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Nearly 2 million people are enrolled in Covered California, the state’s version of the federal Patient Protection and Affordable Care Act health insurance, also known as Obamacare.
That includes more than 360,000 enrollees in the Bay Area.
They could be impacted by the major policy bill that President Trump has urged Republican lawmakers to approve. The Congressional Budget Office reported Wednesday that shorter enrollment periods, formula adjustments and paperwork requirements and other changes together would result in millions more people uninsured by 2034 over previous projections.
Between 2021 and 2025, the total number of health insurance enrollments in California increased from approximately 1.63 million to nearly 1.98 million, driven by steady growth in both new enrollments and renewals, with new enrollment rising by 39% and renewals increasing by 19% over the five-year period.
Since 2021, the nine-county Bay Area has seen steady growth in Covered California enrollments through new enrollment and renewals, with total sign-ups increasing across most counties, except Solano County. Overall enrollment in the region rose by 5.9%, from 340,550 to 360,680.
While most counties experienced growth, ranging from 2.8% in Contra Costa to 14.6% in San Mateo, Solano County was the only one to see a slight decline in total enrollment, dropping by 0.6% over the same period.
Alameda County consistently led the region, reaching more than 82,600 total enrollments in 2025, up from 72,050 in 2022. Santa Clara County followed closely, with the most significant overall growth in the region — an increase of 15.5%, from 67,840 to over 80,700 enrollees.
New enrollment rose notably throughout the region. Santa Clara County’s new enrollments increased from 9,860 in 2022 to 15,320 in 2025, while Alameda saw a jump from 10,450 to 14,330. Smaller counties like Marin and Napa also experienced steady gains.
Renewals remained the primary driver of total enrollment, accounting for most sign-ups in each county. Alameda, Contra Costa, and Santa Clara counties recorded the highest renewal counts, with Santa Clara rising from 56,940 in 2022 to 65,390 in 2025.
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Updated on: June 4, 2025 / 3:24 PM EDT / KFF Health News
Millions would lose Medicaid coverage. Millions would be left without health insurance. Signing up for health plans on the Affordable Care Act marketplaces would be harder and more expensive.
President Trump’s domestic policy legislation, the One Big Beautiful Bill Act that cleared the House in May and now moves to the Senate, could also be called Obamacare Repeal Lite, its critics say. In addition to causing millions of Americans to lose their coverage under Medicaid, the health program for low-income and disabled people, the measure includes the most substantial rollback of the ACA since Mr. Trump’s Republican allies tried to pass legislation in 2017 that would have largely repealed President Barack Obama’s signature domestic accomplishment.
One difference today is that Republicans aren’t describing their legislation as a repeal of the ACA, after the 2017 effort cost them control of the House the following year. Instead, they say the bill would merely reduce “waste, fraud, and abuse” in Medicaid and other government health programs.
“In a way, this is their ACA repeal wish list without advertising it as Obamacare repeal,” said Philip Rocco, an associate professor of political science at Marquette University in Milwaukee and co-author of the book “Obamacare Wars: Federalism, State Politics, and the Affordable Care Act.”
The GOP, Rocco said, learned eight years ago that the “headline of Obamacare repeal is really bad politics.”
Democrats have tried to frame Mr. Trump’s One Big Beautiful Bill Act as an assault on Americans’ health care, just as they did with the 2017 legislation. 
“They are essentially repealing parts of the Affordable Care Act,” Rep. Frank Pallone Jr. (D-N.J.) said as the House debated the measure in May. “This bill will destroy the health care system of this country.”
Nearly two-thirds of adults have a favorable view of the ACA, according to polling by KFF, a national health information nonprofit that includes KFF Health News. 
In contrast, about half of people polled also say there are major problems with waste, fraud, and abuse in government health programs, including Medicaid, KFF found.
“We are not cutting Medicaid,” House Speaker Mike Johnson said May 25 on CNN’s “State of the Union,” describing the bill’s changes as affecting only immigrants living in the U.S. without authorization and “able-bodied workers” whom he claimed are on Medicaid but don’t work.
