Heads up, Californians. In March, the governor and state legislature want you to vote on Proposition 1,[1] which would change how county governments spend about $3 billion a year from a special tax designed to strengthen the mental health safety net.

If approved, Prop 1 would make county officials focus more money on programs to remediate serious mental illness, homelessness, and substance abuse, even if that forces them to find other ways to pay for current prevention and intervention efforts.

Prop 1 also seeks approval of a $6.4 billion bond to build inpatient and outpatient treatment facilities, and housing for the homeless, especially veterans.

I’ve spent months trying to understand the state’s mental health safety net as a journalist who’s covered thousands of stories, notably in Silicon Valley, and as a person who was once put under a three-day psychiatric hold known as a 5150.

Without arguing pros or cons, I worry that saturation news coverage of the presidential primary will leave Prop 1’s complex issues virtually ignored.

That’s why I suggest an experiment. Imagine if stories on mental health, homelessness, and substance abuse were assembled and made freely available on a popup website. Californians deeply concerned about these issues could dive into this pool of stories, find items for or against Prop 1, and circulate these on social media. That grassroots debate would help this non-partisan initiative compete for attention in a crowded marketplace of ideas.

Governor Gavin Newsom says Prop 1 seeks “the most significant changes to California’s mental health system in more than 50 years.”[2]

I’d put it differently. The record shows that unforeseen consequences of two prior reforms created problems Prop 1 is now supposed to solve. A popup website would encourage serious debate as Californians consider whether this third time is the charm.

Deinstitutionalization

In the late 1960s, then Governor Ronald Reagan closed state psychiatric hospitals and released non-violent patients to community care. For that he’s often accused of dumping patients on the streets. But he was arguably acting in line with policies President John F. Kennedy set in motion by signing the Community Mental Health Act[3] shortly before his assassination in 1963.

Releasing people from asylums was the tenor of the times and deinstitutionalization was its mantra. One Flew Over the Cuckoo’s Nest, the 1962 novel that inspired a play, movie[4] and Netflix series,[5] created Nurse Ratched to personify the abuse of psychiatric patients. To JFK, the issue was personal. His father had hidden away JFK’s sister Rose without telling the family that she’d been forced to undergo a lobotomy.[6]

In 1967, the California state legislature passed the bipartisan Lanterman-Petris-Short Act. It set a high legal threshold for committing a person to an asylum or holding them against their will for presumed mental health disorders.[7]

Over the next 30 years, as states nationwide shut psychiatric hospitals and shifted to community care they, like California, saw mentally ill people land on the streets or in jails. Deinstitutionalization had outstripped the therapeutic know-how and resources needed to make community-based treatment work.

The Millionaire’s Tax

In 2004, mental health advocates in California sought to remedy those shortcomings by winning passage of Proposition 63.[8] It collected an extra penny of state income tax from every dollar a person earned above a $1 million deductible. Proceeds from the tax went to county governments, which maintain California’s mental health safety net.

Proponents thought counties would use Prop 63 money to enroll mentally ill homeless people in voluntary treatment programs and help them get off the streets. This was expected to reduce overcrowding at homeless shelters and keep people out of jails.[9]

Although Prop 63 has raised more than $30 billion since 2004[10] it has failed to meet those expectations. The reasons why are debatable and include factors such as more people being pushed onto the streets by rising rents and home prices; increased drug and alcohol abuse; the 2007-2008 financial crisis, the pandemic, and other social ills.

But Prop 1 expresses state legislators’ bipartisan belief that county leaders – who have passed 19 mental health budgets since 2004 – should be forced to spend money from the millionaire’s tax on serious mental illness, homelessness, and substance abuse. “It’s now about accountability,” Newsom said at a Prop 1 signing ceremony at Los Angeles General Medical Center. “That’s why we had to get aggressive with the counties.”[11]

Since the tax was created by an initiative, changes require voter approval. Legislators requested the $6.4 billion bond to fund what they describe as the largest expansion of mental health treatment and residential facilities since deinstitutionalization began.[12]

Now what?

When Newsom administration officials outlined their plans at a public hearing in April, a member of the commission hosting the event asked a profound yet simple question: “I’m just curious: how are you communicating this to the public?”[13]

I ask myself that as a California journalist. Journalism’s self-appointed mission is to fairly summarize issues, highlight facts, and present an array of views to help citizens make informed decisions.

In the runup to the March presidential primary, the public will get bombarded with candidate coverage while Prop 1 and its related issues will be starved for attention.

A popup would level the playing field. Participating news organizations could pool stories on mental illness, homelessness, and addiction on a nonpartisan, nonadvocacy website. This concentration of articles would offset the volume of candidate coverage.

The popup would attract a relatively small but deeply committed audience with varied views: mental health workers and police officers who see troubled people in different lights; family members with no legal say in the affairs of mentally distressed adult children; activists who fear that weakening the right to refuse treatment would disempower people from disadvantaged communities.

A sophisticated social media debate would surface subtle but important issues lurking beneath the surface such as the difference between assertive community treatment and full-service partnerships, and the tension between ounce of prevention versus pound of cure programs. News media could turn what bubbles up into new stories and feed these back into the pool, creating a virtuous cycle of social media and word of mouth debate to promote an informed citizenry.

Whatever Prop 1’s fate, 50-year-old problems won’t get solved unless elected officials and public servants at all levels come to some shared understanding of what voters want. The clarity of that understanding will depend on the quality of pre-election debate.

A popup to raise Prop 1’s profile would serve an immediate public interest and provide a test case for using collaborative journalism to support democratic problem-solving.

Thank you for reading and sharing this column. Please use the comment box to share ideas, critiques, or express interest. Put your name and email address in the body of the message to get a reply.

[1] https://www.sos.ca.gov/elections/ballot-measures/qualified-ballot-measures

[2] https://calmatters.org/health/mental-health/2023/09/gavin-newsom-mental-health-2024-election/

Newsom said. “Now, it will be up to voters to ratify the most significant changes to California’s mental health system in more than 50 years.”

[3] https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2021.160404

[4] https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_Nest

[5] https://en.wikipedia.org/wiki/Ratched_(TV_series)

[6] https://people.com/books/why-rosemary-kennedys-siblings-didnt-see-her-after-her-lobotomy/

[7] https://tinyurl.com/sn42bbpk

[8] https://tinyurl.com/abbb3499

[9] https://tinyurl.com/3wdmdntb

[11] https://www.youtube.com/watch?v=9uRmsqO7Iz4

Circa 1:27:10 into video

[12] https://www.gov.ca.gov/2023/10/12/governor-newsom-puts-historic-mental-health-transformation-on-march-2024-ballot/

[13] https://otter.ai/u/wZTC5ajC8u0VlMg2S06ZE0rsY7k?tab=summary

My otter file 1 MHSOAC 27April 1:23:09