California wants to force people into mental health care. Advocates say it will backfire

California’s Proposition 1 – the only statewide measure on the ballot – would significantly restructure California’s mental health system.

It is also one of the most complex and convoluted measures voters have had to decide on in recent years. The full text of the proposition in the state’s 112-page voter guide takes up 68 pages.

The measure has two parts. First, it would raise $6.4bn over 20 years to build more housing and treatment facilities for people with mental health and substance use disorders. It would also enact new requirements on how the state’s mental health budget would be spent – redirecting about a third toward housing and rental assistance for unhoused people with serious mental illness or addiction, and another 35% toward treatments for that population.

California’s governor, Gavin Newsom, who proposed the measure as a crucial part of his plans to solve the state’s dire homelessness crisis, has said it would “prioritise getting people off the streets, out of tents and into treatment”. Opponents, including disability rights activists, mental health advocates and the American Civil Liberties Union, countered that it would take money away from community-based preventative mental health programs to finance locked-door psychiatric institutions and involuntary treatment.

“It’s good politics, as Newsom positions himself to run for president in 2028,” said Samuel Jain, a senior policy attorney for Disability Rights California, an advocacy group. “It’s not good policy.”

The bond measure was not controversial until late last year, when lastminute amendments to the bill placing it on the ballot stripped language preventing the funds from being used on involuntary confinements. The changes came hours before it was too late to change the legislation, said Jain, who added: “It came as a really big surprise.”

The result, Jain said, was a hefty, opaque ballot measure that lumps housing for veterans and unhoused people and treatment programs for people with severe mental illness and substance use disorders alongside funding for programs that could facilitate coerced institutionalisation.

Critics have also pointed out that the $6.4bn bond would fund only about 4,350 new homes for people, according to the state legislative analyst’s office – which is hardly enough to shelter California’s estimated 180,000 unhoused people.

Meanwhile, the Yes on Prop 1 campaign, backed by healthcare companies such as Sutter Health and Kaiser Permanente and unions backing the state’s prison guards and construction workers, have amassed about $14.3m to sell the measure, focusing on how the program would help veterans and the unhoused. The no campaign has raised just about $1,000, according to campaign finance records.

But taken along with other major mental health programs that Newsom and legislators have championed, advocates worry that Prop 1 will further efforts to institutionalise and lock away unhoused people. The governor’s other landmark mental health reforms include the Care court program, which will empower families, healthcare providers and outreach workers to ask state courts to compel people with certain severe mental disorders into treatment programs designated by local governments, and SB43, which expands the group of people who can be placed in involuntary psychiatric holds or forced to undergo medical treatment to include people with serious