The program is “intended for the most vulnerable populations of Americans, which is pregnant women and young single mothers, the disabled, the elderly,” he said. “They are protected in what we’re doing because we’re preserving the resources for those who need it most.” 
The 2025 legislation wouldn’t cut as deeply into health programs as the failed 2017 bill, which would have led to about 32 million Americans losing insurance coverage, the Congressional Budget Office estimated at the time. By contrast, the One Big Beautiful Bill Act, with provisions that affect Medicaid and ACA enrollees, would leave 11 million more people without health insurance by 2034, according to the CBO’s latest estimates, released June 4.
That number rises to about 16 million when including the Trump administration’s proposed tightening of ACA marketplace eligibility and if Congress doesn’t extend premium subsidies for Obamacare plans that were enhanced during the pandemic to help more people buy insurance on government marketplaces, the CBO says. Without congressional action, the more generous subsidies will expire at the end of the year and most ACA enrollees will see their premiums rise sharply.
The increased financial assistance led to a record 24 million people enrolled in ACA marketplace plans this year, and health insurance experts predict a large reduction without the enhanced subsidies.
Loss of those enhanced subsidies, coupled with other changes set in the House bill, will mean “the ACA will still be there, but it will be devastating for the program,” said Katie Keith, founding director of the Center for Health Policy and the Law at Georgetown University.   
Republicans argue that ACA subsidies are a separate issue from the One Big Beautiful Bill and accused Democrats of conflating them.
The House-passed bill also makes a number of ACA changes, including shortening by a month the annual open enrollment period and eliminating policies from Joe Biden’s presidency that allowed many low-income people to sign up year-round.
New paperwork hurdles the House bill creates are also expected to result in people dropping or losing ACA coverage, according to the CBO.
For example, the bill would end most automatic reenrollment, which was used by more than 10 million people this year. Instead, most ACA enrollees would need to provide updated information, including on income and immigration status, to the federal and state ACA marketplaces every year, starting in August, well before open enrollment. 
Studies show that additional administrative hurdles lead to people dropping coverage, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
“Not only do people drop out of the process, but it tends to be healthier, younger, lower-income folks who drop out,” she said. “That’s dumb because they go uninsured. Also, it is bad for the insurance market.”
Supporters of the provision say it’s necessary to combat fraudulent enrollment by ensuring that ACA beneficiaries still want coverage every year or that they are not being enrolled without their permission by rogue sales agents. Most of the Medicaid coverage reductions in the bill, the CBO says, are due to new work requirements and directives for the 21 million adults added to the program since 2014 under an expansion authorized by the ACA.
One new requirement is that those beneficiaries prove their eligibility every six months, instead of once a year, the norm in most states. 
That would add costs for states and probably lead to people who are still eligible falling off Medicaid, said Oregon Medicaid Director Emma Sandoe. Oregon has one of the most liberal continuous eligibility policies, allowing anyone age 6 or older to stay on for up to two years without reapplying. 
Such policies help ensure people don’t fall off for paperwork reasons and reduce administrative burden for the state, Sandoe said. Requiring more frequent eligibility checks would “limit the ability of folks to get care and receive health services, and that is our primary goal,” Sandoe said.
The 2017 repeal effort was aimed at fulfilling Mr. Trump’s promises from his first presidential campaign. That’s not the case now. The health policy provisions of the House bill instead would help to offset the cost of extending about $4 trillion in tax cuts that skew toward wealthier Americans. 
The Medicaid changes in the bill would reduce federal spending on the program by about $700 billion over 10 years. CBO has not yet issued an estimate of how much the ACA provisions would save.
Timothy McBride, a health economist at Washington University in St. Louis, said Republican efforts to make it harder for what they term “able-bodied” adults to get Medicaid is code for scaling back Obamacare.
The ACA’s Medicaid expansion has been adopted by 40 states and Washington, D.C. The House bill’s work requirement and added eligibility checks are intended to drive off Medicaid enrollees who Republicans believe never should have been on the program, McBride said. Congress approved the ACA in 2010 with no Republican votes.
