Can a .4 billion mental health ballot measure solve California’s homelessness?

Can a $6.4 billion mental health ballot measure solve California’s homelessness?

Homeless people walk in a homeless encampment along Coyote Creek near Old Oakland Road on May 11, 2023, in San Jose, Calif. (Dai Sugano/Bay Area News Group)

For decades, thousands of Californians struggling with mental health and addiction have been stuck on the streets. Now, voters will decide whether a March 5 ballot measure is the answer to getting them the care they so desperately need.

Proposition 1, the only statewide measure on the ballot, would raise almost $6.4 billion in bonds for more than 11,000 new homeless treatment beds and housing units. The two-part measure would also use money already in the mental health system to expand intensive care programs and build supportive housing, potentially leaving less funding for early intervention or other services. It would do both without raising taxes.

Proposition 1 supporters admit it would help only a fraction of California’s 181,000 homeless residents. But they say the measure primarily targets homeless people with the highest needs — the ones voters are most likely to see wandering in traffic or not yelling at anyone.

While disability rights advocates and some local officials have raised concerns about the possibility of more involuntary detentions and changes to mental health funding, Proposition 1 has broad support from Republican and Democratic state lawmakers, who have sent mass voters amid mounting public pressure. to get a handle on the homeless. They describe Proposition 1 as the linchpin of an ongoing mental health overhaul aimed at forcing more people with severe psychiatric disorders into treatment.

“We’ve created more flexibility, more tools, more accountability, more resources,” said Governor Gavin Newsom. “Now, we need more beds.”

What exactly would Prop. 1?

The measure would allow the state to issue $6.38 billion in bonds to add about 6,800 beds for people who need mental health care or addiction treatment, in hopes of making up for a bed shortage that also stretches statewide. Including state hospitals, California currently has about 21,000 psychiatric beds. Prop. 1 would also fund about 4,350 homeless housing units, with about 2,350 designated for homeless veterans.

Counties can use the money to build or expand a variety of treatment centers, from long-term residential care facilities for those in more stable conditions to closed-door clinics for those in crisis. New housing projects will have outreach services to connect residents with mental health care or drug counseling.

Although the added mental health beds would not be specifically for homeless people, the main goal is to help those with more severe disorders and disabilities, who often end up on the streets.

According to a UC San Francisco survey of homeless people across the state last year, more than two-thirds said they were experiencing mental health symptoms.

However, experts say people with severe conditions make up a minority of the homeless population, making it clear that the state must also continue to invest in housing if it hopes to end homelessness.

“This conversation is focused on a very small subset because those people become more visible when they’re outside,” said Ray Bramson, chief operating officer of Destination: Home, a Silicon Valley homeless solutions nonprofit.

The bond money would be distributed through project grants that counties would apply for. According to a report by the Legislative Analyst’s Office, the bonds would cost the state about $310 million annually over 30 years, less than half a percent of expected general fund revenue.

Proposition 1 would also require counties to spend 30% of the cash they receive from the voter-approved Mental Health Services Act — a state tax on millionaires — on rental assistance and the construction of supportive housing, including for homeless people. The mental health tax raises approximately $1 billion each year.

Additionally, counties will have to spend 35% of those funds on people with the most critical needs. For some counties, that could mean shifting money away from programs to help those with milder symptoms. The measure would also redirect about $140 million annually from counties to strengthen state mental health programs.

Homeless encampment in People's Park on Tuesday, January 2, 2024, in Berkeley, California.  UC Berkeley hopes to build housing on that site.  (Aric Crabb/Bay Area News Group)
Homeless encampment in People’s Park on Tuesday, January 2, 2024, in Berkeley, California. UC Berkeley hopes to build housing on that site. (Aric Crabb/Bay Area News Group)

What else is the state doing to repair its strained mental health system?

Supporters of Proposition 1 blame the closing of many of California’s mass psychiatric hospitals beginning in the 1960s for the overburdened mental health system it has today.

The closures were part of a nationwide movement to “deinstitutionalize” people with mental health problems and other disabilities. This effort culminated with then-Gov. Ronald Reagan signs the Lanterman-Petris-Short Act, which strictly limits when people can be involuntarily committed.

The state now has a shortfall of roughly 7,730 treatment and residential care beds, according to a 2021 study by public policy think tank RAND. That’s about 1,000 more than Proposition 1 promises to create.

However, Oakland Mayor Sheng Thao said that adding the beds would ensure that local officials are successful in “bringing in those who cannot make decisions for themselves, because of whatever situation they are in, and t ‘They are given an opportunity to live their lives in a dignified way.’

To force more homeless people into treatment, Proposition 1 supporters point out that two recent reforms have been phased in across the state.

The first is CARE Court, a new program that allows health care professionals, family members and others to petition judges to order certain homeless people into mental health programs. The second is a state law that took effect this year changing foster care rules to force more homeless people unable to provide for their basic needs into involuntary care.

What are the arguments against Prop. 1?

Disability rights groups argue that the measure and accompanying mental health reforms represent a potentially dangerous regression to the inhumane forced treatment of the past.

Some taxpayer groups say issuing new bonds would inevitably lead to wasteful spending and burden the state with more unsustainable debt as it already struggles to balance its budget.

At the same time, local officials worry that changes to Mental Health Services Act funding could force cuts to some existing county mental health programs and staff.

Susan Ellenberg, president of the Santa Clara County Board of Supervisors, worries that less money for programs to treat residents’ mental health disorders before they become serious could hinder the county’s efforts to prevent homelessness. She also said the changes would require the county to give up $9 million to support state programs.

Who supports the measure?

Proposition 1 has won support from various business, labor, construction and health care groups, including the Service Employees International Union and Kaiser Permanente. As of January 24, supporters had reported raising more than $16 million in campaign contributions, while opponents had raised just $1,000.

The measure appears to have early voter support, with 68% in favor, according to a December poll by the Public Policy Institute of California. Proposition 1 needs a simple majority to pass.

Alison Monroe, of Alameda County Families Advocating for the Seriously Mentally Ill, said the move may have saved Diana Staros, who she cared for as a teenager, from overdosing at an East Oakland laundromat last year at age 28.

Staros was living in a residential home in Oakland when he died. Monroe believes Staros needed more intensive treatment for schizophrenia in a closed-door facility, but she said few such options were available in Alameda County.

“She probably wouldn’t have favored it at all and said it’s closing,” Monroe said, “but at least she’d be alive.”

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