Mental health advocates warn of cuts to services if California Proposition 1 passes

There’s only one proposition on the March 5 California primary election ballot — but it’s a $6.4 billion question.

Proposition 1 asks voters whether to approve billions in funding for the construction of new inpatient and outpatient mental health and substance abuse treatment centers, as well as toward housing options for veterans and the homeless.

But that’s not all that Prop. 1 does.

The ballot measure also asks voters whether to approve a restructuring of state Mental Health Services Act (MHSA) funding, which comes from a 2004 millionaire’s tax, that would shift an estimated $140 million in county funding to the state.

The measure has been championed by a coalition of Democratic leaders, including California Gov. Gavin Newsom, as well as members of the law enforcement community.

But county officials and mental health advocates are sounding the alarm about the ramifications if Prop. 1 becomes law.

Why are mental health advocates opposed to this measure?

Advocates like Karen Vicari, director of Public policy for Mental Health America of California, which advocates for mental health services and which opposes Prop. 1, believe that it will lead to less, not more, money going into vital services.

“We do not believe it will increase access to mental health services, it will decrease access to mental health services,” Vicari told The Bee in a recent interview.

Specifically, the restructuring of the MHSA funding will divert “significant amounts of money away from primarily upstream mental health services.”

That includes cuts ranging from 30% to 50% to voluntary outpatient, peer-run and community-based treatment programs, according to the American Civil Liberties Union of Northern California.

That includes prevention and early intervention services that aim to keep people from reaching dire circumstances to begin with, and which are “incredibly effective to keep people out of involuntary care,” Vicari said.

Instead, Prop. 1 funding will go toward people who are already in crisis, something Vicari called “a fail-first system of care.”

“The people that are going to be left out are the people with mild to moderate mental health challenges and the people who have already been stabilized,” she said.

Sacramento Mayor Darrell Steinberg, who authored what became the MHSA while still in the Legislature, spoke to The Bee on behalf of the Yes On Proposition 1 campaign.

He acknowledged that, yes, Prop. 1 would shift funding away from programs like what Vicari described, but as MHSA’s original champion, he said this ballot measure is about recognizing the original intent of the act.

“Change is hard, but sometimes change is necessary,” he said.

Steinberg said that while the county programs were worthwhile, he believes that MHSA money “needs to be focused on the people who are the sickest of the sick.”

What sort of programs would be cut if Proposition 1 passes?

In addition to early intervention and prevention services, other community-based programs that could go away as funding shifts toward the state’s top-down approach include culturally specific services that cater to hard-to-reach culture groups, according to Vicari.

“So if we cut those services, it’s really going to have a disproportionate impact on different racial and ethnic groups,” she said.

Vicari provided The Bee with a list of Sacramento County services that would face the most severe cuts under Proposition 1, including mobile crisis support teams and suicide prevention and outpatient services.

Other Sacramento-area services that would see cuts include the Adult Psychiatric Support Services Clinic and the Community Outreach Recovery Empowerment Program, which serve more than 7,500 people at any given time; the Wellness and Recovery Program, which serves more than 2,400 people; Children’s Community Mental Health Services, which services more than 9,500 annually and the Mental Health Urgent Care Clinic, which serves 7,800 people.

Steinberg disputed that funding for these programs is just going to go away. He said that there are streams of revenue now that didn’t exist when the MHSA first became law. Programs like California Advancing and Innovating Medi-Cal (CalAIM) can replace the funding streams for those programs who would lose funding if Prop. 1 passes, Steinberg said.

“As opposed to having one initiative try to provide the funding for everything,” he said.

But won’t this measure help house the homeless?

It’s true that Proposition 1 would devote about $2 billion in funding to convert derelict hotels into housing for the homeless, and also to build new housing.

Supporters of the measure say that the measure will result in substantial housing opportunities for the unhoused population, as well as those in danger of losing housing.

“It’s not just about the net number of people who are currently on the street, it’s also about the people who are at risk of becoming homeless,” he said.

But critics of the measure, including the ACLU and Mental Health America of California point to a Legislative Analyst’s Office analysis of the ballot measure that said that the ballot measure would reduce statewide homelessness “by only a small amount.”

And while proponents of the measure say that it will help get unhoused people off the streets and into treatment beds, Vicari said that is not the case.

“You basically have to have a serious mental health challenge, and the vast majority of unhoused people do not have a serious mental health challenge,” she said.

Will this measure drive people into involuntary treatment?

Nothing in the measure itself deals with involuntary inpatient treatment.

However, critics of the measure say that it will provide the infrastructure for forced treatment.

While the measure provides more than $4 billion in funds for both inpatient (which often is involuntary) and outpatient treatment centers, the proposition’s cuts to outpatient services means that counties will have little incentive to build outpatient facilities.

“Instead of housing, Proposition 1’s bond measure focuses on funding about 10,000 inpatient psychiatric beds, which are typically used for involuntary treatment, and creates a funding stream for for-profit locked mental health facilities, where people with mental health needs can be placed long-term without the right to leave, consent or refuse certain treatments, or other basic civil liberties,” according to the ACLU.

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