Mental health advocates warn of cuts to services if California Proposition 1 passes

By | March 4, 2024

There is only one proposal on the ballot for California’s March 5 primary, but it’s a $6.4 billion question.

Proposal 1 asks voters whether to approve billions in funding to build new inpatient and outpatient mental health and substance abuse treatment centers, and housing options for veterans and the homeless.

But that’s not all Prop. 1 does.

The ballot measure also asks voters whether to approve a restructuring of the state’s Mental Health Services Act (MHSA) funding, which comes from a 2004 millionaire tax that would bring an estimated $140 million in county funding to the state shifted.

The measure has been championed by a coalition of Democratic leaders, including California Governor Gavin Newsom, and by members of the law enforcement community.

But county officials and mental health advocates are sounding the alarm about the consequences if Prop. 1 becomes law.

Why are mental health advocates against this measure?

Advocates like Karen Vicari, director of Public Policy for Mental Health America in California, who advocates for mental health care and opposes Prop. 1, believe this will lead to less, not more, money going to vital services.

“We don’t believe this will increase access to mental health care, it will decrease access to mental health care,” Vicari recently told The Bee.

Specifically, the restructuring of MHSA funding will “divert significant amounts of money away from primarily upstream mental health services.”

That includes cuts ranging from 30% to 50% on voluntary outpatient, peer-run and community-based treatment programs, according to the American Civil Liberties Union of Northern California.

That includes prevention and early intervention services that aim to keep people from ending up in difficult circumstances and are “incredibly effective at keeping people out of involuntary care,” Vicari said.

Instead, funding from Prop. 1 go to people who are already in crisis, something Vicari called “a healthcare system that fails first.”

“The people who are going to be left out are the people with mild to moderate mental health issues and the people who have already been stabilized,” she said.

Mayor of Sacramento Darrel Steinbergwho authored what became the MHSA while still in the Legislature, spoke to The Bee on behalf of the Yes On Proposition 1 campaign.

He acknowledged that, yes, Prop. 1 would shift funding away from programs like what Vicari described, but as MHSA’s original champion, he said this ballot measure is about recognizing the original intent of the law.

“Change is hard, but sometimes change is necessary,” he said.

Steinberg said that while the provincial programs were worthwhile, he believes the MHSA money “should be targeted to the people who are sickest.”

What types of programs would be eliminated if Proposition 1 passes?

In addition to early intervention and prevention services, other community programs that could disappear if funding shifts to the state’s top-down approach include culturally specific services that target hard-to-reach culture groups, Vicari said.

“So if we cut those services, it’s really going to have a disproportionate impact on different racial and ethnic groups,” she said.

Vicari provided The Bee with a list of services in Sacramento County that would face the most severe cuts under Proposition 1, including mobile crisis support teams, suicide prevention and outpatient services.

Other services in the Sacramento area that would see cuts include the Adult Psychiatric Support Services Clinic and the Community Outreach Recovery Empowerment Program, which serve more than 7,500 people at any one time; the Wellness and Recovery Program, which serves more than 2,400 people; Children’s Community Mental Health Services, which serves more than 9,500 people annually, and the Mental Health Urgent Care Clinic, which serves 7,800 people.

Steinberg disputed that funding for these programs will simply disappear. He said there are now revenue streams that didn’t exist when the MHSA first went into effect. Programs like California Advancing and Innovating Medi-Cal (CalAIM) can replace funding streams for those programs that would lose funding if Prop. 1 is adopted, Steinberg said.

“Instead of having one initiative, try to provide funding for everything,” he said.

But won’t this measure help house the homeless?

It’s true that Proposition 1 would direct about $2 billion in funding to converting abandoned hotels into housing for the homeless, as well as building new housing.

Supporters of the measure say it will result in significant housing options for the unhoused population, as well as for those at risk of losing their homes.

“It’s not just about the net number of people currently on the streets, it’s also about the people at risk of homelessness,” he said.

But critics of the measure, including the ACLU and Mental Health America of California, point to a Legislative Analyst’s Office analysis of the ballot measure, which said the ballot measure would reduce homelessness statewide “by only a small amount.”

And while proponents of the measure say it will help get unhoused people off the streets and into treatment beds, Vicari says that’s not the case.

“You basically have to have a serious mental health problem, and the vast majority of people who are unhoused do not have a serious mental health problem,” she said.

Will this measure encourage people to undergo involuntary treatment?

Nothing in the measure itself concerns involuntary residential treatment.

However, critics of the measure say it will provide the infrastructure for forced treatment.

Although the measure provides more than $4 billion in resources for both inpatient (which is often involuntary) and outpatient treatment centers, the cuts to outpatient services mean that counties will have little incentive to build outpatient facilities.

“Rather than housing, the Proposition 1 bond measure focuses on funding approximately 10,000 psychiatric beds, typically used for involuntary treatment, and creates a funding stream for for-profit, locked-down mental health facilities where people with mental health care needs can receive long-term are placed. term without the right to opt out, consent to, or refuse certain treatments or other fundamental civil liberties,” the ACLU said.

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