California’s Prop. 1 passed — now the real work on mental health begins
After more than two weeks of suspense, Proposition 1, Gov. Gavin Newsom’s marquee ballot measure to overhaul California’s behavioral health system, appears to have barely passed muster with voters. But it was hardly the overwhelming bipartisan victory the governor had been hoping for.
The message to elected officials, and Newsom in particular, is clear: Voters are increasingly skeptical about pouring billions of dollars into homelessness and behavioral health programs that don’t seem to measurably improve street conditions.
Prop. 1 is a crucial opportunity for the state to prove that it can deliver results.
The measure is highly complex, and effectively implementing it will require the state, counties and cities to set aside their longstanding disagreements about who’s more to blame for the crises on our streets and collaborate instead.
More people with behavioral health issues than ever are eligible to be compelled into treatment — either voluntarily, through Newsom’s signature CARE Court program, or involuntarily, through expanded conservatorship laws — meaning the state needs even more places to house them and workers to care for them.
Prop. 1 aims to address these needs in two main ways. First, it requires counties to redirect a sizable portion of the $2 billion to $3.5 billion they typically receive annually from the Mental Health Services Act — a voter-approved 1% tax on millionaires — to house and provide intensive wraparound services for the highestneeds individuals. Prop. 1 also calls for the state to invest more in oversight and behavioral health workforce development. Second, Prop. 1 authorizes $6.4 billion in bonds to create an estimated 10,000 behavioral health treatment beds and supportive housing placements.
But for these new initiatives to have the maximum positive effect, the governor and legislators must close glaring legal loopholes in California’s behavioral health system. The state also needs to improve its process for transitioning people into facilities that can offer them the appropriate level of care — particularly when they’re coming from highly structured institutions such as jails, prisons or state mental hospitals.
A bill from Assembly Member Matt Haney, D-San Francisco aims to do just that for a small but significant population: seriously mentally ill inmates convicted of certain violent felonies whom a judge has cleared for release from a state mental hospital.
Under current law, the state must release these offenders back to their last county of legal residence within five working days — a perilously short timeline that often leaves officials scrambling to develop reentry plans and line up appropriate housing and treatment. Haney’s bill would increase that timeline to up to 30 working days and permit the court to require that agencies involved in the prisoner’s release present a coordinated exit plan beforehand.
Haney introduced the bill in response to a column by editorial board member Emily Hoeven, which revealed that Fook Poy Lai, the man accused of violently stabbing a San Francisco Chinatown bakery worker last May, had been released from a state mental hospital exactly one week before and initially placed in a single-room-occupancy hotel with no onsite services near an open-air drug market.
“Anyone can look at the process as it is now and say, ‘That’s going to fail,’ ” Haney told the editorial board. “Even when there’s a bed available or a treatment plan available, this dangerously short transition time can make it near-impossible to identify it and transition appropriately.”
Haney said he’s also considering additional legislation to empower judges to consider the circumstances under which an inmate exiting from a state hospital is likely to succeed in the community and, if necessary, require the individual to be released to a clinically appropriate stepdown facility and participate in treatment.
“If the only question (before the judge) is whether they’re safe at this moment” to be released, “that’s not the right question. And you’re never going to get the right answer,” Haney said.
That’s a sentiment shared by Dr. Robert Okin, former chief of psychiatry at Zuckerberg San Francisco General Hospital and a professor emeritus of psychiatry at UCSF School of Medicine, who recommended judges be given that discretion after being briefed on the Fook Poy Lai case.
“The potential for violence can’t be determined without consideration of the context into which the patient will be discharged,” Okin said.
Okin floated other suggestions that state lawmakers should seriously consider, such as requiring that local case managers meet with inmates before they’re released from state hospitals to build trust
and familiarity, establishing clear postdischarge medication plans that have patient buy-in and scheduling initial treatment sessions in individuals’ new housing placements so they don’t have to worry about transportation or other complications.
If signed into law, Haney’s bill could impact hundreds of people each year. According to his office, 1,656 violent offenders were released from state mental hospitals from January 2018 through October 2023.
Of course, the total number of people experiencing homelessness, mental illness and substance use disorder who repeatedly cycle through California’s hospitals, emergency rooms, treatment facilities, jails and prisons is far greater. Haney’s bill underscores the importance of going through programs and laws with a finetoothed comb to discover concerning cracks and then working to close them.
Prop. 1 alone can’t and won’t address the entirety of the state’s behavioral health problem. Now that the measure has passed, the real work begins.