Executive Summary

This brief will cover the public perception of California’s Proposition 1 and current policy considerations and developments with federal elections on the horizon. Some key pieces of our analysis include analyzing the context of Proposition 1 and an in-depth overview of the current actions the Californian and federal government are taking, public popularity, and criticism.

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Overview

Currently, even as the popularity of therapy and treatment reaches an all-time high, mental health is the only medical field in which patient outcomes have worsened. Studies are quick to offer many causes for such a trend, often arguing that social media, isolation, and the COVID pandemic have all deteriorated from collective mental healthiness. The National Institute of Health finds, when studying depression before and after the pandemic, that 27.7% more Americans reported some form of depression during the period.¹ This is likely due to the everpresent fear of infection, death of a loved one, and overall separation from family and friends.² 

While mental health declines, the existing gap between symptoms, diagnosis, and treatment is still difficult to overcome. The continued shortage of mental health professionals prevents those seeking treatment from accessing help. In 2021, less than half of the adolescents with a major mental health condition received care.³ That is in large part due to there being a staggering 10.8% of individuals with mental illness being uninsured.⁴ 

To combat worsening health and improve access to care, congresses have been rapidly enacting mental health-related legislation. Just this week, the Biden administration announced close to $40 million in grant opportunities for the Substance Abuse and Mental Health Services Administration, a branch of the Department of Health and Human Services. On the state level, California has been a national leader in mental health action for decades. Since Governor Newsom came into office in 2018, he has passed groundbreaking policies including a 2020 parity law and his 2022 CARE Courts bill. The former expanded healthcare coverage of mental health diseases, notably including addiction and substance use disorder.⁶ The latter implemented CARE Courts, an alternative judicial process built for mentally unhealthy individuals that prioritizes accessing medical and housing resources, as opposed to the entirely law-based rulings in the regular court system.⁷  

Governor Newsom’s action is not without cause. California experiences the most alarming homelessness in the country, with over 180,000 individuals without residence.⁸ Further, from 1995 to 2016, California hospitals lost 30% of acute mental health hospital beds, highlighting the inaccessibility of resources.⁹ When coupling homelessness and lacking resources with factors including increased drug usage and worsening mental health, it is no surprise that addressing mental health and related concerns is now a staple in California politics. Earlier this month, the narrow passage of Proposition 1 took unprecedented steps in proliferating mental health resources, but many are concerned that the fine print will lead to more individuals needing such resources in the first place.

Policy Problem

A. Public Popularity

California residents were more likely to be in favor of Proposition 1 due to its argument for tackling the humanitarian crisis of homelessness, mental illness, and substance abuse.¹⁰ Their empathetic message, promises to treat individuals, combining compassion and common sense.  Attracting those who need compassion the most, when often receiving judgment. Proposition 1 aims to act as a call to action, fixing “our” broken mental health system and moving people permanently off the streets, out of tents, and into treatment.¹¹ Government Gavin Newsom provides the following necessary steps to finally change the mental health system that has been broken since the 1960s:¹² 

Prop. 1 will expand community-based mental health and addiction services across the state and serve tens of thousands of Californians annually.  

The initiative will create supportive housing settings where over 11,000 Californians with severe mental health needs can live, recover, stabilize, and thrive. 

One in three California prisoners has a diagnosed mental illness. Today, we spend $100,000 per incarcerated person during their time behind bars. Research shows it’s costly and counterproductive. The proposition will prioritize treatment not punishment for the mentally ill. 

Over 10,000 California veterans, many suffering from PTSD, are homeless and on the streets. Proposition 1 will provide $1 billion to serve veterans experiencing homelessness, mental health, and substance abuse issues. 

Address shortage of mental health workers:

‍Currently, those with serious mental health issues can wait six months or longer just for an introductory appointment. Prop. 1 will help fund additional professionals so that people with mental health needs can get help in real time. 

Requires strict accountability: Democrats and Republicans support Prop 1. Because it addresses mental health and homelessness without raising taxes. And Prop 1. has strict accountability measures, including mandatory audits, to ensure that funds are spent as promised.

