California’s Governor, Gavin Newsom, is spearheading a significant transformation of the state’s approach to behavioral health and mental illness. This reform agenda, unveiled earlier this year, has recently seen the signing of crucial legislation and the approval of a ballot measure aimed at tackling the longstanding mental health crisis.
The two landmark bills, AB 531 and SB 326, signed into law, are now scheduled to appear on the March 2024 ballot as Proposition 1. The proposed ballot measure seeks approval for a $6.38 billion bond issue, intended to fund the addition of 11,150 treatment beds and supportive housing units. Moreover, it aims to provide outpatient treatment services for approximately 27,000 individuals.
Sen. Susan Talamantes Eggman, one of the architects of this legislation and a co-author of the Community Assistance, Recovery and Empowerment Act (CARE Act), emphasized the urgency of addressing the crisis, emphasizing that “the days of looking away are over.”
This legislative initiative represents a significant shift in the way the state perceives and treats mental illness. Notably, SB 43, which expands the criteria for conservatorship by incorporating substance use disorder, was signed into law, allowing for increased opportunities to hold individuals against their will when deemed necessary. Furthermore, Proposition 1 aims to allocate funding for mental health campuses, supportive housing (including locked facilities), and additional healthcare staff.
While these reforms are substantive, they are arriving from multiple directions, and the absence of an overarching strategic plan raises questions about their effective coordination. There is a pressing need to address structural inequities within the behavioral health care system, and some experts call for greater accountability from insurance companies, with a focus on allocating more funding for personnel rather than infrastructure.
Jonathan Sherin, former director of mental health for Los Angeles County, argues that the legislative efforts, although well-intentioned, tend to concentrate on processes rather than outcomes. He suggests that counties need the flexibility to devise their own strategies for achieving community-defined outcomes.
The successful implementation of these reforms, such as the CARE Act and SB 43, remains uncertain. The CARE Act emphasizes individualized voluntary treatment plans, but a failure to comply may result in the presumption of “gravely disabled,” triggering an involuntary hold.
In conclusion, California is taking unprecedented steps to address its mental health crisis. The state’s comprehensive approach, involving legislative initiatives and increased funding, holds the potential to be a model for the nation. However, the challenge ahead is considerable, with uncertainties surrounding the coordination and impact of these reforms. Addressing the root causes of the crisis, structural inequities, and a clear focus on achieving positive outcomes will be key to the success of these groundbreaking measures.
