospitals — and a hearing on the ratios. For the first time, the California Department of Public Health has created a centralized unit focused solely on evaluating the state’s acute psychiatric hospitals, according to Jesse Tamplen, vice president of acute care transitions and behavioral health services at John Muir. The unit is staffed with reviewers who have nursing or clinical backgrounds rather than general acute care surveyors. The change means all affected hospitals will be reviewed by the same specialized unit rather than through regional offices. Separately, the state health department also held a public hearing July 23, 2026, on the staffing ratios.
5. Turnover concerns persist, and some leaders say media coverage is compounding stigma. Ms. Barlow said the CHA is continuing to hear about “an unprecedented level” of nurses. That includes requesting leaves of absence, taking extended vacation time or resigning outright, driven largely by dissatisfaction with new duties nurses have taken on as mental health technician and counselor positions shrink. Because the ratio must be met at all times, she said, even a single nurse calling in sick can push a unit out of compliance and force a hospital to reduce capacity. Separately, Ms. Pace raised a different concern: that coverage of the staffing crisis is reinforcing public stigma around psychiatric care. “This conversation is focusing primarily on violence and fear … and I feel like we’ve taken steps backwards now in all the progress we’ve made at eliminating that stigma,” she said, adding that framing could discourage patients from seeking treatment and nurses from entering the field. “Now the public has this impression that psychiatric hospitals are inherently unsafe, or people with mental illness are dangerous, and it’s an inaccurate generalization.”
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