Mental health services are trending towards criminalization rather than care, threatening the progress of the peer movement.
This November will mark 20 years since California voters passed the Mental Health Services Act (MHSA). Since then, $31 billion has been raised through the Act’s 1% tax on incomes above $1 million. After some significant delays, that money began funding vital community mental health services.
These funds succeeded in increasing investment in peer support and recovery-oriented treatment. These investments have reaped benefits beyond the services themselves. For example, people who recovered their lives through appropriate services funded by MHSA have chosen to help others in crisis.[5] A growing peer support workforce enables increasing numbers of people to benefit from recovery-oriented treatment. That, in turn, leads to more people wanting to join that workforce.
In 2020, California formally recognized the importance of peer support by enacting legislation to certify peer support specialists as a new category of health workers. The legislation also made peer support a covered Medi-Cal benefit. California now has 2500 certified peer support specialists.
However, the new wave of coercive, punitive mental health laws threatens the progress made by the MHSA and the peer movement. A series of new policies, including CARE Court, SB 43, and Proposition 1, push the system towards carceral approaches to addressing mental health needs. These policies rely on a narrative that people with mental health issues are not taking care of themselves and must be pushed into treatment; however, community mental health options are severely lacking, along with the housing needed for people to stabilize their lives. These programs are even more concerning considering other attempts to criminalize homelessness and disability in California, as described later in this report. Our current system is far from perfect, but we need to focus on expanding what works: voluntary, culturally competent services in the community.
Court-ordered treatment is expanding.
In 2022, California enacted CARE Court. The legislation applies to people with schizophrenia or other psychotic disorders but was oversold as a program to help people with mental health disabilities who are unhoused. CARE Court permits almost anyone to file a petition against another person and provides no housing guarantees, leading to an ineffective and coercive system of services. Peer-reviewed research has repeatedly demonstrated that court-ordered mental health treatment is not more effective than voluntary treatment.[6]
The results of CARE Court thus far show that it is based on a false premise that large percentages of unhoused people are unhoused because they live with schizophrenia spectrum disorders and refuse treatment or social supports. The number of participants is far below the expected uptake, and the demographic data we have seen already shows racial inequities. CARE Court funding, which is expected to reach about $300 million a year for implementation, funds the court system, not services or housing. Ultimately, CARE Court is a burdensome and costly program that misses the mark on addressing mental health and homelessness.
New laws expand involuntary holds for people with mental health disabilities.
Legislation enacted in 2022 added a second 30-day involuntary hold to existing statutory 72-hour, 14-day, and 30-day holds. These extended involuntary holds keep people in locked facilities rather than in the community, remove civil rights and civil liberties, and increase the risk that the person will be subjected to a longer, virtually permanent conservatorship.
Legislation enacted the following year takes further steps to subject people with mental health disabilities to involuntary holds in locked settings. The 2023 law expands the definition of “gravely disabled” and allows the hearing officer to consider evidence previously inadmissible. The expansion of involuntary holds creates additional pathways to conservatorships, which restrict the rights of people with mental health disabilities.
“Modernization” is a step backward.
Passage of Proposition 1 in March 2024 has the potential to disastrously expand forced institutional treatment for Californians with mental health disabilities. Prop 1 reallocates 30% of MHSA funds towards housing interventions and requires that existing funds serve an additional population: people with substance use disorders. This means that programs providing mental health services, such as programs serving racial, ethnic, and linguistic minorities, will see cuts. Disabled Californians are entitled to appropriate community-based permanent housing and mental health services. We reject the idea that people with substance use disorders and mental health disabilities need to be pitted against each other for the same funding, as this initiative does. California needs to adequately resource mental health and substance use disorder services rather than forcing marginalized groups to compete for limited funds.
Further, the dollars from the bond measure in Prop 1 could go to short-term treatment beds including expensive locked institutional settings. Locked facilities frequently violate disabled peoples’ rights, and coercive treatment practices are less effective than voluntary treatment, which is currently woefully underfunded across the state.
This initiative is a step in the wrong direction. Rather than funding programs that already work and should be expanded, the governor is imposing a top-down system that does not consider specific community needs.
The 2024-2025 budget contains further cuts in behavioral health, such as behavioral health bridge housing, youth behavioral health programs, and CalWORKs mental health and substance abuse services. If the governor truly wanted to “modernize” California’s mental health system, these programs would be growing, not facing cuts.