After days of uncertainty, the results are finally in: Californians, by a slim majority, have voted to throw their support behind Gov. Gavin Newsom鈥檚 latest effort to overhaul how the state cares for people with serious mental illness.
The Associated Press on Wednesday declared that by the narrowest of margins, 50.2% to 49.8%.
The passage of the two-pronged ballot measure will give Newsom funds to fulfill promises he has made while rolling out a series of other in recent years 鈥� more housing, more treatment beds and a concerted focus on unhoused people with serious mental illnesses.
But it leaves the governor鈥檚 critics 鈥� including disability rights advocates and individuals living with mental illness 鈥� worried about cuts to other mental health programs and fearful it will result in the state placing more people in involuntary treatment.
The governor championed Prop. 1, which he has said 鈥渨ill help California make good on promises made decades ago.鈥�
The initiative includes a $6.4 billion bond to pay for treatment beds and permanent supportive housing. It also requires that counties spend more of the mental health funds they receive from a special tax on income over $1 million on services for people who are chronically homeless.
While the ballot measure initially seemed a shoo-in, public support wavered in recent months. In part, that鈥檚 because the state鈥檚 came into stark focus 鈥� with the Legislative Analyst鈥檚 Office projecting last month that it might be as big as $73 billion. Opponents of the ballot measure had also raised concerns that it could siphon money from community mental health organizations, possibly causing some to close.
Public and a multi-million dollar advertising campaign eventually carried the measure to victory 鈥攂ut just barely.
鈥淚t鈥檚 still not a huge vote of confidence,鈥� said Thad Kousser, a UC San Diego professor of political science. He says Newsom failed to convince voters of just how effective other billion-dollar investments in helping unhoused people have been.
鈥淭o me, given the strong message, the money behind the message, the lack of organized opposition, I would have guessed at the beginning of this campaign it was headed for a 60-40 win,鈥� Kousser said.
Nevertheless, it did squeak by. And under the just-approved ballot measure, counties are now required to invest 30% of the money they receive from the state鈥檚 鈥渕illionaire鈥檚 tax鈥� into housing programs, including rental subsidies and navigation services. Half of that will be used to target individuals who are chronically unhoused or living in encampments. Up to a quarter of the money could be used to build or purchase housing units.
The second part of the measure, the bond, is divided into two parts. About $4.4 billion will go toward inpatient and residential treatment beds. The rest is earmarked for permanent supportive housing, half of which would be set aside for veterans.
Darrell Steinberg, the mayor of Sacramento who co-authored the 2004 law that created the millionaire鈥檚 tax, said that, back then, he could 鈥渙nly dream that there would someday be a governor that would make mental illness and fixing the broken system a cornerstone of his governorship.鈥�
鈥淕avin Newsom has done that,鈥� he said.
Gavin Newsom鈥檚 mental health plans
Mental health has been one of Newsom鈥檚 priorities since before he took office. He campaigned for the governorship with big ideas about how might be fixed and, specifically, about how funds from the 鈥渕illionaire鈥檚 tax鈥� for mental health could be better used.
In a 2018 post on Medium months before he was elected, Newsom decried the state鈥檚 lack of commitment to .
鈥淲e fall short because we lack the bold leadership and strategic vision necessary to bring the most advanced forms of care to scale across the state,鈥� he wrote. 鈥淲e lack the political will necessary to elevate brain illness as a top-tier priority. We lack the unity and fervor needed to rally the medical and research communities around an unyielding search for ever-better diagnosis and treatment. We鈥檙e all living with the fallout.鈥�
The need for mental health treatment continued to skyrocket since he took office. The COVID-19 pandemic dramatically worsened the problem. The public experienced escalating trauma and anxiety, while mental health providers became increasingly burnt out.
Meanwhile, the number of unhoused people in the state continued to explode鈥� growing 40% since 2018, the year Newsom was elected, to a current estimate of 181,000.
In response, Newsom has championed a stream of major mental health initiatives. These include:
- A $4.7 billion package of programs for .
- The creation of new court systems to address the needs of people with serious mental illness. They鈥檙e called Community Assistance, Recovery, and Empowerment .
- A new law that makes it easier to force certain people with serious mental illnesses into involuntary treatment. It amended originally laid out in the landmark 1967 Lanterman-Petris-Short Act, which limited involuntary confinement in the interest of protecting the civil rights of people with mental illnesses.
- In addition, his administration is also overseeing the implementation of a statewide effort that promises to expand and streamline access to mental health care for people insured by Medi-Cal, the public insurance program for low-income Californians. It鈥檚 called (CalAIM).
Expecting better outcomes
Sen. Susan Talamantes Eggman, a Stockton Democrat who has carried legislation to enact Newsom鈥檚 mental health programs, said the stream of recent policy changes will eventually lead to changing outcomes 鈥� but not yet.
鈥淧olicywise, the landscape is shifting dramatically,鈥� she said. 鈥淚t will take a few years for practice to catch up.鈥�
She emphasizes that Prop. 1 has a lot of transparency and accountability measures attached, to ensure that the measure leads to concrete change.
But Newsom鈥檚 critics worry that many of his big initiatives 鈥� including Prop. 1, CARE Court and the broadened definition of grave disability 鈥� reflect an effort to move the state toward more forced treatment.
鈥淚t鈥檚 all in preparation of hiding the homeless instead of helping them,鈥� said Paul Simmons, executive director of Californians Against Prop. 1. 鈥淚t will still be a bridge to nowhere, pushing people into a system that can鈥檛 even handle what we have now.鈥�
Questions about Prop. 1
Alex Barnard, a New York University professor who has written extensively about California鈥檚 mental health system, called fears of returning to mass reinstitutionalization 鈥渁 little bit overstated.鈥� But, he said the state is indeed moving toward a more paternalistic and institutional approach toward treating the most seriously mentally ill.
The passage of Prop. 1 will help the administration to fully implement both CARE Court and the recent law expanding the definition of grave disability. But it also raises some thorny issues, he said.
One of these: What type of treatment beds will the state purchase with the bond money and where?
Another: How will county systems deal with the money they stand to lose for mental health services?
A state facing a massive deficit is not coming to the rescue, he said.
And then, there鈥檚 the question of just how transformative this latest influx of money will prove to be for actual Californians.
鈥淭he status quo has been remarkably enduring even in the face of a lot of attempts at reform,鈥� he said. 鈥淭he system has had an incredible amount of inertia.鈥�
CalMatters reporter Jeanne Kuang contributed to this story.