CALIFORNIA, USA — This story was originally published by CalMatters.
A last-minute change to one of Gov. Gavin Newsom’s signature mental health proposals this week shocked advocates for disabled Californians, who called the move a “bait and switch” that could open the door to the involuntary institutionalization of people with mental health illnesses.
The dispute centers on a more than $6 billion bond that would be used to build treatment facilities and supportive housing for people suffering from mental illness or addiction disorders. It’s a companion to a separate proposal likely heading to the ballot that would adjust California’s 20-year-old Mental Health Services Act in a way that would compel local governments to spend more money on housing for homeless people with mental illnesses.
The bond was not controversial this year until the final week of the legislative session, when the bill that would place it on the ballot was amended in a way that stripped language prohibiting the money from being used on involuntary confinements. The replacement language mirrors 2021 legislation that created the Behavioral Health Continuum Infrastructure Program, a $2.2 billion investment that has been used to fund locked facilities like acute psychiatric hospitals.
The Senate today voted 35-2 to place the bond on the ballot. In a 63-7 concurrence vote, assemblymembers accepted the amendments. The bond will go before voters on the March primary election ballot.
“We are horrified,” said Samuel Jain, senior attorney with Disability Rights California. “The administration at the last possible moment … put in language that completely changes the intent of this bill.”
The bond measure, totaling nearly $6.4 billion, has been touted by Newsom as a way to address California’s acute shortage of mental health treatment beds. It would be used to build 10,000 treatment beds and supportive housing units, a portion of which would be reserved for veterans with mental health or addiction struggles.
Disability Rights California and other advocates told CalMatters that in both private and public meetings Newsom officials emphasized the money would fund housing and unlocked treatment settings for people with severe mental health illnesses and substance use disorders. A recent fact sheet from the governor’s office that was published before the amendments stated the facilities would be in “all unlocked, community-based settings.”
“All of these presentations have been a misrepresentation of what this bill will actually do,” Jain said.
Newsom officials disagree with the assertion that mental health and disability advocates were misled. Discussions with county behavioral health officials, first responders, and family members of people with severe mental illness led to the changes, Newsom spokesperson Brandon Richards said.
“There was an articulated desire to ensure that the $6.38 billion bond…be used for the full spectrum of behavioral health treatment sites,” Richards said.
The changes do not upend the state’s commitment to supporting community-based treatment, Richards said. Michelle Baass, director the the Department of Health Care Services, said in a late-night committee hearing on the amendments that the state’s policy objective is still to serve Californians with behavioral health needs in the “least restrictive” way possible.
Assemblymember Jacqui Irwin, a Democrat from Thousand Oaks, who is carrying the measure did not respond to comment by deadline.
More funding for mental health beds
If legislators and voters approve the bond, the amendments do not mean all of the money would be used on locked treatment facilities, but it does allow for that investment.
According to state records, at least 16 locked facilities have been funded from the 2021 law that set aside money for behavioral health beds. However, a majority of the grants from the program have gone toward unlocked, community-based care. Newsom officials also contend that secure facilities have an appropriate place in behavioral health treatment and that patients can voluntarily admit themselves if they are suicidal or believe they may harm others.
In a policy priority letter last month, the California chapter of the National Alliance on Mental Illness supported using the bond funds for “acute beds” that are used for involuntary psychiatric holds. Representatives for the organization did not return a request for comment before publication.
The mental health alliance, which supports family members of people with serious mental illnesses, was a proponent of Newsom’s CARE Act legislation that passed last year. That law allows courts to place a person with a severe mental illness into an involuntary treatment program. Although the alliance advocates for community-based treatment and voluntary treatment as a first step and has asked the state to fund such programs, its members believe court-ordered intervention is sometimes necessary.
“We are aware that there are individuals with serious mental illnesses who have very high complex needs, at times, due to their illness, lack insight or good judgment about their need for medical treatment. In cases like this, a higher level of care may be necessary, but must be the last resort,” the organization said in a statement in support of the CARE Act.
Mayors back Gov. Gavin Newsom’s bond
But some advocates for people living with mental illnesses say all forms of forced treatment cause long-term psychiatric harm.
“We are exposing people to what is a very traumatic experience of having your agency taken away and not providing effective programming,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network. “People are not progressing with their recovery when it’s against their will.”
Savage-Sangwan said people of color are disproportionately affected by forced treatment in part because they have less access to preventive interventions. Instead, “intensive day programs, wraparound support, group therapy, and social service linkages” have been shown to be much more effective, Savage-Sangwan said.
“We know what works, and what works is community-based programs that are voluntary and address a range of needs,” Savage-Sangwan said. “When people engage voluntarily we have better outcomes.”
Eleven years ago, LaTanya Ri’Chard was involuntarily hospitalized and restrained in Virginia at age 38. Ri’Chard had been incorrectly diagnosed with bipolar disorder and schizophrenia and was suffering from severe medication side effects including paranoid thoughts, she said. Law enforcement locked her to a wheelchair and placed her in an isolated room for more than a week with no other treatment, she said.
“They treated me like an animal. It was terrifying,” Ri’Chard said.
Today, Ri’Chard works as a peer support specialist in Merced County and is associate director of the peer-support nonprofit Communities Voices.
“I see people being treated the way I was treated, and I can’t have that. I don’t want it for me. I don’t want it for the world,” Ri’Chard said.
Many of these groups that remain opposed to the sister proposal to the bond measure told CalMatters they did not oppose the bond specifically because it was supposed to dramatically expand the state’s capacity for community-based programs. If approved by the Legislature, both proposals will appear on the same ballot measure as Proposition 1.
Big City Mayors, which organized a successful last-minute lobbying effort to increase the bond by $1.5 billion, said it did not ask for the other amendments. The organization, which represents the state’s 13 most populous cities, still supports the bond measure, said Rachel Laing, spokesperson for San Diego Mayor Todd Gloria, president of Big City Mayors.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.