Endorsement: Yes on Proposition 1, a modest step forward on mental health care

Proposition 1 on the March 5 ballot won’t help the vast majority of the approximately 180,000 Californians living on the street, nor even most of the estimated one-third with serious psychiatric illnesses, substance use problems or both. It’s important to say that upfront, because the “Treatment not Tents” campaign urging a “yes” vote could leave voters with the impression that the measure offers a far more sweeping solution to homelessness and inadequate behavioral health treatment than it does.

But better to get too few new resources than none at all. When compared with the cost of doing nothing, Proposition 1 is an important step forward in meeting California’s responsibility to the most vulnerable homeless people and those housed Californians with behavioral health problems most at risk of ending up on the street. 

It is a worthy addition to other state, local and private investments, and it warrants support. The Times urges voters to approve Proposition 1.

The measure has two parts. A state bond would raise $6.4 billion to build treatment facilities and desperately needed affordable housing. Interest would be paid from the state budget, not from any new tax.

The second part is an amendment of the Mental Health Services Act, the 2004 ballot measure taxing annual income over $1 million by 1%. The tax would remain unchanged, but the proceeds would be reallocated with new mandates on counties to spend more on housing, and would expand to cover people dealing with addiction as well as mental illness.

It would increase funding for housing units and treatment beds for people with the most serious mental illnesses and addictions. How big an increase? It depends. It costs more to acquire property and build in Los Angeles County than, say, Siskiyou County, but the need is greatest here.Many nonprofit providers of mental health care and substance use treatment argue that Proposition 1 might actually decrease the services that are available and even, ironically, push some patients out of housing and onto the street. It’s not an idle concern. Counties will have less flexibility over how to spend their allocation, and that could jeopardize a host of urgently needed services such as emergency psychiatric response teams, treatment beds for people diverted from jail and outpatient treatment for people who are not deemed ill enough to qualify under the new mandates — but whose conditions would worsen if they lose their current services.

Proponents argue that counties have resources to backfill any funds lost to new housing mandates, and it’s at least partly true. Changes in state law currently underway broaden availability of Medi-Cal reimbursement, for example, for services such as peer support or visits to sobering centers. But tapping those and other resources will depend on the creativity and industry of county governments and their mental health departments, and the many hundreds of clinics and other care providers who contract with them.

It shouldn’t have to be that way. California needs a much greater investment in mental health care, substance use treatment and affordable housing than Proposition 1 will provide. The bond portion just builds buildings. The changes to the Mental Health Services Act will also help train a larger care and treatment workforce, which is important. But it’s also part shell game and part crossed fingers, relying on counties to be more efficient.

That’s nothing new. For half a century, Sacramento and the 58 counties have blamed each other for failing to meet our collective responsibility to treat and care for the mentally ill and addicted. Proposition 1 will help, but it is not a game changer, and the tension will remain.

So will the need for more affordable housing. The seriously mentally ill people who will be housed and treated under the measure represent just one piece of the larger mosaic of homelessness. But it’s an important piece, and Californians should put it in place.