California's transformative Proposition 1, narrowly passed by voters, aims to radically reduce soaring homelessness by changing the way money is spent on housing and mental health services. But critics argue the measure will hamper local health care efforts, ultimately affecting some vulnerable Californians and failing to fully address three intertwined but distinct problems.
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Officials announced its passage Wednesday evening after more than two weeks of vote counting. The contest was unexpectedly tight — 50.2 percent in favor to 49.8 percent against — despite backing from Democratic Gov. Gavin Newsom, the mayors of Los Angeles and San Francisco, and more than $13 million spent on advertising.
In a statement Wednesday, Californians Against Prop. 1 said the win was "an embarrassing squeaker of a victory that contains a strong warning."
A day after the race was called, Newsom praised the proposition at a news conference.
"We're here today celebrating this journey and this successful effort to fundamentally reshape and reform the approach we take to address the issue of mental health, substance abuse disorder and challenges that continue to vex us out on the streets and sidewalks, and those that are suffering alone," Newsom said.
Meanwhile, voters in Chicago narrowly rejected a referendum to boost funding for the city's effort to combat homelessness. The money would have come from raising sales taxes for properties above $1 million while lowering the tax on less expensive properties.
Here's a look at both sides of the debate over California's new policy.
What Prop 1 does
Currently, California's mental health system is funded in large part by the 2004 Mental Health Services Act. It taxes millionaires 1 percent for every dollar in income they make over $1 million.
The provisions in Prop 1 were passed in a bipartisan effort by the state legislature and signed by Newsom in October before being put on the March ballot for approval by California voters. It introduces changes in two main ways.
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First, it will shift some control from counties to the state when it comes to funding for housing programs, behavioral health services and full-service treatment programs. In the past, county programs received about 95 percent of the total money available from the Mental Health Services Act. And though the counties will continue to receive the vast majority of that cash (about 90 percent), that shift will mean an estimated (and not insignificant) $140 million goes to the state instead, according to California's Legislative Analyst's Office.
With that money going to the state to spend it on its own programs and priorities, counties will be required to spend more of the funding they receive on housing services and wraparound services, such as education and employment assistance. Going forward, less money will be available for counties to spend on programs like mental health outreach or care, and they will be monitored more closely for how they spend it.
The second part of the proposition authorizes around $6.4 billion in bonds to pay for major projects. About $1 billion will be devoted to housing for veterans. More than $4 billion will be spent on building mental health and drug and alcohol treatment facilities, some of which will be used to treat people who are involuntarily committed. The remainder of the money will be allocated to state programs that provide grants for communities to build new housing or convert existing hotels and motels to housing.
What critics are concerned about
The proposition drew unconventional coalitions of both advocates and opponents. Newsom called it a "unity agenda," but the same could be said of those on the other side.
Among its supporters were U.S. VETS, the National Alliance on Mental Illness of California and Democratic mayors such as San Francisco Mayor London Breed and Los Angeles Mayor Karen Bass. But it also had the support of the California Correctional Peace Officers Association and the California Chamber of Commerce.
Meanwhile, opposition to the proposition brought together other strange bedfellows, including Mental Health America of California, the state's Senate minority leader, Republican Brian Jones, the League of Women Voters of California, the Howard Jarvis Taxpayers Association and other county leaders.
Karen Vicari, director of public policy at Mental Health America of California, worries about the measure's effect on local programs, an issue that the governor has sidestepped.
"It's all about prioritization. It's all about making determination. It's all about change," Newsom said at a celebratory press conference. "If you support the status quo, then that argument holds a lot of weight. I don't… This is a different approach. This is a new strategy change."
But opponents like Vicari say that culturally specific services, prevention services and intervention services would likely be cut at the county level in favor of funding programs that serve people with the highest needs. She worries about people with mild to moderate mental health needs who remain stable because they have access to care, as well as people who had higher needs but were able to step down to be classified as mild or moderate with the help of services.
"They're the ones who [we] are the most worried about, because if they lose these upstream services, they're going to end up right back up in the higher-need care," she said.
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Vicari is also concerned that the proposition – and the conversation around it – incorrectly conflates mental health problems, substance use disorders and homelessness. Each one is a problem, both in California and nationally, but no blanket solution can address all three, she said.
"Homelessness in California is an affordable housing issue. It's not a mental health issue. So until we address the root causes, until we build housing for our lowest-income people, homelessness is going to continue to rise," Vicari said.
It's not clear how much permanent housing will be constructed under the new funding structure governed by Prop 1, but its second stipulation allocates funding for around 4,350 units, according to state estimates, about half of which would go to veterans.
California has a huge shortage of permanent housing. The state estimates 180,000 homes need to be built each year to keep up with demand, far more than the actual yearly construction rate of about 80,000 new homes.
In a state-published voting guide, advocates for the proposition said, "The initiative will create supportive housing settings where over 11,000 Californians with the severest mental health needs can live, recover, stabilize and thrive." But opponents argue that much of that housing will be for temporary in-patient treatment, not long-term or permanent housing.
"Temporary beds are not a solution to homelessness," Vicari said.
Other opponents take issue with involuntary mental health treatment, a controversial tactic used in some other states that Newsom recently expanded in California.
Psychologist Sam Tsemberis told the PBS NewsHour that involuntary treatment is not driven by research but "political positioning, and politicians feeling like they have to do something about the number one issue that's on everybody's mind."
While Tsemberis, founder of the Pathways Housing First Institute in Los Angeles, doesn't disapprove of involuntary treatment writ large, he is concerned that patients are likely to return to homelessness when they are discharged. Instead, he would like to see increased funding for subsidized and other low-income housing, as well as wraparound mental health and substance abuse services for people who need it.
Wraparound services will still be a key component of helping veterans with potentially extreme traumas, said Steve Peck, president and CEO of U.S. VETS and president of the California Association of Veteran Service Agencies.
In the past 15 years, homelessness among veterans has fallen 52 percent, while it has risen 13 percent in the general population since 2007.
Despite what he views as legitimate concerns about involuntarily committing Californians who need mental health care, Peck remains cautiously optimistic about its goal of helping veterans. "That was a smaller portion of this larger bill that will help many, many more veterans than it will hurt," he said.