On March 5, California voters will decide on Proposition 1. The ballot measure, backed by Governor Gavin Newsom (D) would see the state borrow billions to fund mental health and substance use disorder treatment, as well as housing and shelter for unhoused people. But various advocates oppose it on the bases that it would expand the practice of forced or coerced treatment, while cutting funding for community-based services that many depend on.
Prop 1 would amend the Mental Health Services Act, passed by voters in 2004. Through a tax on millionaires, that measure raised about $2-3 billion each year that primarily goes to county governments, which have discretion how to use it for mental health-related services. Currently, counties spend 76 percent of this funding on community services and 19 percent on prevention and early intervention for people with mental health issues or at risk of becoming homeless.
Prop 1 would give the state an increased share of this funding. It would also require that counties spend 65 percent of their remaining Mental Health Services Act funds on housing interventions, and just 35 percent on behavioral health services. That would effectively cut the amount counties currently spend on treatment, responding to people in crisis, and outreach to people with mental health or substance use issues.
Meanwhile, Prop 1 would allow the state to borrow up to $6.4 billion in bonds to build 11,150 new dedicated beds and living spaces for unhoused people with mental health and substance use issues. According to the measure, that includes 4,350 housing units, and 6,800 mental health and substance use treatment beds.
Of the total funds, $2 billion would be allocated for local governments to convert hotels, motels and offices into housing, and build new units. These would be reserved for people at risk of homelessness and with mental health or substance use issues, with half set aside for veterans.
The bulk of the funds ($4.4 billion) would go to mental health and substance use treatment. The money would help build mental health treatment centers and recruit and train mental health professionals. The measure estimates that an additional 100,000 people each year would receive treatment, including unhoused people, youth and veterans.
But how many of these people would choose to attend what the California Budget and Policy Center notes would consist of “voluntary and involuntary behavioral health treatment and residential facilities”?
Amid national crises of homelessness, mental health and overdose, there are have been increasing calls for forced or coerced treatment in different parts of the country. Harm reduction advocates oppose this on ethical grounds, when it removes people’s agency and can amount to incarceration, and due to the relative ineffectiveness and potential harms of mandatory treatment.
The push for Prop 1 comes months after Gov. Newsom approved legislation to make it easier to put people into involuntary treatment. And it happens as the US Supreme Court considers a landmark case that threatens legal protection for unhoused people sheltering outdoors; Newsom favors governments having more enforcement power.
Supporters of Prop 1 include not only the League of California Cities, state firefighters union, Veteran Service Agencies, and the National Alliance on Mental Illness, but also the state police and prison guard unions.
“The $6.4 billion of debt would primarily fund forced treatment and institutionalization—not the community-based mental health services and housing Californians desperately need.”
Opponents include some housing, mental health and human rights groups and local service providers. Among them, the American Civil Liberties Union of Southern California has urged its supporters to vote no.
“California’s mental health and housing systems need reform, but the numbers show that Proposition 1 is not likely to have any long-term effect in addressing California’s houselessness crisis, improving mental health systems, or helping alleviate mass incarceration,” said Carmen-Nicole Cox, director of government affairs at ACLU California Action, in a statement.
“Prop 1’s changes to the Mental Health Services Act would force mental health, housing, and substance use disorder programs to compete for funding,” she continued, “and the $6.4 billion of debt it would impose on California would primarily fund forced treatment and institutionalization—not the community-based mental health services and housing Californians desperately need. Californians should vote NO on Prop 1.”
The intial proposal would have funded just housing for people with mental health and substance use needs, Cox eplained, but lawmakers amended the text to allow it to be used primarily to fund inpatient beds and locked residential facilities. Cox described these as “treatment settings that segregate people from their communities and violate their civil rights.”
Patt Denning, PhD, cofounder of the Harm Reduction Therapy Center in San Francisco and a leading proponent of harm reduction psychotherapy, also worries that Prop 1 will double down on involuntary treatment while failing to expaned voluntary and residential treatment. Now retired, she was a mental health provider for over four decades, working with many people experiencing mental health and substance use issues, poverty and homelessness. During those years, many voluntary and “day” treatment clinics shut down, she told Filter, reducing their numbers by roughly half.
“People ask, ‘Why won’t they go to voluntary treatment?’ A lot of people don’t like the treatment we give them.”
The remaining system is incredibly difficult to access, she continued, citing the example of a former patient experiencing a family crisis who spent many weeks trying to get an appointment at an outpatient mental health clinic. “The capacity isn’t there even for someone like her who could navigate the system.”
“It’s insane to keep saying we need more beds and more coerced and involuntary treatment, when we’re not giving people the opportunity for voluntary treatment,” Denning said in relation to Prop 1. “And [people ask], ‘why won’t they go to voluntary treatment?’ A lot of people don’t like the treatment we give them. Even if it’s not coerced, the methods are coercive—you’re not allowed to have a cellphone, to communicate freely, and you have to commit to lifelong sobriety from all drugs.”
“People are voting with their feet in terms of residential treatment,” she emphasized. “They don’t like it, it doesn’t help.”
Besides objections to what it will fund, some community groups also oppose Prop 1 because it would cut funding from services they have provided for many years. The Associated Press spoke with with Tiffany McCarter at the African American Family & Cultural Center in Oroville, which works with at-risk youth to provide after-school programs and counseling; those programs could face cuts under Prop 1. Other providers concerned about their funding include the Hospitality House in San Francisco, which helps unhoused people find jobs, and the 6th Street Center for Youth in Chico which works with vulnerable youth and students.
Rather than Prop 1, Denning supports state and local governments doing more to address rising housing costs in California.
“Housing is the main issue, not even mental health or substance use,” she said. “If we really believe in Housing First to stabilize people, and we provide outpatient treatment at all different levels, the problem will begin to be solved.”
Photograph of tents in Los Angeles in 2023 by Hu Nhu via Wikimedia Commons/Creative Commons 4.0
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