California’s mental health ballot measure is the best chance in decades to change the system

This story appeared on Calmatters

Kimberlee Booth, center, of San Luis Obispo marches with other supporters following speeches at a rally in support of Prop. 1 at the state Capitol on Jan. 31, 2024. The proposition aims to reform mental healthcare in the state. Photo by José Luis Villegas for CalMatters

California voters are deciding the fate of Proposition 1, a mental health funding reform and bond measure on the March primary ballot. Below, the guardian of a woman who died after receiving inadequate treatment says Prop. 1 can help change a failing system. The opposing view: A mental health advocate says the measure will force major cuts and give public dollars to private industry.

Guest Commentary written by

Alison Monroe

Alison Monroe

Alison Monroe is a retired editor in Oakland and co-founder of Families Advocating for the Seriously Mentally Ill, or FASMI.

For nine years, I begged Alameda County agencies to give my intermittently homeless and schizophrenic ward the care she needed to stay alive and well. Last September, some 12 years after I became her legal guardian, she fatally overdosed on meth and fentanyl.

The mental health system operating in California counties like mine could not save my daughter, and Proposition 1, the mental health funding reform and bond measure on the March ballot, is our best chance in many years to change it

The Mental Health Services Act, the “millionaire’s tax” of 2004, has generated tens of billions of dollars for California’s counties to help people suffering from the most “serious, disabling and persistent” forms of mental illness. But unfortunately today’s system fails to keep people with serious mental illness alive, well and out of jail.  

Repeated audits, such as the Mental Illness Policy Org’s 2013 report “Bait and Switch,” showed how mission creep and waste were undermining the implementation of the MHSA. Money has been made available for health fairs, speakers’ bureaus, support groups and advertising campaigns to “be aware of mental health,” but not adequately for beds and homes – outside jail – for the seriously mentally ill.  

Without actual places to live, stay and be treated, there is no continuum of care and no recovery for our family members, many of whom do not even know they are ill. We don’t want them institutionalized – we want them to be treated right away when the illness appears, and before their brains are damaged by sustained psychosis and street drug use.

Early on in my nine-year struggle for my daughter, public facilities kept discharging her despite knowing she would immediately use meth and run away. I could not understand why so much MHSA money was being spent so freely while the county rationed hospital beds and supportive residences so strictly. 

At one point, I didn’t even want to eat the (excellent) ham sandwiches served at public meetings for Alameda County’s behavioral health department simply because MHSA money paid for them. I eat them now because, well, people have to eat – and because I dare to ask for so much more from the system.

At first, my group, FASMI, wasn’t sure what to make of Prop. 1. We initially opposed Senate Bill 326, one of the legislative parents of Prop. 1, as not going far enough to reform the system. It doesn’t include a right to treatment – something families have been asking for and which ought to be a human right for everyone with a no-fault illness. 

But the Prop. 1 package provides many good things, including state oversight and evaluations of county outcomes, which the MHSA sufficiently lacked. It includes treatment of substance abuse so our dual-diagnosis family members don’t fall between stools. It also moves population-based prevention programs (5% of the MHSA budget) to the state, where oversight officials can decide free of local lobbying what it might mean to prevent mental illness.

Furthermore, Prop. 1 retains local funding that can prevent relapse and deterioration of people already diagnosed with serious illness, which was the original meaning of “prevention” in the MHSA.  

The $6.4 billion bond measure included with Prop. 1 designates $2 billion for supportive housing and $4.4 billion for mental health treatment beds – 10,000 of them. I was overjoyed that the bill was amended late to make clear that at least some of the bond money could be used to build secure beds, locked or unlocked, temporary or longer-term – not only hospitals but crisis residentials, residential drug-treatment and dual-diagnosis programs, and peer respites.

Prop. 1 is not intended to solve homelessness. It’s about the mentally ill, treating conditions that affect 82% of the homeless population at some point, according to a UCSF study. To solve the kind of homelessness that is due to rising rents and stagnant income, we need totally different measures.  

Prop. 1 will not “hide” anyone, either. Many of our loved ones are already being hidden in jails and prisons, and – for a day or two at a time – in psychiatric emergency rooms. We will not allow them to drop out of sight or out of mind.

A vote against Prop. 1 is a vote to preserve a failed system. This measure will give the state more control over spending and provide new money for actual countable facilities that will give the system a footprint.

Rest assured, this is not blind optimism. When money is thrown at the powerless, it doesn’t necessarily stick, and it can create an increasingly entitled and entrenched bureaucracy wherever it goes. But California has a chance to steer change under Prop. 1 and move in the direction that saves lives.  

The state is finally beginning to force counties to evolve and give the public a unified, responsible system. FASMI and others will watch the implementation of Prop. 1 closely, and we will help the state watch over that implementation. 

We won’t be fooled by ham sandwiches. 

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