Institutionalization About Us Without Us: California’s Proposition 1 

Institutionalization About Us Without Us: California’s Proposition 1 

 

Katherine Wolf

Proposition 1 on California’s March 5 primary ballot exploits widespread prejudice against people with mental health disabilities to lock up victims of California’s affordable housing crisis under the guise of care, while cutting funding from effective, voluntary, community-based mental health services. Replacing voluntary community services with involuntary institutionalization disregards evidence-based practices in mental health and substance use disorder (SUD) treatment, increases mistrust of medicine, and facilitates discrimination against the most marginalized among us. As a scholar with mental health and physical disabilities conducting research in health equity and disability studies at the University of California, I urge you to reject Proposition 1.

California’s affordable housing shortage has left over 180,000 people homeless, creating political pressure on Governor Gavin Newsom and city mayors to make encampments disappear. Since the 2018 Ninth Circuit decision Martin v. Boise imposed moderate constitutional limits on California cities’ ability to arrest unhoused people for existing in public without offering alternate shelter, Newsom and mayors have sought alternate ways to eliminate encampments. Luckily for them, involuntary psychiatric holds do not count as arrests under Martin, and institutional beds count as shelter. Thus, with over $14 million in financing from rich special interests, Newsom and California’s big city mayors are promoting Proposition 1 not to improve mental health care for Californians, but to remove people without housing from sight (“Treatment Not Tents”).

Proposition 1 follows a series of Newsom-endorsed bills since 2019 that erode the civil rights of persons with mental health disabilities and widen the path to institutionalization. They weaken patient privacy and hearsay protections, create a new system of mental health (“CARE”) courts, drastically expand criteria for involuntary psychiatric holds and forced treatment, allow private therapists to initiate those holds, and spend billions to create several thousand new institutional beds. Proposition 1, approved by the legislature in 2023 pending the popular vote, continues this trend. 

The first part of Proposition 1 issues a $6.4 billion bond for buildings, not services. While less than one third of it promises 4,350 units of permanent supportive housing, the remaining more than two thirds, $4.4 billion, funds 6,800 new beds in treatment facilities. These institutional beds, which are not long-term housing, will cost California taxpayers over $646,000 each before bond interest. Worse, after the bond’s author, proponents, and original language promised for months that all the beds would be community-based, unlocked, and only for voluntary treatment, the authors betrayed disabled advocates by amending the bill less than 81 hours before passage to replace every instance of “voluntary” and “unlocked” with language allowing forced treatment. 

The second part of Proposition 1 restructures the Mental Health Services Act (MHSA) into the Behavioral Health Services Act (BHSA). MHSA was designed by disabled people themselves to fund voluntary, community-based treatment programs through a tax on incomes over $1 million that generates over $3 billion per year. BHSA, designed without disabled people, redirects much of that money to cover stand-alone SUD treatment and a new housing mandate. Counties testified that they must cut existing mental health services to compensate. Losing MHSA-funded services risks the mental health of Californians using them and will likely cause some to lose their homes.

Evidence supports such voluntary, community-based services over the involuntary hospitalizations that Proposition 1 funds. Suicide rates skyrocket after psychiatric hospitalizations, and coercion increases the risk. Involuntary hospitalization particularly backfires for SUDs. Mere fear of involuntary hospitalization leads people to hide distress from clinicians or avoid treatment entirely. Those of us with mental health disabilities deserve to seek care and develop honest, trusting relationships with clinicians without fear of force.

Proposition 1 also flouts international and national standards for the civil rights of people with mental health disabilities. World Health Organization and United Nations guidance and several international treaties prohibit involuntary institutionalization and forced treatment. Proposition 1 drags California even further out of compliance. It also violates federal constitutional standards that require treatment in the least restrictive setting possible, which California counties already ignore.

Proposition 1’s legislative authors exposed their discriminatory intent during the hearings. They called no unhoused witnesses and none who disclosed a mental health disability. They ignored the recommendations of opposing witnesses who did. In hearings for both Proposition 1 and the companion bill expanding forced treatment criteria, Proposition 1’s proponents deployed racist and sanist stereotypes, portraying Black and brown people as criminal and people with mental health disabilities as dirty, unaware, violent, incapable of recovery, and likely to die. One even mocked people who hear voices.

Their prejudice is not without consequence. Proposition 1 would disproportionately impose forced treatment on already marginalized Californians. For example, systemic racism leaves Black and Indigenous Californians unhoused at enormous rates compared to white Californians and thus more likely targets of forced interventions under Proposition 1. Physicians (overwhelmingly white and Asian in California) also notoriously overdiagnose Black patients with schizophrenia spectrum and psychotic disorders and disproportionately subject patients of color to involuntary psychiatric holds. 

Unhoused and disabled people deserve evidence-based, racially equitable, and cost-effective policies, designed by and with us, that actually keep people housed. Examples include direct cash payments; rental assistance; affordable permanent housing; and mental health and SUD services that are voluntary, peer-directed, community-based, easily available, culturally responsive, and abundantly funded. Not forced institutionalization. Vote no.

 

For more, read this by Leah Harris, “Return of the Ugly Laws: In the Name of ‘Modernization,’ the Newsom Administration Wants to Disappear Unhoused and Disabled People from the Streets, Rebuild the Asylums”

ABOUT 

Katherine Wolf, MPH, MESc, is doctoral student with mental health and physical disabilities in the Sustainability and Health Equity and Disabled Ecologies laboratories in the Department of Environmental Science, Policy, and Management at the University of California at Berkeley. She conducts research at the intersection of environmental health and disability studies with a particular focus on mental health disabilities.

 

Support Disability Media and Culture

DONATE to the Disability Visibility Project®