California voters are skeptical that more money is the answer to homelessness

KFF Health NewsMar 12 2024

California Gov. Gavin Newsom's expensive ballot-box attempt to tackle the mental health and addiction crisis on the state's streets is leading by a razor-thin margin, a week after the March 5 election. The close vote reflects growing skepticism among voters that he can effectively address the state's homelessness epidemic.

Proposition 1 would fund thousands of new housing units and treatment beds with a $6.4 billion bond and by redirecting $3 to $4 billion in existing mental health tax revenue.

It is the latest in Newsom's arsenal of policy ideas to attack homelessness and marks the most aggressive push in the nation to get people off the streets, into housing, and connected with health care.

Newsom argues the measure is key to gaining control of the public health crisis, in part by aggressively addressing the drug and alcohol addiction that prevents so many homeless people from getting into stable housing.

Yet Newsom, a two-term Democratic governor with national ambitions, has struggled to convince voters that California can responsibly use the money to address the epidemic.

As of March 11, Proposition 1 had a very slight lead in balloting — 50.4% for vs. 49.6% opposed. Tallying the final vote could take weeks, though Newsom advisers said they're confident the measure will ultimately prevail.

Health and policy experts say the tight race reflects public skepticism over pouring billions more into homelessness interventions that critics argue aren't making a visible difference.

"There's been a ton of money going into homelessness with very little progress; the crisis is just getting worse," said Dan Drummond, executive director of the Sonoma County Taxpayers Association. He said he is a lifelong Democrat and voted for Newsom but has lost confidence that Newsom — and state government — can handle the crisis, so he voted against the measure.

Tents and plywood lean-tos are crowding streets and sidewalks from rural Northern California to San Diego. More than 181,000 people are homeless in California, according to the most recent federal tally, and thousands who can't afford housing are living in unsanitary and unsafe conditions, exposed to extreme cold or scorching heat. Often, they struggle with drug use and untreated mental illness.

Newsom has risked enormous political capital on the issue. During a campaign blitz in early March, Newsom promised 11,150 new housing units and treatment beds and broader mental health reforms, including ongoing money for permanent supportive housing and addiction treatment.

No other state has tried as hard as California to attack homelessness. Newsom created an initiative to convert hotels and motels into permanent housing for homeless people. He is asking the Biden administration for permission to provide six months of free rent for homeless people. He launched a Medicaid initiative to provide other social services and housing supports for those on the streets or at risk of becoming homeless. The governor has spearheaded new laws to mandate treatment for those with serious mental health conditions.

So far, Newsom has plowed more than $20 billion into the crisis, with billions more for health and social services. Newsom says at least 71,000 people have gotten off the streets, yet the public health crisis is worsening. Homelessness has risen 20% since he took office in 2019, and addiction and mental illness are more rampant, experts say.

"It is very hard to sit here and tell you that I think we're solving the problem, or that Prop. 1 will solve the problem, even with the billions and billions we are spending," said Stephen Manley, a Santa Clara County Superior Court judge who routinely rules on cases involving homeless people facing mental health- and drug-related misdemeanors and felonies.

"I've got people stuck in jail even though I've ordered them released because there's no beds or housing available, and numbers on the streets just keep rising," he said.

In California, an estimated 48% of homeless people regularly use hard drugs or drink alcohol heavily, have hallucinations, or have had a recent psychiatric hospitalization, said Margot Kushel, a primary care doctor at Zuckerberg San Francisco General Hospital and Trauma Center and a leading homelessness researcher at the University of California-San Francisco.

The missing piece, Newsom said while campaigning for the initiative in the Coachella Valley, is Proposition 1. He argued the state desperately needs the infusion of money to fund new treatment beds and housing, complemented by social services to help people get healthy and stay housed.

"All of this is considered part of this larger mosaic, but the beds are foundational," Newsom told KFF Health News.

Tom Insel, a neuroscientist and psychiatrist who formerly led the National Institute of Mental Health, also served as Newsom's "mental health czar." Though he supports Proposition 1, he said it would "not be a silver bullet."

If the measure passes, he said, "the execution and implementation on the ground is going to be critical to achieving success. We're not great at these capital projects in California. It takes a lot of time that we don't have."

Insel and other addiction experts said the initiative could alleviate bottlenecks in the health care system that can lead to overcrowded emergency rooms and delay care. Homeless people experiencing drug or mental health crises regularly flock to hospitals because they have nowhere else to go.

"We need help at every single level. We need psychiatric and detox beds, long-term addiction beds, permanent supportive housing," said PK Fonsworth, an addiction psychiatrist who treats a steady stream of patients with psychosis and addiction in the emergency room at MLK Community Hospital in South Los Angeles. "Every day in the emergency room, there's a list of dozens of patients that need psychiatric care, especially those suffering from homelessness and addiction. But what I can offer them is extremely limited."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.