Newsom sells voters ‘treatment not tents’ homelessness plan. Critics say it hurts mentally ill

California voters will decide in March whether the state should borrow $6.4 billion to add thousands of new behavioral health beds and change how the state administers mental health services.

Gov. Gavin Newsom on Thursday signed a pair of bills that will place the funding and policy changes on the primary election ballot under Proposition 1.

Standing at a podium with a “Treatment Not Tents” sign, Newsom said, “Today is about holding ourselves to a high level of accountability, a higher level of expectation.”

“I think this is a big day not only for the state, but I think is a model for the nation as well,” the governor told reporters. “I think people recognize we need to do things differently.”

Newsom added that now the focus will be to “galvanize this state, across jurisdictions, north, south east west but also across party lines” to approve the measure.

Newsom first announced his plan for a bond measure in March. His administration then pushed the measures through the Legislature, promoting them as strategies for alleviating the state’s homelessness crisis.

A coalition of people who provide and receive California mental health services worry it could lead to program cuts and an expansion of involuntary treatment.

Here are answers to some key questions:

What’s the intention behind the bond measure?

This ballot measure is part of a broader plan by the governor to address California’s homeless crisis by cracking down on encampments and getting homeless individuals who have been diagnosed with mental illness or substance abuse into treatment programs.

This measure builds off of Newsom’s controversial Community Assistance, Recovery and Empowerment (CARE) Court, which passed last year and launched earlier this month. CARE creates a civil system of mental health courts where judges can order people with severe untreated psychotic disorders, including schizophrenia, into treatment.

On Tuesday, Newsom signed Senate Bill 43, another measure that could have significant implications for California mental health care.

The bill, authored by Sen. Susan Eggman, D-Stockton, would expand the definition of “gravely disabled,” which allows a court-appointed conservator to take on decision-making for people who cannot provide their own food, clothing or shelter.

SB 43 adds criteria that could define a person as gravely disabled if they are unable to ensure their own safety due to an untreated mental illness or substance abuse. Eggman’s bill would also ask courts to take into account whether the person understands their illness and is able to make sound decisions.

What will the bond funding be used for?

The bond funding will go toward constructing, acquiring or rehabilitating more than 11,000 new treatment beds and supportive housing units. The governor’s office projects that such projects will help house and treat more than 100,000 people a year.

Up to $4.4 billion will be used to add treatment beds across the state. Of that pool of money, $1.5 billion will be set aside for local governments to apply for and use for local initiatives. There is $30 million dedicated to tribal communities.

The remaining $2 billion will help provide new permanent supportive housing options, giving residents services as well as a place to stay. Of that, about $1 billion is earmarked for veterans.

How does this change California’s Mental Health Services Act?

The Mental Health Services Act was co-authored by Sacramento Mayor Darrell Steinberg when he was serving as an assemblyman. It was approved by voters in 2004.

MHSA levies a 1% tax on personal incomes above $1 million to fund mental health and substance abuse programs. Those funds represent nearly a third of the dollars in the state’s behavioral health system. Right now, most of the money goes directly to counties, which have broad authority to determine their spending priorities.

The measures before voters in March would shift how counties can spend their allocation.

Under the current system, 76% must go toward community services and support, 19% to prevent and early intervention programs and 5% for “innovation.”

If approved, the bond measure would place substantially more emphasis on finding housing for people diagnosed with substance abuse or mental illness.

Under the governor’s proposal, counties would spend 30% on housing programs and 35% on full-service partnerships — intensive programs for adults with severe and persistent mental illness. The remaining 35% would pay for behavioral health services and supports, half of which must be spent on early intervention.

In response to opposition, Newsom amended the original proposal. The changes make it easier under certain circumstances to transfer money between spending categories and for rural counties to seek exemptions from certain spending mandates.

Steinberg, a proponent of the changes outlined in the governor’s ballot measure, said Thursday that it will “prioritize much more effectively people who are the most vulnerable.”

“There has not been, up until now, the state leadership to demand that the money be spent where the needs are the greatest — and that is to build more beds and to build more roofs,” Steinberg said.

Will this cause more involuntary holds of people experiencing mental illness?

Opponents worry the measure could take California backward by returning to the kind of institutional care that led to many people being held against their will for mental health issues.

An eleventh-hour amendment to the legislation last month removed the terms “voluntary, unlocked” and “and “community-based treatment settings” when describing the facilities that would be built using the bond funds.

Disability Rights California told lawmakers in a letter before they voted that the organization was concerned that it could cause “extensive expansion,” which would undermine the original intent of MHSA.

Newsom spokesperson Brandon Richards has denied those claims. Instead, he said in a recent statement that the changes were made after conversations with families, clinicians and elected officials who wanted to be able to use the funds for “the full spectrum of behavioral health treatment sites.”

The amendments match the state’s existing Behavioral Health Continuum Infrastructure Program, a bond that Richards said “prioritizes services in the most integrated and least restrictive setting that is appropriate to each individual.”

What do opponents say?

A group called Californians Against Proposition 1 announced on Thursday it will mount a campaign opposing the ballot measures. The organization describes itself as a “broad, nonpartisan coalition of people, including those who provide and receive local and statewide mental health services.”

Californians Against Proposition 1 says the ballot measures will cut “effective, voluntary, evidence-based, community-based, accessible, service options” in favor of expanding involuntary treatment.

“This is not ‘modernization,’ as supporters claim,” the group said in an emailed statement. “It is disruption and destruction.”

“Disrespecting the voters and existing programs, Proposition 1 drastically alters, for the worse, how our state government will approach delivery of mental health and addiction recovery services,” the coalition added.

What chance does this measure have of passing?

Newsom now must sell his spending plan and policy changes to voters. It’s unclear whether they will support the ballot measures, but polling shows Californians believe mental health is a major problem in the United States.

A Public Policy Institute of California survey conducted in late August and early September shows 87% of adults across political parties say there is a “mental health crisis in the U.S. today.”

PPIC reported these results are in line with national data from an October 2022 CNN/Kaiser Family Foundation poll that showed 90% of adults think there is a mental health crisis.