After California became a state in 1850, one of its first acts was to establish the Insane Asylum of California in Stockton, the first of 12 state hospitals meant to care for those with mental illness.
At their peak in 1959, the hospitals housed 37,489 people, but by then, mental hospitals had acquired a bad reputation as “snake pits,” treating their patients as inmates and doing little to treat their illnesses. Reform efforts were already underway.
Eight years later, newly elected Gov. Ronald Reagan signed the Lanterman-Petris-Short Act, named for its three legislative authors, that aimed to reduce hospital populations and involuntary commitments and redirect those with mental illnesses into treatment in their own communities.
However, as journalist Dan Morain explained in a deeply researched article last year, the LPS was the product of political tradeoffs, lacked any financing for community-based treatment or housing, and eventually was disowned by its three legislative sponsors.
Nevertheless, the hospitals were depopulated and seven of them were closed. It left countless thousands of mentally ill Californians — and their families — in the lurch, trying to find care in a jumble of private and public clinics and seeking ways to pay for it.
For decades, politicians, mental health professionals and patient advocates have squabbled incessantly over the obvious crisis. Democrats blame Reagan for signing the LPS without funds for local services, but Republicans point out that Democrats controlled the budget process.
In 2004, 37 years after LPS was passed, voters passed Proposition 63, which placed an additional tax on incomes over $1 million and dedicated proceeds to local mental health services. It was sponsored by Darrell Steinberg, then a state legislator from Sacramento with experience with mental health issues in his own family.
Over last two decades, Prop. 63 has pumped billions of dollars into those services. However, California still has an immense population of unhoused and untreated victims of mental illness, many among the state’s nearly 200,000 homeless people.
While running for governor in 2018, Gavin Newsom pledged to make mental health reform a high priority, calling for a “command structure” that would standardize care throughout the state and hold caregivers accountable.
Newsom first won approval of “CARE Courts” that, at least partially, repealed the LPS ban on involuntary commitments. It would allow those with schizophrenia or other major mental conditions to be involuntarily placed in treatment after trial-like hearings.
Proposition 1, the only statewide measure on the March 5 ballot, is Newsom’s second big move, but faces widespread — if politically weak — opposition from counties which have been spending Prop. 63’s revenues, up to $3 billion a year, for the last two decades.
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The measure, backed by millions of campaign dollars, would increase the state’s share of Prop. 63 money from 5% to 10%, thus reducing counties’ share, but also would require them to spend more on housing, education and support services for the mentally ill, reducing funds for treatment.
Opponents say the practical effect would be to deny care to patients that need it.
The other half of the measure, which is not as controversial, would authorize $6.4 billion in bonds to build mental health treatment facilities and housing for homeless veterans and those with mental illnesses.
Although veterans’ housing has nothing directly to do with mental health, it was obviously included to draw voter support and, in fact, television ads for the measure, featuring Newsom, mention nothing other than helping veterans.
Proposition 1 will very likely pass. It and the CARE court program will be the newest episodes in a decades-long debate. They will also be Newsom’s legacy, for better or worse.
Dan Walters is a CalMatters columnist.