Most adult Medicaid enrollees under 65 are already working, studies show. Imposing requirements that people prove they’re working, or that they’re exempt from having to work, to stay on Medicaid will lead to some people losing coverage simply because they don’t fill out paperwork, researchers say.
Manatt Health estimates that about 30% of people added to Medicaid through the ACA expansion would lose coverage, or about 7 million people, said Jocelyn Guyer, senior managing director of the consulting firm.
The bill also would make it harder for people enrolled under Medicaid expansions to get care, because it requires states to charge copayments of up to $35 for some specialist services for those with incomes above the federal poverty level, which is $15,650 for an individual in 2025. 
Today, copayments are rare in Medicaid, and when states charge them, they’re typically nominal, usually under $10. Studies show cost sharing in Medicaid leads to worse access to care among beneficiaries.
Christopher Pope, a senior fellow with the conservative Manhattan Institute, acknowledged that some people will lose coverage but rejected the notion that the GOP bill amounts to a full-on assault on the ACA. 
He questioned the coverage reductions forecast by the CBO, saying the agency often struggles to accurately predict how states will react to changes in law. He said that some states may make it easy for enrollees to satisfy new work requirements, reducing coverage losses. 
By comparison, Pope said, the ACA repeal effort from Mr. Trump’s first term a decade ago would have ended the entire Medicaid expansion. “This bill does nothing to stop the top features of Obamacare,” Pope said.
But McBride said that while the number of people losing health insurance under the GOP bill is predicted to be less than the 2017 estimates, it would still eliminate about half the ACA’s coverage gains, which brought the U.S. uninsured rate to historical lows. “It would take us backwards,” he said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is part of KFF, an independent source for health policy research, polling, and journalism.
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I’ve always been a fan of Apple products for every device, from my iPhone to my Mac to my Apple Watch. There’s something safe about sticking with what you know. Though there’s comfort to be found in familiarity, the safe choice isn’t necessarily always the best one.
Playing it safe and sticking with what you know also means you might not be aware of what’s out there that could be a better fit for your needs. When I stepped outside of my comfort zone to try the Google Pixel Watch 3, I learned a few things. Here’s what surprised me most about trying the Google Pixel Watch 3.
Since 2018, I’ve worn my Apple Watch religiously, giving little to no thought to the other fitness watches and trackers out there. As a short person with somewhat petite wrists, something about the Apple Watch always felt a little too clunky (even in the smaller size available). Clearly, it was never uncomfortable enough to make me stop wearing it altogether; otherwise, I would have given up wearing it a long time ago. However, just because something isn’t uncomfortable doesn’t mean a more comfortable option isn’t available.
After wearing the Google Pixel Watch 3 for only a day, it quickly became apparent that it wins the toss-up between these two watches in terms of comfort—the reasons why can be narrowed down to a few key factors. First and foremost, the circular design of the Google Pixel Watch face just works more naturally for me.
There’s something less awkward about it. Once I tried my rectangular Apple Watch on again, I noticed the rectangular design just felt more clunky. Perhaps this may not be an issue for wearers with larger wrists or hands, but if you’re on the smaller size, the circle design is far more comfortable to wear. Although the actual size of the watch faces is quite similar, the shape makes a huge difference in terms of everyday comfort.
I found it easy to forget I was wearing the Google Pixel Watch 3 throughout the day. Reflecting on my Apple Watch, I would immediately take it off when I got home or had completed a workout. In contrast, I found myself wearing the Google Pixel Watch 3 around the house, which also provides a much more accurate daily step count.
Throughout the many years I’ve worn Apple watches, I’ve searched high and low for third-party replacement bands that are thinner and more comfortable than the ones that come with the watch. Luckily, I’ve found a few go-to watch strap brands I love that have enhanced my comfort when wearing my Apple Watch over the years.
However, I found the watch band that came with the Google Pixel Watch 3 to be far more comfortable. The sport band that comes with the watch has flexible comfort and fits well, even on my small wrist. I still prefer the performance loop band (sold separately) for easier on-off access, but both bands are comfortable.
