by Amalia Freedman, CEO

After two weeks of counting votes, California voters passed Proposition 1 by a hair. The proposition, a two-part initiative aimed at improving equitable access to behavioral health services, provides new funding for treatment facilities and housing support while updating the 20-year-old Mental Health Services Act (MHSA). Millions of Californians who cope with behavioral health conditions — mental illness or substance use disorders (SUD) — rely on services and supports primarily provided by California’s 58 counties through MHSA, and increasingly their needs include housing.

Prop. 1 directs the State to borrow $6.4 billion through bonds to fund housing and treatment facilities. The State will also reallocate MHSA funds at the state and county levels, with a slightly greater proportion of MHSA revenue shifting to the State. Where 95% of MHSA funds were previously distributed to county behavioral health systems, now they will receive 90% with an additional 5% funding expansion of statewide efforts, including training, evaluation, innovation, and administration. There will also be new restrictions on how funds can be used, thus funding is likely to decrease for some behavioral health services.

Improving equitable access to needed services regardless of race, age, gender identity, sexual orientation, or county of residence is a critical step in building a more comprehensive behavioral health system in California. And the challenge to ensure access falls primarily on county leaders. Expectations are high, tensions are high, and the divided voter support may lead to challenging conversations around the changes that will inevitably raise for county leaders and families with individuals facing behavioral health challenges. Still, with Prop 1’s ratification, we believe that the answers to five key questions are essential to begin paving the way for the measure’s implementation.

How will funds be allocated at the county level? First and foremost is the process of allocating funds locally. County officials will be required to spend pre-allocated amounts on housing interventions, services, and treatment for adults with severe mental illness, and for behavioral health services. County leaders will need to drive discussions internally and among stakeholders to determine how to implement this spending while expanding community partnerships to extend service provision.

How will programmatic changes resulting from revisions to the MHSA be addressed? Second, each county must adjust programming from previous MHSA requirements to correspond to the new Behavioral Health Services Act (BHSA). The BHSA expands programming to address the needs of people living with SUDs. County mental health plans will need to determine the degree to which they will expand SUD service provision and further integrate mental health and SUD treatment. It is possible that in some locales, reallocating funds will necessitate changes to or elimination of some county services.

How will counties balance the provision of behavioral health services and affordable housing? The BHSA also prioritizes supportive housing for veterans and individuals with behavioral health challenges who are at risk of experiencing homelessness. Decision-makers will need to weigh the impact on existing services while expanding housing options for vulnerable populations based on the new funding requirements.

How will County leaders advise and advocate for effective implementation of Proposition 1? When MHSA was adopted 20 years ago, it not only changed the flow of funding but also the flow of data. County leaders were instrumental in advising the State regarding these issues. With BHSA, leaders will need to convene stakeholders, including mental health advocates, providers, and community members, to shape policies and programs. They must take the results of these conversations to their colleagues at the County Behavioral Health Directors Association of California (CBHDA) to triangulate opportunities and challenges, and to collaborate with state agencies to ensure the most seamless implementation possible. County leaders and communities will need to balance the new mandates with the unique, local challenges they hope to address.

How will county leaders monitor and measure the outcomes of the new BHSA? Counties will need to monitor whether new housing interventions are effective. They will likely need to examine how SUD services align with existing mental health services and any gaps created in their communities. And they will want to look at how the changes in programming affect access. Within a year or so of implementation, counties may want to conduct needs assessments to determine how the changes have affected the clients each county serves as well as needs and gaps in resources to guide adjustments and improvements among providers.

Proposition 1 adds significant funds to support behavioral health and housing. It also calls on county-level decision-makers to rise to this moment. The months ahead will require thoughtful planning, collaboration, and strategic choices to enhance behavioral health services and housing support for Californians. With thoughtful implementation, Proposition 1‘s new mandates should serve the changing behavioral health needs of Californians.

Originally published by Messenger News Group, April 19, 2024