California bills could revolutionize state homelessness policies and funding

A combination of three bills facing final votes before the California legislature adjourns on September 14 could rewrite homelessness and behavioral health policies as the state’s closely intertwined homeless and mental health epidemics reach new heights.

These bills would expand the classification of “gravely disabled” individuals who could be compelled into state-funded and state-mandated treatment and authorize a 2024 primary ballot vote for a $4.7 billion statewide bond for mental and behavioral health services, supportive housing and residential facilities, and mandate both allocating a portion of mental health services funding to behavioral health services such as drug addiction, and classifying building new housing for the mentally ill as mental health spending.

Senate Bill 43 is seen as the most controversial of the bills, as it would reform the Lanterman-Petris-Short (LPS) Act of 1967, a bipartisan bill passed by a Democratic legislature and signed into law by then-governor Ronald Reagan to limit involuntary mental health commitment of Californians. Under this act, individuals who are identified by peace officers or other qualified individuals as dangers to themselves, others, or could be classified as “gravely disabled” can be held in a mental health facility for up to 72 hours for evaluation, after which a 14 day hold can be carried out. For this second hold, an individual must receive a court hearing within four days of receiving this hold to ensure due process. After this second hold, a temporary and later, more long-term conservatorship can be initiated.

SB 43 would expand “gravely disabled,” which under LPS means an individual who is unable to provide his or her self with food, clothing, or shelter, to include a person who, as a result of a severe substance use disorder or co-occurring mental health disorder with a severe substance use disorder, is unable to provide for their personal needs, which would include maintaining personal safety and securing necessary medical care. According to an analysis from the state legislature, providing just the conservators for those under this vastly expanded definition of gravely disabled — targeted at the state’s growing homeless population — would cost the state in the “low hundreds of millions” of dollars while paying for this new care would cost in the “high hundreds of millions” of dollars.

“Our current model is leaving too many people suffering with significant psychotic disorders in incredibly unsafe situations, leading to severe injury, incarceration, homelessness, or death,” wrote bill author State Senator Susan Eggman, D-Stockton. “While well-intentioned, the dated criteria in LPS no longer work for today’s needs and have contributed to the mass incarceration of those with mental illness. This bill will help to provide dignity and treatment to those who are the most difficult to reach.”

The Big City Mayors Coalition, Psychiatric Physicians, Alliance of California, California State Association of Psychiatrists, and the National Alliance on Mental Illness co-sponsored the bill. A coalition of the ACLU California Action, Disability Rights California, and Western Center on Law and Poverty oppose the bill because it will “perpetuate health disparities, disproportionately burdening the unhoused and Black, Indigenous, people of color (BIPOC) and immigrant racial minorities,” “traumatize individual patients and undermine public health policy by causing patients to distrust behavioral health systems,” and “cause the unnecessary institutionalization of people with disabilities in violation of the [Americans With Disabilities Act].”

SB 43 has passed through committees and floor votes without any opposing votes and now must pass a final floor vote from the Assembly.

Gov. Gavin Newsom’s package of two mental health bills, Assembly Bill 531 and SB 326, are the core of the governor’s legislative agenda. If passed, AB 531 would authorize a 2024 primary ballot vote in March for a $4.7 billion statewide bond for mental and behavioral health services, supportive housing and residential facilities. Of note is that facilities built using these funds could be built by right, allowing them to be rapidly constructed. SB 326, meanwhile, would mandate allocating a portion of mental health services funding to behavioral health services such as drug addiction, classifying building new housing for the mentally ill as mental health spending. While larger cities support SB 326, other counties would prefer maintaining flexibility in setting mental health spending priorities, such as whether or not to use limited mental health funding on housing services.

“This reform will bring much needed accountability currently lacking at the local and state level, increased transparency and visibility into the whole mental health and addiction treatment system, and a modernized focus to address today’s crises, “ said Newsom, speaking on both bills as a single package in a news release. “We are working hand-in-hand with families, experts, advocates, local officials, and more to help all Californians in need of mental health or substance use disorders treatment and support.”

AB 531 passed without any opposition in the Assembly but now faces a full vote in the Senate, where some Republicans have opposed the bill. SB 326 has passed all votes with only one vote against it and faces a pending full Assembly vote.