Cloutier: Without Prop. 1, our dire housing and untreated mental health crisis will get worse

On March 5, Californians will be asked to vote on Proposition 1 — creating housing and a range of treatment options for the state’s unhoused citizens with complex mental health and substance use conditions.

We know this proposition has trade-offs, as any piece of legislation does. But will this move California forward in addressing homelessness and supporting the vast mental health needs across the state? Resoundingly, yes.

Known as “Treatments not Tents,” the proposition would authorize $6.38 billion in bonds to finance housing. There are an estimated 181,399 unhoused Californians; 25% with severe mental illness, 24% with a substance use disorder. While there is overlap between those categories, no reliable studies have established an estimate.

Because of a shortage of care facilities, most of these Californians go untreated, furthering their suffering and driving engagement with law enforcement and hospital use; often making the situation worse for the unhoused person and clogging our emergency rooms with people who need a completely different kind of care. These unhoused Californians are also disproportionately Black, Indigenous, Asian American Pacific Islander and LGBTQ — youth in particular — who endure this neglect.

This ballot proposal would authorize investments in supportive housing and treatment facilities creating up to 4,350 homes, with 2,350 set aside for veterans and an additional 6,800 mental health and substance use treatment places. An estimated 26,700 outpatient slots will also be created that may serve several thousand Californians. In particular, nearly $3 billion of the $6.38 billion is for crisis stabilization, sub acute and acute care, crisis residential, substance use treatment and longer term treatment and rehabilitation options. These settings have been in extreme demand and now there is relief in sight.

When unhoused individuals — 82% of whom struggle with mental illness — can be housed, they are offered a lifeline to build a foundation for stability. They are in a better position to make medical appointments, take medication, job search and more. They are able to escape the chaos on the street in which they cannot engage in care. By helping them build that foundation, we will save lives while also saving millions of dollars.

Proposition 1 will rename and re-prioritize hundreds of millions of dollars that are generated from the Mental Health Services Act (MHSA). The MHSA will be retitled the Behavioral Health Services Act and redirect 30% of funds toward housing supports and away from prevention, early intervention and community services. That is where the trade-off comes in. County services for vulnerable populations will be prioritized with redirecting dollars for housing and care for other vulnerable populations. Proposition 1 will likely create pressure for county and city governments to backfill these dollars, which could cause some programs to close if unfunded.

We need to look at this legislation from a broader perspective. If Prop. 1 wasn’t on the upcoming March ballot, what would that mean for the homelessness crisis in California? There will never be a policy that solves all of the problems within the behavioral health care system. While we need to continue to push for all fairness of care, that shouldn’t undermine our support for the critical solution provided by this proposal.

Prop. 1 is a game changer for our state, one that is finally recognizing the dire needs of its underserved communities. This would open doors for individuals past the stage of needing intervention services. Prop. 1 heralds supplying resources that are vital for mental health and substance use treatment. The reprioritization of funds will require state and county governments to step up to finance sidelined services.

It’s time we dedicate proper funding to both issues while unequivocally voting yes on Prop. 1 — that’s the best step forward to treat the most neglected among us.

Mark Cloutier is CEO of Caminar, a behavioral health organization that serves more than 31,000 individuals annually in the San Francisco Bay Area and Northern California. He previously held leadership roles in major health organizations and foundations including Horizons Services, the San Francisco Foundation, the Center for Youth Wellness, Kaiser Family Foundation and San Francisco AIDS Foundation.