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California's Proposition 1 is complicated. Here's how it could affect the people most in need.

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If you’ve looked at your voter guide for March 5, you may have seen that the text of Proposition 1 is 68 pages. So … it’s definitely complicated, but stick with us as we roll up our sleeves and break it down.

The proposition would do two things, if approved:

  • Approve a $6.38 billion bond to build thousands more units of permanent supportive housing and treatment beds for people with mental illness and/or substance use disorder across the state.
  • Change the terms of the Mental Health Services Act, a law passed by voters in 2004 that uses a 1% tax on high earners (those with incomes over $1 million per year) to help pay for mental health services. More money would be spent on housing and support services for people with mental illness and substance use disorder, and less would be spent on existing county services like outpatient treatment and crisis response. 

During a recent press conference supporting the proposition, Governor Gavin Newsom said the stage has been set for its introduction.
“This is, I think, the last big piece,” he said. “We've radically changed the way we're doing business. We've created more flexibility, more tools, more accountability, more resources; now, we just need more beds.”

It’s worth noting that the proposition does not come at an opportune time for California’s finances. We’re facing a $73 billion budget deficit, and, if Proposition 1 passes, the Legislative Analyst’s Office predicts we’ll be spending $310 million for the next 30 years to pay it off.

More than 171,000 people experience homelessness daily in California. The state doesn’t have enough housing supply for the demand that exists, and costs have risen dramatically. A2016 McKinsey study estimated California needed to build 3.5 million more homes by 2025 and we’ve barely scratched the surface.

However, mental illness and substance use can contribute to people losing housing and hinder their ability to find and stay in stable housing. A recent UCSF study of 3,200 people experiencing homelessness found that 82% had experienced a serious mental health condition, and nearly two thirds of people reported having had a period in their life in which they regularly used illicit drugs. (About the same amount reported a time when they had been heavy drinkers.)

Meanwhile, the LAO says there are not enough places where people can get mental health care and drug or alcohol treatment. Often, jails and prisons provide much of the mental health care in a county. A 2022 report showed almost 63% of people detained in Sacramento County jails have a mental health diagnosis and receive mental health services.

That was the case for Carmichael resident Elizabeth Hopper’s daughter. After 15 years of cycling in and out of treatment for her mental illness and substance use, Hopper’s daughter ended up in Sacramento County jails.

“Certainly when my daughter has had appropriate treatment, then she doesn't have to be homeless and she doesn't have to be incarcerated,” Hopper told me.

Hopper supports Proposition 1 for one of the main reasons the ACLU of Northern California is against it: because it would allow some money to go toward locked facilities.

“This is not about locking people up for good,” she said. “It's about if you are ill enough or your brain doesn't think it's sick anymore and yet you're in a completely different reality … and there's an illness at the base of it, let's get the illness treated.”

Hopper said she agrees that voluntary services are the best option, but involuntary treatment should be part of the continuum of care for people who are the most severely ill.

Voters now must weigh in on the extremely complicated situation and decide whether the financial investment and county-level changes are worth it.

In addition to the ACLU and a number of other mental health organizations, the California State Association of Counties, or CSAC spoke out against the measure, although the organization has not taken a formal stance on the proposition.

“Reducing funding for behavioral health services will take us backward and worsen the crisis in our communities,” said CSAC CEO Graham Knaus in an August 2023 letter.

However, California’s Big City mayor coalition (including Sacramento’s own Darrel Steinberg) support the measure, and are throwing their weight behind Newsom, who says it’s the way to get people who need the most help into treatment.

However they vote, Californians must return their ballots by March 5th.

Correction: A previous version of this story incorrectly stated that the California State Association of Counties was opposed to Proposition One. They spoke out against the measure when it came before the Legislature, but never took a formal position on the proposition. The story has since been updated.

I’m interested in how health care policy impacts Sacramento and California, who gets access to care and the issues facing health care providers. It’s no secret that health care in the United States is complicated. My hope is to shed light on stories of people trying to get care and the experiences of those providing treatment.
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