Serious mental health reforms await voters' consideration in March

Sep. 30—Pending a signature by the governor, voters across California will decide next spring the fate of how localities deal with serious mental health issues in a ballot measure on whether the public thinks the money could be spent better.

This comes a month after the Legislature's passage of a bill to overhaul the state's Mental Health Services Act, a ballot measure approved by voters in 2004 that levies a 1% tax on personal incomes above $1 million to fund programs and services for those with serious mental health issues.

The tax generated $3.3 billion in the 2022-23 fiscal year, nearly a third of the dollars in the state's behavioral health system, according to the Legislative Analyst's Office.

The plan is tied to AB 531, a $6.38 billion bond measure for the March 2024 ballot that would add 10,000 new behavioral health beds in California, and bring serious changes to ways in which counties can use the money.

This includes a 30% funding requirement for housing assistance, a separate share for substance abuse programs and increased state oversight.

But in Kern County and other counties across California, health providers and analysts believe the proposed changes to MHSA would force major cuts to ongoing services.

"Borrowing from Peter to pay Paul," said Christina Rajlal, the MHSA Behavioral Health Program supervisor at Kern Behavioral Heath and Recovery Services.

While the intention of the bill is to add local accountability, its opponents maintain the fundamental shift will jeopardize existing programs.

During a Sept. 14 meeting with Hasfa Kaka, who was appointed senior adviser on homelessness by Gov. Gavin Newsom in May, Kern BHRS Director Stacy Kuwahara gave Flood Ministries — Bakersfield and Kern's primary street outreach provider — as an example of one program that could be axed.

"There's no way I can get around cutting services," Kuwahara said.

A July report by the Legislative Analyst's Office, which advises the Legislature on policy and fiscal matters, estimated the housing mandate could result in a $718 million loss to existing county mental health programs.

"There are very deep concerns throughout the state, not only of the counties," Rajlal said. "Everyone is doing a deep dive to understand the complexity of how this is going to touch all of the different systems — education, law enforcement, the hospitals, the emergency departments."

Gov. Gavin Newsom, who many agree has made mental health one of his chief priorities, says the bill represents a pivot to the next stage of homeless intervention, by redirecting funding to early prevention and housing — the first and final moments of homelessness — with an emphasis on people with mental illness, substance use disorders or both.

The bill has received bipartisan support in the Legislature and from organizations such as the Big City Mayors, which includes Bakersfield, and even the original author of MHSA, Darrell Steinberg, the mayor of Sacramento.

"The status quo is simply unacceptable," Newsom said. "This reform will ensure our state has a true mental health care system that has real accountability so people can get help."

This "critically needed" overhaul, Newsom said in a statement, would be among the "most significant changes to California's mental health system in more than 50 years."

State Sen. Susan Talamantes Eggman, D-Stockton, who authored the bill, said it comes at the right time.

"The landscape has changed dramatically in 20 years," she said.

In that span, homelessness statewide has exploded.

Meanwhile, California cities have low vacancies for affordable housing — an average 1% in Bakersfield — leaving housing options such as downtrodden motels, which are arguably more dangerous than being outside.

Many homeless people — including in Kern — idle in shelters, vouchers in hand, as they await affordable housing to be built.

Or they frequent county jails and emergency rooms, Eggman said.

In Kern County specifically, a 2020 report by California Health Policy Strategies found that roughly 87% of jail-incarcerated people had an open mental health case, a 70% increase since 2009.

"Our jails are full of people with behavioral health issues," Eggman said. "L.A. County jail is the biggest behavioral health system we have in California, which is not qualified, and our prisons are full of folks."

This follows studies published in June by UC San Francisco that show housing and cost of living to be the primary drivers of the state's 171,000 homeless people — 30% of the nation's total.

Within that population, there are high rates of mental health problems and substance use; 82% reported a period in their lives in which they dealt with a mental health condition, and more than half reported the use of illicit drugs or heavy drinking.

"I don't think ... any average Californian, if they look around and see, (would) say what we're doing has been working," Eggman said. "We can't just keep doing the same thing we've always been doing and argue that it's the most effective."

The new system will instead build off the successes, Eggman said, as more people today are insured through the Affordable Care Act or MediCal — "a 12% increase since 2003." And 60% of the state's homeless people, according to the California Health Care Foundation, are registered through MediCal.

It also builds off the incoming CARE Court, a referral system Newsom signed into law last year that will compel people struggling with a mental health crisis into treatment, and the recent expansion of MediCal services through the passage of California Advancing and Innovating MediCal, or CalAIM, which Eggman said will help cover costs.

MHSA, when it passed, was revolutionary, Eggman said. It provides large sums of cash to build out community-based mental health infrastructure that was long promised to replace state hospitals following their dissolution beginning in the 1950s.

"But nothing for housing or substance abuse," Eggman said.

And upon passage, she acknowledged that decisions would need to be made. Eggman added that she's asked localities to approach her team with their concerns, but has yet to receive a response.

"We are asking people to reprioritize ... we're not asking them to do without," Eggman said. "Those who are 'lining up' are folks who think they could potentially have something to lose."

Opponents say it's taking money from one crisis to put toward another.

"I think you will see more formal stances and positions coming from entities and agencies but also other players that will be affected," Rajlal said.

Newsom has until Oct. 14 to take action on the legislation. If signed, the decision to modernize MHSA will appear on the March 2024 ballot as part of Proposition 1.