The endorsement question for Proposition 1: Does it improve mental health? | Opinion

It is a moral failure that wealthy and liberal California has thousands of people suffering from mental illness and substance abuse while they live on our streets and go untreated every day.

We believe the passage of Proposition 1 could be a cost-effective use of the limited taxpayer dollars spent on mental health treatment and we recommend that Californians vote “yes” on Prop. 1.

California’s mental health system is a semi-system at best, with little prospect of expansion given the state’s looming financial crisis.

The proposition would allow the state to sell $6.4 billion in bonds. Of that, $4.4 billion would go to new facilities for mental health and substance abuse treatment. The remaining $2 billion would be dedicated to related housing and new construction, as well as the conversion of existing facilities such as hotels. More than half of this housing would be targeted for at-need veterans.

It is Prop. 1’s proposal for ongoing funding that creates misgivings. Prioritizing mental health care for homeless people means less money for Californians struggling to function with moderate mental illnesses because the financial pie isn’t expanding to run a bigger system.

Twenty years ago, then-Assemblyman Darrell Steinberg and mental health activists went around lawmakers and appealed directly to voters, as they propose to do again now. They placed on the 2004 ballot a new, 1% tax on California millionaires to expand mental health services. The Mental Health Services Act gave counties considerable discretion on how to spend the money.

Now, Prop. 1 would eliminate some of that discretion by prioritizing personalized support services, such as the comprehensive treatments needed by thousands of homeless individuals. Steinberg argues this was the initiative’s intent all along. An estimated $140 million in MHA funds annually (about 5%) would shift from counties to the state.

Gov. Gavin Newsom, Sen. Susan Talamentes Eggman of Stockton, now Sacramento Mayor Steinberg and others deserve credit for giving the mental health issue the attention it deserves. The governor has already revamped mental health policy by establishing a future Care Court system that allows judges to require up to two years of mental health and substance abuse treatment, an authority that has been missing for decades in our statutes.

With a historic institutional shakeup of the system, California counties now need the facilities to treat and house more homeless people and veterans, and that is the investment decision inside Prop. 1.

What California is doing, however, is expanding the institutional capacity of the mental health system without expanding the money to operate it. MHSA provides roughly a third of all mental health funding in California, but an important third. Opponents of the proposition, concerned lawyers and mental health providers predict that funding for moderately ill Californians will be slashed for peer-support and consumer-run programs.

Prop. 1 threatens the resources of one group in need in favor of another that is even more desperate and at risk.

This is not a trade-off that California should be proud of. The changes to MHSA can be made only by voters because they were the ones who approved it. And while the Legislature agreed to place Prop. 1 on the ballot, it would have been politically impossible to get the votes to guarantee the mental health programs the billions more it needs going forward.

The mental health semi-system’s struggles do not end with the passage of Prop.1. It does mark an achievement by its backers in California’s fight against homelessness and for better care of its at-risk veterans. It also kicks the same old can of chronic under-funding down the road. Mental illness has long been the orphan of California’s healthcare system, and that tradition looks likely to continue.

This story was originally published February 7, 2024 at 5:00 AM.