Proposition 1 on the March 5 ballot will not help the vast majority of the approximately 180,000 Californians living on the streets, or even the majority of the estimated one-third with serious psychiatric illnesses, substance use problems, or both. It's important to say it up front, because the “Treatment, Not Tents” campaign urging a “yes” vote could leave voters with the impression that the measure offers a much broader solution than it offers to homelessness and inadequate behavioral health treatment.
But it's better to get too few new resources than none. Compared to the cost of doing nothing, Proposition 1 is an important step toward meeting California's responsibility to the most vulnerable homeless people and those housed Californians with behavioral health issues who are most at risk of ending up on the streets. .
It is a valuable addition to other state, local and private investments, and deserves support. The Times urges voters to approve Proposition 1.
The measure has two parts. A state bond would raise $6.4 billion to build desperately needed affordable housing and treatment facilities. The interest would be paid out of the state budget, not any new taxes.
The second part is an amendment to the Mental Health Services Act, the 2004 ballot measure that taxes annual income over $1 million at 1%. The tax would remain unchanged, but revenue would be reallocated with new mandates for counties to spend more on housing and expanded to cover people suffering from addictions and mental illness.
It would increase funding for housing units and treatment beds for people with the most serious mental illnesses and addictions. How big is the increase? It depends. It costs more to acquire property and build in Los Angeles County than, say, Siskiyou County, but the need is greater here.
Many nonprofit providers of mental health care and substance use treatment argue that Proposition 1 could actually decrease available services and even, ironically, drive some patients out of their homes and onto the streets. It is not an idle concern. Counties will have less flexibility in how to spend their allocation, and that could jeopardize a number 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 considered sick enough to qualify under the new mandates, but whose conditions would worsen if they lost their current services.
Advocates argue that counties have resources to replenish funds lost due to new housing mandates, and that's at least partly true. Changes in state law currently underway expand the availability of Medi-Cal reimbursement, for example, for services such as peer support or visits to sober living centers. But tapping into those and other resources will depend on the creativity and diligence of county governments and their mental health departments, and the hundreds of clinics and other care providers that contract with them.
It shouldn't have to be like this. California needs a much larger investment in mental health care, substance use treatment, and affordable housing than Proposition 1 will provide. The bond portion only builds buildings. Changes to the Mental Health Services Act will also help train a larger care and treatment workforce, which is important. But it's also partly a game of hands crossed and fingers crossed, hoping counties will be more efficient.
Thats nothing new. For half a century, Sacramento and all 58 counties have blamed each other for failing to fulfill our collective responsibility to treat and care for the mentally ill and addicted. Proposal 1 will help, but it is not a game changer and tension will remain.
So will the need for more affordable housing. The severely mentally ill people who will be housed and treated under the measure represent just one piece of the broader mosaic of homelessness. But it's an important piece and Californians should implement it.