Overall, through pooling resources and promoting cooperation across various sectors, the proposition aims to implement concrete measures that can enhance the well-being of vulnerable individuals and communities throughout California.‍

B. Californian’s Criticism

Despite the widespread social benefits that may be introduced to longstanding issues regarding mental health illnesses associated with homelessness, Proposition 1 remains a highly controversial bill due to the traditional concerns of a large-scale welfare policy compounded by the unique exclusionary public health implications that the clauses of the bill may be interpreted as. With the bill passing on March 20, 2024 by a narrow 0.4% margin, common critics of Proposition 1 have cited the financial struggles to be faced by various aspects of the medical sector due to the refocusing of public health funding towards the promises of the bill.¹³ On another account, skepticism regarding the effectiveness of Proposition 1 in terms of promptly reducing homelessness has also been raised, supplemented by arguments that Proposition 1 is an overfunded project that will jeopardize the provision of more pertinent and widely applicable medical services.

Of all the opposing arguments, the most prominent concern that has driven over 3.5 million California voters to reject Proposition 1 has been the issue of funding. With the bill being driven by over $6.38 billion dollars in bonds and tax revenue redistribution and nearing $10 billion dollars in total payment, Proposition 1 is set to become one of the most heavily-funded reform efforts under California governor Gavin Newsom’s jurisdiction.¹⁴ While the bill does not raise taxes for California citizens, critics have pointed out that the extensive use of bonds to pay for the 11,150 behavioral beds and more can lock the state government into making long-term payments even in times of revenue downturn.^{15, 16} Moreover, the adjustments to allow the fiscal feasibility of Proposition 1 include the redirection of over 30% of the funding guaranteed by the 2004 Mental Health Services Act (MHSA), drawing many citizens to claim that such a large portion of funding for a considerably smaller demographic reflects an imbalance in providing equitable mental health services.¹⁷ Considering that the MHSA provides for individuals and families with serious mental health issues through community assistance, early intervention, innovation, technological supplements, and workforce education services, the enactment of Proposition 1 will inevitably take away from the extent of the various provisions previously in place.

Policy Considerations

Criticism of Proposition 1 has extended beyond just California, with experts from states across America providing their insight into the proposal. Aside from the issue of funding, opponents of Proposition 1 have questioned the general effectiveness of the bill in combating both mental health concerns and homelessness. Much like how most government-sponsored bills to “revolutionize” a certain industry or field are perceived, the specific allocation of the proposed $6.38 billion dollars as outlined by the Newsom administration has raised concerns for the bill becoming a typical statistically-pleasing, practically-depleting slew of policies. 

Prominent critics have pointed out the fact that the 11,150 behavioral health beds and 26,700 outpatient treatment slots will ultimately account for just 3% of the total unhoused California population. To overtake at least 30% of the current MHSA funding—which provides for an empirically necessary psychiatric care service—and spend it on a far smaller number of mental health and drug abuse patients, many opponents claim, is not only an inefficient fiscal plan but also an ineffective public health policy. On a similar line of reasoning, opponents of Proposition 1 have also pointed out that the bill’s focus on providing temporary shelters to those afflicted by mental illnesses rather than the prevention of such illnesses rooted in drug abuse will only exacerbate the issue in the long run.

With all of that criticism in mind, it is unlikely that many states across the country follow California’s legislative action. Despite the claimed benefits, policy experts across America acknowledge the lack of funding and efficacy that comes with the proposal. 

Conclusions

Overall, this brief includes a detailed description of the public perception of California’s Proposition 1. The analysis considers the context behind the proposal, proponents’ and opponents’ arguments for the legislative action, and considerations as a result of the debates over the policy. 

Acknowledgment

The Institute for Youth in Policy wishes to acknowledge, Michelle Liou, Joy Park, Nolan Ezzet, and other contributors for developing and maintaining the Policy Department within the Institute.