While there are many reasons people choose to wear an Apple Watch, my primary reason for using it is for fitness tracking purposes. I don’t use my Apple Watch for phone calls, text messages, checking emails, or even tracking my sleep very often. I choose to wear it because I enjoy tracking the metrics of my workouts (heart rate, calories burned, etc) and using it to keep track of my daily step count.
With my primary fitness tracking needs in mind, one feature that made the Google Pixel Watch 3 stand out to me above the Apple Watch is real-time step counting. When you start a workout on the Apple Watch, such as an outdoor walk, you can track various metrics, including duration, distance, and pace. Yet, you can’t track the number of steps you have walked within a specific workout from the watch face or from the app. You can only see the number of steps you have walked for the entire day up until that point.
The Google Pixel Watch 3 completely dodges this frustrating issue. Just as you’d expect and desire, you can track your steps on both outdoor and indoor walks in real time, right from the watch face. As an avid walker, I really appreciate this simple yet important feature. While wearing the Google Pixel Watch 3, I found myself more motivated to keep walking as I kept an eye on my step count during every walk.
If you are someone who uses your watch for phone calls, emails, and its many other features, making a switch might not make sense. But if you’re someone who’s focused solely on fitness tracking — or who has noticed fit issues with your current watch (whether it’s an Apple Watch or another device), I recommend evaluating your options the way I did — and the Google Pixel Watch 3 is a solid one.

Some workouts are worth doing, and fitness buffs are raving about the 5×5 workout to maximize strength and hypertrophy. It’s a simple concept, but it might just propel your fitness to the next level and get you over those hurdles. 5×5 is a functional workout that’s been used for decades to enhance athletic performance. Let’s look at the benefits of the 5×5 workout, how to choose the right weight, and the best exercises to include in your routine.
What is the 5×5 workout?
The 5×5 workout involves performing a small selection of full-body compound lifts and strength training moves for 5 sets of 5 reps, such as the bent-over barbell row and the overhead press. It’s similar to a push pull legs routine that stimulates muscle growth. You’ll lift heavy weights without reaching burnout or overworking your muscles. Each day, your session will include one or two lower and upper-body movements, such as a deadlift paired with a row. After the heavy lifting, you’ll typically move on to more isolated exercises that strengthen supporting muscles. You’ll perform the same lifts every week and gradually increase the weight over time.
You don’t always have to complete a high-intensity workout to get results. Low-intensity cardio can also help you build fitness and stamina. When you’re trying to incorporate more cardio into your training schedule, you might be looking for more interesting and different ways to workout. Low-intensity zone 2 cardio is gaining traction in the fitness world, and it turns out there are evidence-based reasons to give it a try. 
What is low-intensity exercise?
Low-intensity exercise refers to physical activity performed at a steady heart rate. You might also have heard this type of exercise referred to as steady-state training or long, slow-distance training. The American College of Sports Medicine reports that low-intensity training involves using 57-63% of your maximum heart rate for about 30 minutes or longer. At this point you’ll be working in the ‘low-intensity steady state’ or LISS as it’s called in sports medicine. 
From weekend warrior to cardio bunny and juice head, you hear gym jargon everywhere. Progressive overload is one of the latest, but this one is worth thinking about. There’s a good reason why fitness trainers, exercise enthusiasts, powerlifters, influencers, and others are discussing this term. When you’re strength training and firing up those muscles, you should consider giving progressive overload a try to maximize your results. Read on to learn more about progressive overload, what it is, why it matters, and how to include it in your strength training workouts.
What is progressive overload?
Progressive overload refers to a specific type of strength training approach where you gradually increase the difficulty or intensity of your workouts over time. This way, you can optimize your results by continuing to challenge your body. 
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After a long legislative session of rallying and endorsing, Katherine Villeda felt displeased to see Connecticut lawmakers fail to expand the state-funded healthcare program, HUSKY Health, for more undocumented residents.
“I’m not surprised,” Villeda said. “It doesn’t take away from the disappointment, because I feel like we were at a really important juncture where I think the state could have decided to strengthen the HUSKY program and ensure that people who are currently on HUSKY… will be secured in their coverage.”
