California misfires on a measure for the mentally ill homeless

On Tuesday when they cast their ballots in the state’s primary, California voters will also have the opportunity to weigh in on Proposition 1, a proposal to deal with the mental health issues contributing to the state’s exploding crisis of homelessness.  

California clearly needs to do something.  The Golden State is the poster child for the national tragedy of homelessness.  More than 171,000 Californians are currently homeless, roughly a third of all the homeless people in the United States, an increase of nearly 40 percent in just the last five years. And, while the mentally ill are a minority of homeless people, they are both a highly visible and especially difficult population to deal with. Many represent a danger to themselves and others. 

Unfortunately, Proposition 1 is unlikely to fix the problem. 

Proposition 1 has two key components. First, it would approve a $6.4 billion bond to provide mental health and substance abuse services and housing. Roughly $4.4 billion of this funding would go toward providing resources for mental health and substance abuse treatment, including both short-term facilities and badly needed state psychiatric hospital beds. The number and type of facilities would be determined by the legislature at a future date. 

There is no doubt that California needs more psychiatric beds. In 1980, there were more than 37,000 beds in state mental health facilities. After waves of deinstitutionalization, fewer than 5,500 remain. It is strange, therefore, that the measure directs the remaining $2 billion to fund subsidized housing, half of which would be reserved for veterans. This is odd, given that advocates of Proposition 1 concede that the measure would provide fewer than half the necessary psychiatric beds.

California’s skyrocketing housing costs are undeniably the biggest factor driving homelessness in the state. But the answer lies not in shifting those costs to the taxpayers, but in removing the exclusionary zoning restrictions and other regulatory barriers that limit supply and keep rents high. After all, California has spent more than $20 billion over the last five years to fight homelessness, nearly all directed to subsidized housing. Yet homelessness has increased over that period.   

If the bond measure falls short of what is needed, it at least represents a step in the right direction. More troubling is the second part of Proposition 1, which would revise the 2004 Mental Health Services Act (MHSA) to require counties to spend a greater proportion of allocated funding on housing, employment assistance, and education.  

Currently, counties are able to spend MHSA funds for those purposes, but whether they do so and how much is up to them. Proposition 1 would let the state determine how the funds are spent and would mandate that more be spent on housing and supportive services.  Roughly a third of MHSA funds would have to be spent on subsidized housing and rental assistance. 

This shift would mean that less would be spent on treatment, acute mental health crisis response, and outreach to those who may need mental health care. Community-based mental health programs, voluntary crisis care, and other critical mental health services are all likely to face cuts.

California could end up with less mental health care at a time it needs more.   

In recent years, California has taken small steps in the right direction. It has begun to loosen zoning and other barriers to housing construction. And earlier this month, California began operating CARE Courts, a mechanism that allows family members, mental health providers, and first responders to refer a mentally ill person to a special judicial proceeding that can require an individual to receive treatment for their mental health issues, including institutionalization if necessary. 

Sadly, Proposition 1 seems to be more backsliding than progress.