References

1. Catherine K. Ettman et al., "Prevalence of Depression Symptoms in US Adults before and during the COVID-19 Pandemic," The Journal of the American Medical Association, last modified September 2, 2020, accessed March 25, 2024, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146.
2. Amanda MacMillan, "4 Possible Reasons Why Mental Health Is Getting Worse," Health, last modified August 21, 2023, accessed March 25, 2024, https://www.health.com/condition/depression/8-million-americans-psychological-distress.
3. Michael William Flores et al., "Estimates of Major Depressive Disorder and Treatment among Adolescents by Race and Ethnicity," The Journal of the American Medical Association, last modified October 9, 2023, accessed March 25, 2024, https://jamanetwork.com/journals/jamapediatrics/article-abstract/2810184.
4. "The State of Mental Health in America," Mental Health America, accessed March 25, 2024, https://mhanational.org/issues/state-mental-health-america.
5. "Biden-Harris Administration Announces $39.4 Million in Funding Opportunities for Grants to Help Advance the President's Unity Agenda," US Department of Health and Human Services, last modified March 22, 2024, accessed March 25, 2024, https://www.hhs.gov/about/news/2024/03/22/biden-harris-administration-announces-39-4-million-funding-opportunities-grants-help-advance-presidents-unity-agenda.html.
6. Jocelyn Wiener, "California Poised to Become National Leader on Mental Health and Addiction Coverage," CalMatters, last modified September 29, 2021, accessed March 25, 2024, https://calmatters.org/health/2020/08/california-leader-mental-health/.
7. Manuela Tobias and Jocelyn Wiener, "California Lawmakers Approved CARE Court. What Comes Next?," Calmatters, last modified September 14, 2022, accessed March 25, 2024, https://calmatters.org/housing/2022/09/california-lawmakers-approved-care-court-what-comes-next/.
8. Sam Levin, "California's Homelessness Crisis Is the Worst in the US. But Who Is Struggling the Most?," The Guardian, last modified December 19, 2023, accessed March 25, 2024, https://www.theguardian.com/us-news/2023/dec/19/california-us-street-homelessness-youth-unsheltered-annual-report#:~:text=Note%3A%20Estimates%20as%20of%20January,shelters%20or%20temporary%20set%2Dups.
9. "California Psychiatric Bed Annual Report," California Hospital Association, last modified August 2018, accessed March 25, 2024, https://calmatters.org/wp-content/uploads/2019/04/CHA-Psych-Bed-Data-Report-Sept.-2018.pdf.
10. “Proposition 1 Arguments and Rebuttals.” Official Voter Information Guide, https://voterguide.sos.ca.gov/propositions/1/arguments-rebuttals.htm. Accessed 28 March 2024.
11. “Proposition 1 [Ballot].” Legislative Analyst's Office, 5 March 2024, https://lao.ca.gov/BallotAnalysis/Proposition?number=1&year=2024. Accessed 28 March 2024.
12. Wolffe, Kate. “Proposition 1: Early results show Newsom's mental health bond too close to call.” Capital Public Radio, 6 March 2024, https://www.capradio.org/articles/2024/03/06/proposition-1-early-results-show-newsoms-mental-health-bond-too-close-to-call/. Accessed 28 March 2024.
13. Dahl, Bj, and Amy Maetzold. “California proposition 1 results and what the 2024 ballot measure would do if approved.” CBS News, 6 March 2024, https://www.cbsnews.com/losangeles/news/what-is-california-proposition-1-and-what-would-the-2024-ballot-measure-do-if-the-state-votes-to-approve-it/. Accessed 28 March 2024.
14. “Proposition 1.” Official Voter Information Guide, https://voterguide.sos.ca.gov/propositions/1/. Accessed 28 March 2024.
15. “Work Accelerates on Historic Transformation of California's Mental Health System | California Governor.” California Governor, 21 March 2024, https://www.gov.ca.gov/2024/03/21/work-accelerates-on-historic-transformation-of-californias-mental-health-system/. Accessed 28 March 2024.
16. Luna, Taryn, and Gavin Newsom. “The cost of Prop. 1: Newsom's plan to transform California's mental health system.” Los Angeles Times, 1 March 2024, https://www.latimes.com/california/story/2024-03-01/california-primary-election-proposition-1-cost-newsom. Accessed 28 March 2024.
17. Hwang, Kristen, and Jeanne Kuang. “California election result: Proposition 1 mental health bond passes.” CalMatters, 5 March 2024, https://calmatters.org/politics/elections/2024/03/election-result-proposition-1/. Accessed 28 March 2024.
18. “MHSA Program Policy.” DHCS, 28 April 2021, https://www.dhcs.ca.gov/services/MH/Pages/MHSA-Program-Policy.aspx. Accessed 28 March 2024.
19. Garrow, Eve. “Don't Be Fooled by Proposition 1's False Promises | ACLU of Northern CA.” The ACLU of Northern California, 16 February 2024, https://www.aclunc.org/blog/don-t-be-fooled-proposition-1-s-false-promises. Accessed 28 March 2024.
20. “California Homelessness: Here's What $6B Prop. 1 Would Do.” The San Francisco Standard, 18 January 2024, https://sfstandard.com/2024/01/18/homelessness-california-ballot-prop-1/. Accessed 28 March 2024.

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