Villeda is the coalition director for HUSKY 4 Immigrants, a group that advocates for the undocumented community to have healthcare access. This legislative session, she was pushing for a bill that would have raised the age of eligibility for undocumented residents up to 26.
Currently, undocumented residents ages 15 and under are eligible to enroll in the HUSKY Health program, an extension that took effect last year.
Villeda said she finds it unacceptable that Connecticut is expanding coverage for undocumented residents incrementally with “arbitrary” cut offs like the current one.
“Why are we randomly cutting, like, not allowing kids to enroll in coverage when they’re in high school so that they can engage in team sports,” she said, “or make sure that we’re setting them up to have healthier futures as young adults?”
She pointed to other states in New England that provide coverage up to adulthood, like Vermont’s Immigrant Health Insurance Plan which covers undocumented youth up to age 19 and Maine’s Children’s Health Insurance Program, which covers children under 21.
Villeda said she’s heard concerns from parents in the community with kids who are going to age out of the program. Community members like them, Villeda said, are committed to seeing the HUSKY program expanded.
“At the same time, I feel very relieved that they didn’t cut the [current] HUSKY program,” Villeda said, considering the federal challenges that state lawmakers are contending with.
Potential harm to undocumented youth with Medicaid cuts
Lawmakers in Washington D.C. are currently considering a package, dubbed the “One Big Beautiful Bill Act”, with serious spending cuts that could impact the HUSKY Health program.
Under the bill, states like Connecticut that provide state health care regardless of immigration status could be punished for doing so, even though the state uses its own funding to cover immigrant health care, not federal Medicaid funding.
Georgetown Public Policy expert Joan Alker said if the current proposal were to pass, the federal government would cut $3 billion of Medicaid funding to Connecticut if it continued the HUSKY Health program. The move would gut half of Connecticut’s Medicaid funding.
Since the HUSKY Health program is completely state-funded, it could be a potential source to pull funding from in order to cover that hole left by clawed back federal dollars.
“I’d be very surprised if Connecticut does not drop those children,” Alker said. “Estimates I have—there’s about 15,000 children under 15 who are covered by the state of Connecticut.”
Representative Jillian Gilchrest, a West Hartford Democrat and House chair of the Human Services committee, said the uncertainty around the federal funding cuts had lawmakers like her focused on “holding the line” on the healthcare coverage for undocumented youth.
“I think the fight is very challenging to expand upon what we have at this moment in our country’s history, when we’re really trying to defend to keep health care for anyone who is undocumented in our state,” Gilchrest said.
Nevertheless, Gilchrest said before cuts can negatively impact those covered undocumented immigrants, she is committed to blocking those efforts from the federal government.
“There’s many of us, including myself, who will be pushing to fight back the federal government trying to involve themselves in how we spend our state dollars,” she said.
The fight for healthcare access carries on
Sonia Hernandez, a community organizer with the pro-immigrant advocacy group Make the Road Connecticut, has family members and friends in her community with children that have HUSKY healthcare coverage. She said they’re worried about what will happen to their kids once they are past the age of 15 if the program isn’t expanded.
“You can’t tell your kids, ‘Don’t get sick after you turn 15,’” Hernandez said in Spanish.
Hernandez said it’s unfortunate that the HUSKY wasn’t expanded this session, but she and her fellow advocates are going to continue “con la lucha”, or “with the fight”.
“We knew that this fight was going to be more difficult than in other years,” she said, “but regardless, we’re going to keep the attitude and positivity to keep fighting. Yes, in some cases there’s fear, but we don’t want that fear to define us and to take away from what we’ve been able to achieve.”
Given that we are still in the first year of President Trump’s return to office, Hernandez said she and her fellow advocates are aware that there will be more challenges ahead.
The fight moving forward will not just be for expansion, she said, but also to make sure the current HUSKY Health program stays the same.
“Independent of our immigration status, we are human beings,” she said, “and one of our humanitarian rights is to have suitable access to healthcare, especially for the most vulnerable who are children and older adults.”
