>>Investments in mental health care will help alleviate California’s homelessness crisis

The encampment on 28th and C in Downtown Sacramento was no different than other homeless encampments throughout California: Around 30 people, most living in tents, having been on the streets for months or years.

Every day for nearly three months, local outreach teams helped get people off the street. At a city council meeting, I asked: How many were enrolled in comprehensive, “wraparound” mental health and substance abuse treatment services? The stunning answer: Only one.

But why hasn’t the Mental Health Services Act (MHSA), the millionaire’s tax initiative I led in 2004, done more to alleviate the homeless crisis for the thousands of people with serious mental illness and substance abuse living on our streets? The answer: very little MHSA money is focused on chronic homelessness.

To be clear, the MHSA’s billions have helped tens of thousands of people get the care they need. And, until recently, it was essentially the primary source for addressing the needs of people without insurance or access to mental health care.

Opinion

Now, nearly 20 years later, Gov. Gavin Newsom and Senator Susan Talamantes Eggman are seeking to modernize the MHSA. Senate Bill 326, if approved by the voters next March, would give the Legislature greater flexibility in dispersing MHSA funds. Newsom and Egman propose a more aligned approach for counties to spend dollars on proven responses to data-driven needs while retaining local flexibility to meet local needs. Larger percentages of funding will be allocated to housing for people living with serious mental illness or substance abuse and wraparound services, with a specific focus on the chronically homeless and a continuing focus on community care, including prevention and early intervention.

While there has been wide support across the state, from mental health advocates and first-responders to local leaders like me, a few changes have drawn a predictable response from some county leaders who suggest that if they’re required to spend more MHSA dollars on chronic homelessness, valuable programs must be cut.

Currently, California’s 58 counties invest billions of dollars in community-based care with virtually zero state guidance. For the first time, a California governor is proposing that the state has both the right and the obligation to set priorities that address the most serious crisis of our time. Newsom is creating accountability to deliver results and establishing ongoing funding for statewide housing and workforce to ensure our state has the mental health care beds and health care workers it needs.

The governor’s call to prioritize the chronically homeless mirrors the original intent of the act.

In 2004, we wrote Proposition 63 to build on a successful pilot program I authored to begin fulfilling then-Governor Ronald Reagan and the legislature’s unkept promise when they shut state hospitals. Their well-intended policy promised to shift 90% of the savings from hospital closures to community-based mental health care, but that never came to fruition. The idea, the language and the campaign for the MHSA in 2004 emphasized addressing the most tragic consequence of that failed promise: the growing numbers of chronically homeless people living with serious mental illness.

Nearly two decades later, homelessness remains a top priority for most Californians, as recent studies show the money being spent is not focused enough on addressing this crisis. Newsom’s proposal would bring about much-needed accountability at the local level so Californians can finally see results.

Approximately 82% of unsheltered Californians live with a serious mental health condition, according to UCSF. Current MHSA rules require the majority of direct service funds be directed toward the ‘whatever it takes’ approach, but MHSA’s oversight and accountability commission reported that nine out of 10 counties with the highest homeless population are failing to meet this requirement.

Orange County, the only county meeting the required standard, saw a 17% drop in people experiencing homelessness from 2019 to 2022 — even while the statewide homelessness rate went up. That success is not a coincidence.

As for concerns about cutting prevention programs, it’s important to note that the modernization of the MHSA is not occurring in a funding vacuum. Over the past decade, state and federal funding for behavioral health has more than doubled. A recent report provides a detailed look at these funding increases.

Until now, California has never had a governor who made behavioral health a real priority. Newsom and the Legislature have invested billions of dollars in a complete overhaul of our statewide behavioral health network. Combining these new investments with a more focused and accountable MHSA is the best chance we have to make good on one of California’s longest unfulfilled promises.

Darrell Steinberg is the current Mayor of Sacramento, former president of the California State Senate and led the Proposition 63 initiative in 2004.