Will California’s Prop 1 Live up to its promise?

The following article is by Linda Mimms. Linda L. Mimms, M.A. Public Policy, Duke University is the Vice Chair of the Board, Schizophrenia & Psychosis Action Alliance. She is also involved with the California Coalition for CARE, the California Advocates for Treatment, the National Shattering Silence Coalition (NSSC), and the National Alliance on Mental Illness (NAMI). To contact Linda, you may reach her at [email protected]. Follow Linda on Linkedin here.

California Proposition 1 was a ballot measure that narrowly passed in March. It will provide billions of dollars to fund housing and treatment facilities for the mentally ill and/or addicted.

Prop 1 is an integral piece of several mental health reforms California Governor Gavin Newsom has spearheaded over the past few years. These initiatives include the Community Assistance, Recovery and Empowerment (CARE) Act, passed in September 2023, and Senate Bill 43, the first reform/update of the 1967 Lanterman-Petris-Short Act (LPS), passed in October 2023 with an optional county implementation date of January 1, 2024-2026. LPS is California’s involuntary psychiatric treatment law. To put Prop 1’s importance in context, it is helpful to understand these new laws.

The CARE Act creates a new pathway through a civil court process to deliver mental health and substance use services to individuals who are diagnosed with schizophrenia or other psychotic disorders and are not engaged in treatment. It is intended to serve as a voluntary upstream intervention for individuals experiencing severe impairment to prevent avoidable psychiatric hospitalizations, incarcerations, and Lanterman-Petris-Short mental health conservatorships (these are different from probate conservatorships, exemplified by Britney Spears’ conservatorship.)

The CARE Process is designed to provide earlier action, support, and accountability for both CARE clients and the local governments responsible for providing behavioral health services to these individuals. It authorizes specified adults, including families and first responders, to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan that may include treatment, housing resources, and other services.

Senate Bill 43 updates and modernizes the definition of grave disability in the Lanterman-Petris-Short Act. The 1967 LPS law allows for involuntary detention if someone is a danger to themselves or others or is “gravely disabled,” defined as no longer able to provide for their own food, clothing, or shelter because of a mental health disorder.

The new definition of “gravely disabled” expands the above definition to now include the inability of someone to care for their personal safety or medical needs due to severe substance abuse disorder, a mental health disorder and severe substance use disorder, or chronic alcoholism. This is not a “conservatorship bill” as has been publicized by reporters and others, but an LPS reform bill. It is aimed at not only the homeless population but includes all people who are suffering from untreated serious mental/brain illnesses and/or addictions. SB 43 went into effect on January 1, 2024, but counties have until 2026 to implement the change.

Proposition 1 was touted as a homelessness solution with the tagline, “Treatment Not Tents,” but it is much more than that. It consists of two major initiatives and while it was directed at the homeless population, it includes all people living with untreated serious mental/brain illnesses and/or addictions both on and off our streets. Prop 1 will refocus billions of dollars in existing funding to fulfill the original promise of the 2004 Mental Health Services Act: to direct funding and programs to our sickest with serious mental/brain illness.

First, it introduces a $6.4 billion bond to fund new housing, including permanent supportive housing, and new treatment facilities. It is divided into two parts. Around 4.4 billion will go toward inpatient and residential treatment beds. The rest is directed to permanent supportive housing, half of which will be for veterans.

Second, Prop 1 modernizes and reforms the Mental Health Services Act (MHSA), which was passed as Proposition 63 (the millionaires’ tax) by voters in 2004. It provides new mandates for how counties must spend funding from the nearly 20-year-old MHSA, which raises billions each year for state and local programs. Counties have had broad discretion on how to spend this money, with little oversight and accountability. Prop 1 aims to course correct and promote the original intent of the MHSA which is to expand and transform California’s behavioral health system to better serve individuals with, and at risk of, serious mental/brain illnesses, and their families. This involves directing services and supportive housing to those with the most serious brain illnesses and evaluating the effectiveness of programs to get and keep people in recovery. People, including our veterans, living with chronic, treatable brain diseases, need the additional resources Prop 1 will bring for supportive housing, including both community and acute care settings, to obtain and remain in recovery.

Prop 1 will not require a reduction of behavioral health services. It will entail a shift in funding to allow increased state oversight of county expenditures that is sorely needed, together with reevaluation of each of the 58 counties existing treatment and supportive housing programs. Prop 1 will cement critical resources within the legislative framework to ensure the original MHSA intent remains intact.

Overall, Prop 1 represents a significant step forward in addressing the needs of individuals with serious mental/brain diseases and/or addictions in California. Proper implementation and ongoing oversight will be essential to ensure that the promised resources and services reach those who need them most.

If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058.