Connecticut Public’s state government reporter, Michayla Savitt, and Frankie Graziano, host of the politics show “The Wheelhouse”, contributed to this report.
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If you’re reading this, you believe in trusted journalism and in learning without paywalls. You value access to educational content kids love and enriching cultural programming.

Now all of that is at risk.

Federal funding for public media is under threat and if it goes, the impact to our communities will be devastating.

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Costs related to opioid use disorder (OUD) can reach nearly $1 trillion per year when factoring in health insurance and uninsured costs, substance use treatment, lost productivity at both work and home and criminal justice.
That estimate is from a secondary research report by Avalere Health, a strategic health care partner that works through advisory, medical, and marketing teams to ensure support, treatment and overall care for every patient. The report found total annual costs related to OUD to be $934 billion nationwide, with most of that, $438 billion, coming from lost employer productivity, followed by employee productivity, at $248 billion.
OUD costs $111 billion annually in health insurance and uninsured costs, as well as $73 billion in lost household productivity. Other costs include criminal justice ($52 billion) and substance use treatment ($12 billion).
But with treatment, those costs can be tamed, the report found. Treatments including behavioral therapy alone save as much as $144,000 per case, while adding additional treatments increases overall cost savings to as much as $295,000 per case when combined with long-acting injectable buprenorphine. Combining behavioral therapy with methadone or sublingual buprenorphine saves as much as $271,000 per OUD case.
Those numbers are significant considering that in 2022, approximately 6.1 million people in the U.S. reported having an OUD, according to the report. OUD is defined as chronic opioid use that causes clinically significant distress or impairment.
The report further found that “appropriate treatment decreases rates of financially motivated and violent crimes.” That’s likely because, as those with OUD become less dependent on the drug, they no longer have the drive to obtain the funds necessary to purchase it.
Yet, “despite the well-established benefits of OUD treatment, individuals with OUD face significant barriers to treatment,” the report notes.
“Barriers to care include physicians’ stigmatizing attitudes and reluctance to treat OUD, inadequate provider training, geographic distances between patients and treatment settings, and social stigma associated with accessing treatment,” the report reads.
In Florida, the report found that OUD costs state and local governments between $200 and $299 per capita, a figure that places the Sunshine State in line with about half the nation. OUD per capita costs are less in Arkansas, California, Georgia, Kansas, Louisiana, Minnesota, Nebraska, South Dakota, Texas, and Wyoming. West Virginia posts the highest cost of OUD, at least $500 per capita. Connecticut, Kentucky, Maine, Massachusetts, Nevada, New Hampshire, New Jersey, Ohio, and Pennsylvania all have costs to state and local governments ranging from $400 to $499 per capita.
Previous research has attempted to quantify the opioid crisis, with the Council of Economic Advisers estimating it cost the U.S. $504 billion in 2015. According to the report, another study found a cost of more than $1 trillion in 2017, while a subsequent study reported a $1.5 trillion price tag in 2020. To put that into perspective, the report notes that the Centers for Disease Control and Prevention estimated the economic toll of heart disease and stroke at $254 billion in health care costs and $168 billion in lost productivity, far more than even the most conservative of the previous estimates on OUD costs.
Report researchers and authors looked at targeted literature to model overall costs and treatment savings associated with OUD at the state and national levels, focusing on outpatient care and involving several stakeholders, including government, private business, individuals and households, society at large, and OUD patients.
The research and report writing team includes Margaret Scott as the principal, research scientist Tim Collins, Senior Associate Gina Krupp, Associate Amanda Sitkowski, Managing Director Michael Ciarametaro, and Associate Principal Chani Seals.
Janelle Irwin Taylor has been a professional journalist covering local news and politics in Tampa Bay since 2003. Most recently, Janelle reported for the Tampa Bay Business Journal. She formerly served as senior reporter for WMNF News. Janelle has a lust for politics and policy. When she’s not bringing you the day’s news, you might find Janelle enjoying nature with her husband, children and two dogs. You can reach Janelle at [email protected].
