Back in April 2024, a 15-year-old girl was found dead in a driveway in San Francisco.
That death led to an investigation that uncovered a hidden truth. For-profit psychiatric facilities in California had been dangerously understaffed. Cutting nurses wasn’t a mistake—it was the business model.
Following the investigation, California Governor Gavin Newsom stepped in with emergency staffing rules that could change how psychiatric care is delivered in the state.
The Investigation
Reports confirmed what psych nurses have known for years.
For-profit hospitals staffed 35% fewer frontline workers per patient than general hospital psych units. They staffed 41% fewer than nonprofit facilities.
Those numbers have real consequences. Patients were left alone for hours. Violence broke out between patients. Emergencies went unnoticed. In some cases, people died because no nurse or aide was there to help.
This wasn’t about one bad hospital. This was how the system operated.
Newsom’s Emergency Order
Governor Newsom is moving quickly and is not waiting years for more studies.
The proposed rules are:
Adult psychiatric hospitals: one RN for every six patients
Adolescent psychiatric hospitals: one RN for every four patients
Every unit must have RN coverage 24 hours a day
If approved, these rules are expected to take effect in January 2026.
Why Staffing Was So Low
The reason is simple: cost.
For-profit hospitals boosted revenue by cutting payroll. Every nurse removed from the schedule made each patient “worth” more money on paper. The people who paid for this choice were the patients and the nurses. Patients received unsafe care. Nurses were left with unsafe workloads.
What This Means for Nurses
For-profit hospitals will now be forced to hire thousands of nurses. This means more jobs, safer working conditions, and likely higher pay. Psychiatric nurses in California currently earn about $97,000 a year, and that figure will likely rise as demand grows.
Nonprofits and general hospitals are already closer to safe staffing levels, but they will now compete directly with for-profits for the same workforce. This gives nurses more leverage in pay and contract negotiations.
Adolescent psychiatric units will see the most growth. Nurses who move into this specialty will likely find the strongest job security and bargaining power.
The Political Fight
Every major reform comes with resistance.
On one side are Newsom, nurses, and patient advocates who argue that safe staffing saves lives. On the other side are for-profit hospitals and their lobby groups, who claim that the new rules will lead to closures and that there are not enough nurses to meet demand.
These arguments are designed to defend the financial model that created the crisis in the first place.
Prop 1 and the Bigger Picture
In March 2024, California voters passed Proposition 1, which approved a $6.4 billion bond to expand mental health services over the next five years. Starting in July 2025, the state will receive about $100 million per year to build behavioral health programs and expand the workforce.
At the same time, new laws are expanding forced treatment. More patients will enter the system. Without proper staffing, the system cannot handle this increase safely.
What Happens Next
Over the next year:
Final staffing ratios will be confirmed in January 2026
Lawsuits from the hospital lobby are expected
Hospitals will begin aggressively hiring nurses
Facilities that refuse to adapt may shut down
In the long run:
Other states may copy California’s approach
Federal standards could eventually be introduced
Psychiatric care in the U.S. could be reshaped for decades to come
Steps for Nurses
If you already work in psychiatric care:
Keep documenting unsafe conditions
Prepare for large hiring waves, especially in adolescent units
Use this opportunity to push for fair pay and manageable workloads
If you work in other specialties:
Follow this process closely—safe staffing laws can spread
Support safe staffing efforts in your field
Consider moving into psychiatric nursing, one of the fastest-growing areas of healthcare
The Bottom Line
This fight is bigger than ratios. It’s about the 15-year-old girl in San Francisco who never came home.
California is expanding mental health treatment. With that expansion comes a responsibility to make sure care is safe and properly staffed. Right now, it isn’t.
Psychiatric staffing ratios are not a luxury. They are a matter of life and death.
Hospitals will resist. But one way or another, psychiatric nurses are about to become some of the most in-demand workers in California.
And that will change everything.