Newsom proposes sweeping mental health reform in California

Governor Gavin Newsom is asking lawmakers and voters to approve sweeping mental health reforms that would commit billions of dollars in public funding for behavioral health-based housing and treatment centers across California.

The Democratic governor’s proposal, unveiled in San Diego on Sunday, would raise at least $3 billion through a bond measure to fund the construction of new mental health campuses, residential facilities and permanent supportive housing. Newsom wants to redirect an additional $1 billion in funds each year from an existing income tax on high earners to operate the facilities, his office said.

“It’s unacceptable what we’re dealing with, on a massive scale now, in the state of California,” Newsom said at an event at Alvarado Hospital Medical Center to announce his plan. “We need to address the reality of mental health in this state and in our nation.”

The governor’s call for a 2024 ballot measure to modernize the state’s behavioral health system is the cornerstone of his state-of-the-state tour.

Instead of delivering a traditional speech to lawmakers on Capitol Hill this year, Newsom traveled around California to launch his political platform for his second term. The governor unveiled an ambitious goal in Sacramento to reduce statewide homelessness, visited San Quentin to announce the transformation of the maximum-security prison into a rehabilitation center and touted a new contract at Downey to produce insulin at low cost under a state label.

Aides to the governor have touted his efforts to rework the state’s mental health system as an opportunity to turn the page on decades of failure to build an effective community system in California. Newsom often points to former Governor Ronald Reagan’s efforts to end involuntary commitment and shut down public psychiatric hospitals in the late 1960s as the main driver of why so many people live on the streets or behind buildings. bars today.

A stronger mental health system is imperative to Newsom’s agenda to reduce homelessness and fix the criminal justice system. At a time when violent crime is on the rise and voters remain frustrated with the lack of progress on the homelessness crisis, it’s also critical to the Democratic governor’s legacy.

“He’s committed to it,” said Sean Clegg, one of Newsom’s top political strategists. “He’s going to lead and he’s going to spend his political capital.”

A key part of Newsom’s plan is to reform the Mental Health Services Act of 2004, which was approved by voters under Proposition 63 to establish a 1% income tax for millionaires in California to strengthen funding for county-run services.

Funding has fluctuated over the years, but was around $3.3 billion in the 2022-23 fiscal year, according to the Office of the Nonpartisan Legislative Analyst. Funding for Proposition 63 now represents about 30% of the state’s public mental health system, the governor’s office said.

Newsom’s announcement would overhaul the funding structure to redirect 30% of Proposition 63 funds each year, or about $1 billion, toward operating community housing for those at risk or currently homeless and those suffering. serious mental illnesses and substance use disorders. Some of the housing created would be reserved for veterans in California.

The proposal also includes changes to Proposition 63 that would allow money to be spent only on drug treatment for eligible individuals, which is currently not allowed, according to the governor’s office.

The governor’s office said the bond measure it proposed for the 2024 ballot would pay for enough new mental health care beds to serve more than 10,000 additional people each year. The state faces a shortage of 6,000 behavioral health beds, aides said. Newsom said the goal was to raise between $3 billion and $5 billion with the bond measure.

“It’s a big idea. It’s a half-century behind in the state of California,” Newsom said.

Sacramento Mayor Darrell Steinberg, who helped draft Proposition 63 when he was a state legislator, said he supports Newsom’s changes.

“We are reaching 20 years, and after nearly two decades, there is still time to update and modernize good law and make it more focused on the most serious consequences of untreated mental illness,” said Steinberg.

Steinberg said Proposition 63 has helped “hundreds of thousands of people,” but now needs a greater focus on people living in homeless camps with severe mental illness and those coming out of the criminal justice system.

“There is already a concentration. You just have to focus more,” he said.

Los Angeles Mayor Karen Bass said Newsom’s plan will free up more space for those in need.

“These reforms will help us address the crisis on our streets and bring more Angelenos back home with the support they need,” Bass said in a statement. “I support these efforts and look forward to working with the governor and the legislature to ensure their success on the ballot.”

State Sen. Susan Eggman (D-Stockton) said she would unveil legislation to implement Newsom’s plan and put it on the ballot. Proposition 63 has been a good start to addressing California’s mental health crisis, Eggman said, but she agrees it’s time for a “remodel.”

The changes will accelerate the construction and sustainable financing of the kind of “housing that heals”, but they are so rare, she added. This could include new cottage communities or less restrictive, more neighborhood-focused adult residential housing, rather than locked facilities that keep people separated from the general population.

Sunday’s announcement would add to a series of recent changes made by lawmakers to revamp California’s mental and behavioral health system since its last major overhaul six decades ago.

This includes expanding Medi-Cal and providing certain benefits to incarcerated people before they are released from prison. Eggman was one of two lawmakers last year who helped push through Newsom’s new program to treat people with serious mental illness, known as the CARE Court (for Community Assistance, Recovery and Empowerment).

The plan introduced a new justice system that would compel treatment for people with serious mental illnesses, a population the state estimates at between 7,000 and 12,000. Eight counties, including Los Angeles, are expected to roll out CARE Courts this year, with the rest of the state joining in 2024.

CARE Court will allow family members, first responders, and medical professionals, among others, to ask a judge to order an assessment of an adult with a diagnosed psychotic disorder to determine what services that individual needs.

Organizations representing the families of affected loved ones have strongly supported Newsom’s ambitious new agenda, but the proposal has drawn intense opposition from civil rights and disability advocates, who have spent much of the year to raise serious concerns that CARE courts would suppress personal freedoms and funnel people at risk into the legal system.

In January, many of the same groups that had lobbied the CARE tribunal filed a lawsuit asking the state Supreme Court to block the rollout of the new law, which Newsom signed into law in September as Senate Bill 1338.

This year, Eggman introduced a bill to expand the definition of “severely disabled,” used to determine whether someone is eligible for guardianship. The change could mean more people could be eligible for guardianship if their mental or physical health poses “a substantial risk of serious harm” due to their condition.

“I think all of these pieces that we’ve put together, and this overhaul of (the Mental Health Services Act), is going to be the last big piece of transformation,” Eggman said.

Andy Imparato, executive director of Disability Rights California, said more money for mental health housing was a good thing and Newsom’s announcement seemed to be largely good news.

While an integral part of Newsom’s reform effort would be to strengthen accountability and transparency around access, quality and spending of county behavioral health and Medi-Cal plans, Imparato said concerns about how some counties spend Proposition 63 funding. He wants to make sure money for new housing isn’t taken from other treatment services.

Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Assn., Agrees.

“We want to thank the governor for hearing our calls to address the shortage of housing options for customers,” Cabrera said. “However, we need these investments to add up rather than divert resources from upstream prevention and treatment. There is no way to end this crisis without both: housing and treatment services. »

Imparato also said Disability Rights California and other organizations that vehemently opposed CARE Court may still be reluctant to work with Newsom on another mental health initiative.

It will be critical, Imparato said, that peer helpers and those with lived experience of mental illness and substance use disorders have a place at the table in this year’s proposal.

“Hopefully we’ll see more of a collaborative approach,” he said.