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Our mental health facilities are often discriminatory and resistant to change, while professionals in the field are overburdened and underfunded to the point of burnout
Illustration: Chris Bentham
Outside the hallway was dark. I looked down at my hands to find they were shaking. A nurse greeted me as he walked past, flipping up the hood of his rain jacket. 
I followed, pushing open the door and staring out on to the wet road. How was it that a doctor became this way? When had she lost her will for change, her energy to try? Her belief that she could make a difference?
There is a pervasive, singular narrative that seems to resist challenge, one which most of us digest without action: the problem with our mental health service is that it’s underfunded and understaffed.
But this is not the whole picture. A picture that is messy and confronting; uncomfortable enough to make
us look away. Yet, it is a truth that we urgently need to acknowledge if things are to truly change.
Much of my post-graduate mental health nurse training was ‘on the job’, so I scribbled notes constantly. These notes became a means to complain, but also as my way of psychologically surviving. I never intended for those notes to become a book, they were an attempt to make sense of my shock and disbelief at what I saw happening to people behind locked doors.
When I began sharing these stories, I realised how profoundly relieved I was that they, too, were furious and saddened and fuelled by hope into action. I wondered if getting these stories into the world could shock people out of their complacency, and encourage others to speak up.
Fragile Minds is not a memoir – it isn’t a book about me. By taking us room by room through a ward, A&E and community team, it is an attempt to counter the systemic silencing of certain voices. The stories I tell are as complex as the messages they contain, and I hope readers are gripped by the woven narrative revealing the human beings behind the labels and titles.
We meet staff who believed they could make a difference, but are worn down by morally ambiguous tasks, impossible workloads and a systemic resistance to change; the patients who are failed by hastily made diagnoses, overreliance on medication, coercion and inconsistency of care and the inspiring individuals struggling for justice. 
The nurse turned to William and, lowering her voice as if speaking to a toddler, said: “It’s just a little tablet… just take it quickly all in one go and then you can see your aunt. Do you understand me?” William looked fixedly at her. I could see his chest rising and falling beneath his T-shirt.
“Yes, I understand you,” he said. “I just don’t agree with you.”
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Through my current work as a therapist and mental health mentor, I know how validating it is for someone to say, “I understand” or “That’s not OK” or “I believe you.” We can feel hopeless and gaslit when we aren’t heard.
I speak to so many people who feel worse about themselves and their prospects after seeing a mental health professional. Who feel unseen or judged, pathologised or dismissed. Who feel they are broken. Coupled with this, they worry it is their fault the professional didn’t understand, didn’t really help, rather than questioning the system or care they’re receiving.  I speak to trainees and professionals who are interrogating their experiences, asking; “Is there something wrong with me if I feel uncomfortable working like this?” 
Through the stories in Fragile Minds, I want to bolster those asking questions and demanding more, both the survivors of poor treatment and the staff who resist the pressure to conform.
It’s not a narrative that laments how our service just needs better funding, it asks more complex questions about whether our whole systemic approach to treating mental ill-health is working.
Mental distress and ill health are not the same as a broken leg. We cannot get fully well without considering that our distress contains meaning. Distress tells us something about our lives. A ‘symptom’ is threaded through with personal narratives, traumas, losses, fears, the societal barriers and discriminations that have plagued us.
If we are aided early on to explore and acknowledge these threads, to heal from them, distress can be a map which enables us to live differently. Despite my ambivalence towards not continuing within psychiatry, I now feel honoured to work alongside individuals both with and without a diagnosis, helping them to validate and make sense of their own narrative. 
Because in mental health, the ‘expert’ is not the clinician in the white coat or the cardigan, it is you. ‘Madness’ and emotional distress can and should be temporary. It is a meaningful crisis filled with the potential for change, for hope.
We are not getting well, and our system isn’t working. I hope that Fragile Minds furthers our understanding, empathy, and ability to effect change.
Fragile Minds by Bella Jackson is out 3 July (Transworld, £20). You can buy it from the Big Issue shop on bookshop.org, which helps to support Big Issue and independent bookshops.
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