With the passage of Prop. 1, Gavin Newsom is once again changing the way Californians with mental illness get help


To sum up

Gov. Gavin Newsom has made mental health a priority since taking office five years ago. The ballot initiative approved by voters this week will provide billions of dollars to fund housing and treatment facilities for mentally ill Californians.

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After days of uncertainty, the results are finally in: Californians have narrowly voted to support Gov. Gavin Newsom’s latest effort to overhaul how the state cares for people with serious mental illnesses .

The Associated Press reported Wednesday that Proposition 1 passed by the narrowest of margins, 50.2 percent to 49.8 percent.

Passage of the bipartisan ballot measure will give Newsom funds to fulfill promises he’s made while rolling out a number of other mental health policies in recent years, more housing, more treatment beds and a concerted approach in homeless people with serious mental illness.

But it leaves the governor’s critics, including disability rights advocates and people living with mental illness, worried about cuts to other mental health programs and fearing the state will place more people in involuntary treatment .

The governor defended Proposition 1, which he has said will help California keep promises made decades ago.

The initiative includes a $6.4 billion bond to pay for treatment beds and permanent supportive housing. It also requires it counties spend more of the mental health funds they receive from a $1 million-plus excise tax on services for the chronically homeless.

While the ballot measure initially seemed like a shock, public support wavered in recent months. In part, that’s because the states’ growing deficit came into sharp focus with the Legislative Analyst’s Office projecting last month that it could reach $73 billion. Opponents of the ballot measure had also raised concerns that it could divert money from community mental health organizations, possibly causing some to close.

Public concern about homelessness and a multi-million dollar advertising campaign eventually carried the measure to victory, but just barely.

It’s still not a big vote of confidence, said Thad Kousser, a professor of political science at UC San Diego. He says Newsom failed to convince voters of how effective other billion-dollar investments have been to help the homeless.

“For me, given the strong message, the money behind the message, the lack of organized opposition, I would have guessed early in this campaign that he was headed for a 60-40 victory,” Kousser said.

Kimberlee Booth, center, of San Luis Obispo walks with other supporters after speeches at a rally in support of Prop.  1 at the state Capitol on January 31, 2024. The proposal aims to reform mental health care in the state.  Photo by Jose Luis Villegas for CalMatters
Kimberlee Booth, center, of San Luis Obispo walks with other supporters after speeches at a rally in support of Prop. 1 at the state Capitol on January 31, 2024. The proposal aims to reform mental health care in the state. Photo by Jose Luis Villegas for CalMatters

He squeaked though. And under the just-passed ballot measure, counties are required to invest 30 percent of the money they receive from the state’s millionaires tax on housing programs, including rental subsidies and housing services. navigation Half will be used to target people who are chronically unhoused or living in camps. Up to a quarter of the money could be used to build or buy homes.

The second part of the measure, the link, is divided into two parts. About $4.4 billion will go toward inpatient and residential treatment beds. The rest goes to permanent supportive housing, half of which would go to veterans.

Darrell Steinberg, the Sacramento mayor who co-authored the 2004 law that created the millionaires tax, said at the time he could only dream that one day there would be a governor who would make mental illness and repairing the broken system a cornerstone his governance.

Gavin Newsom has done that, he said.

Gavin Newsom’s Mental Health Plans

Mental health has been a priority for Newsoms since before she took office. He campaigned for governor with big ideas about how California’s mental health system could be fixed, and specifically how the millionaire tax funds could be better used for mental health.

In a 2018 post on Medium months before he was elected, Newsom denounced states’ lack of commitment to improving mental health care.

We fall short because we lack the bold leadership and strategic vision needed to bring the most advanced forms of care to scale across the state, he wrote. We lack the political will to elevate brain disease as a top priority. We lack the unity and fervor needed to rally the medical and research communities around an unyielding pursuit of ever better diagnosis and treatment. They all lived with the falls.

The supporters of Prop.  1 march at the State Capitol in Sacramento on January 31, 2024. Photo by Jos Luis Villegas for CalMatters
The supporters of Prop. 1 march at the State Capitol in Sacramento on January 31, 2024. Photo by Jos Luis Villegas for CalMatters

The need for mental health treatment continued to increase since he took office. The COVID-19 pandemic dramatically worsened the problem. The public experienced escalating trauma and anxiety, while mental health providers became increasingly exhausted.

Meanwhile, the number of homeless people in the state continued to rise by 40% since 2018, the year Newsom was elected, to a current estimate of 181,000.

In response, Newsom has championed a number of important mental health initiatives. This includes:

  • A $4.7 billion package of programs for child and youth mental health.
  • The creation of new judicial systems to meet the needs of people with serious mental illnesses. They are called Courts of Community Assistance, Recovery and Empowerment (CARE).
  • A new law that makes it easier to force certain people with serious mental illnesses into involuntary treatment. It modified the definition of severe disability originally established in the Lanterman-Petris-Short Act of 1967, which limited involuntary confinement in order to protect the civil rights of people with mental illness.
  • In addition, his administration is also overseeing the implementation of a statewide effort that promises to expand and streamline access to mental health care for people insured by Medi-Cal, the insurance program public funds for low-income Californians. It’s called California Advancing and Innovating Medi-Cal (CalAIM).

Hoping for better results

Sen. Susan Talamantes Eggman, a Stockton Democrat who has passed legislation to enact Newsom’s mental health programs, said the stream of recent policy changes will eventually lead to changes in outcomes, but not yet.

In political terms, the landscape is changing dramatically, he said. It will take a few years for practice to catch up.

Learn more about the lawmakers mentioned in this story

Susan Talamantes Eggman

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Susan Talamantes Eggman

State Senate District 5 (Stockton)

Susan Talamantes Eggman

State Senate District 5 (Stockton)

How you voted in 2021-2022

liberal conservative

District 5 Demographics

Race/Ethnicity

latin 36%

white 32%

asian 21%

black 6%

multi-race 4%

voter registration

Dem 44%

GOP 26%

No party 22%

Contributions of the campaign

Senator Susan Talamantes Eggman has taken at least 1.3 million dollars from party sector since she was elected to the legislature. This represents 21% of their total campaign contributions.

He emphasizes that Prop. 1 has many transparency and accountability measures attached to it, to ensure that the measure leads to concrete change.

But Newsom’s critics worry that many of his big initiatives, such as Prop. 1, CARE Court and the expanded definition of severe disability, reflect an effort to move the state toward more coercive treatment.

Everything is set up to hide the homeless rather than help them, said Paul Simmons, executive director of Californians Against Prop. 1. It will still be a bridge to nowhere, pushing people into a system that can’t even handle what we have now.

Questions about the Prop. 1

Alex Barnard, a New York University professor who has written extensively about California’s mental health system, called fears of a return to mass reinstitutionalization somewhat overblown. But, he said the state is moving toward a more paternalistic and institutional approach to treating the more seriously mentally ill.

The approval of Prop. 1 will help the administration fully implement both the CARE Court and the recent law expanding the definition of severe disability. But it also raises some thorny issues, he said.

One of them: What kind of treatment beds will the state buy with the bond money and where?

Another: How will county systems deal with the money they may lose for mental health services?

A state facing a massive deficit is not coming to the rescue, he said.

And then there’s the question of how transformative this latest influx of money will be for real Californians.

The status quo has been remarkably durable even in the face of many attempts at reform, he said. The system has had incredible inertia.

CalMatters reporter Jeanne Kuang contributed to this story.


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