February 25, 2024

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

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For decades, thousands of Californians struggling with mental health and addiction languished on the streets. Now voters will decide whether a March 5 ballot measure is the solution to get them the care they desperately need.

Proposition 1, the only statewide measure up for a vote, would provide nearly $6.4 billion in bonds for more than 11,000 new treatment beds and homeless housing. The bipartisan measure would also use money already in the mental health system to expand intensive care programs and build supportive housing, potentially leaving less money for early intervention or other services. It would do both without raising taxes.

Proponents of Proposition 1 acknowledge that it would help only a fraction of California’s estimated 181,000 unhoused residents. But they say the measure mainly targets homeless people with the highest needs — those voters are most likely to see wandering in traffic or not yelling at anyone.

While disability rights advocates and some local officials have expressed concerns about the prospect of more involuntary detentions and changes in mental health funding, Proposition 1 has broad support from both Republican and Democratic state lawmakers, who are pushing the measure amid increasing public sent pressure to voters. to get a handle on homelessness. They describe Proposition 1 as the centerpiece of an ongoing overhaul of mental health care aimed at getting more people with serious mental health disorders into treatment.

“We have created more flexibility, more tools, more responsibility and more resources,” said Governor Gavin Newsom. “Now we need more beds.”

What would Prop. 1 exactly?

The measure would allow the state to issue $6.38 billion in bonds to add an estimated 6,800 beds for people needing mental health or addiction treatment, in hopes of addressing a bed shortage that is also spreading nationwide extends. Including state hospitals, California currently has an estimated 21,000 psychiatric beds. Prop. 1 would also fund approximately 4,350 homeless housing units, with approximately 2,350 set aside for homeless veterans.

Counties could use the money to build or expand a range of treatment centers, from long-term residential care centers for people in more stable condition to closed-door clinics for those in crisis. New housing projects would have on-site services to connect residents with mental health or drug counseling.

While the additional mental health beds would not be specifically for the homeless, the overarching goal is to help people with the most serious conditions 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.

Still, experts say people with serious conditions make up a minority of the unhoused population, making it clear that the state must also continue investing in housing if it hopes to end homelessness.

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

The bond money would be distributed through project grants, which counties would apply for. According to a report from the Legislative Analyst’s Office, the bonds would cost the state an estimated $310 million a year over 30 years, less than half a percent of projected general fund revenues.

Proposal 1 would also require counties to spend 30% of the money they receive from the voter-approved Mental Health Services Act (a state tax on millionaires) on rent subsidies and supportive housing, including for the homeless. Mental health taxes generate about $1 billion annually.

Additionally, counties would be required to direct 35% of that money to those with the most critical needs. For some provinces, this could mean money being diverted to programs to help people with milder symptoms. The measure would also transfer about $140 million each year from counties to strengthen the state’s mental health programs.

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

Supporters of Proposition 1 blame the closure of many major psychiatric hospitals in California starting in the 1960s for the overburdened mental health system it has today.

The closures were part of a statewide movement to “deinstitutionalize” people with mental health issues and other disabilities. That effort culminated with then-Gov. Ronald Reagan signs the Lanterman-Petris-Short Act, which sets strict limits on the extent to which people can be involuntarily committed.

The state now faces a shortage of about 7,730 treatment and 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.

Still, Oakland Mayor Sheng Thao said adding beds would ensure local officials are able to “bring in those who can’t make decisions for themselves, because of whatever situation they’re in, and give them the opportunity to take their lives.” lead in a dignified manner.”

To force more homeless people into treatment, Proposition 1 advocates point to two recent reforms that are being 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 require certain homeless people to participate in mental health programs. The second is a state law that went into effect this year that changes conservatorship rules to force more homeless people who can’t meet their basic needs into involuntary care.

What are the arguments against proposal 1?

Disability rights groups argue that the measure and accompanying mental health reforms represent a potentially dangerous regression from 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 even more unsustainable debt as it already struggles to balance its budget.

At the same time, local officials are concerned that the changes to Mental Health Services Act funding could lead to cuts to some existing mental health programs and staff in the province.

Susan Ellenberg, chair of the Santa Clara County Board of Supervisors, worries that less money for programs to treat residents’ mental disorders before they become severe 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?

Proposal 1 has received support from several business, labor, construction and health care groups, including the Service Employees International Union and Kaiser Permanente. By January 24, donors 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. Proposal 1 needs a simple majority to pass.

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

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

“She probably wouldn’t have been in favor of that at all and said she’s being locked up,” Monroe said, “but at least she would still be alive.”

2024 MediaNews Group, Inc. Distributed by Tribune Content Agency, LLC.

Quote: Can a $6.4 billion mental health ballot measure solve homelessness in California? (2024, February 12) retrieved February 12, 2024 from https://medicalxpress.com/news/2024-02-billion-mental-health-ballot-california.html

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