SACRAMENTO -- How much difference will a March ballot measure make when it comes to fighting California's massive homelessness crisis? That's the question before voters as they weigh in on Proposition 1, which has been touted as California's chance to finally do something about the epidemic on the streets.
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Prop. 1, the only proposition on California ballots this March, asks voters to green-light a $6.4 billion bond for treatment beds and housing units catering to people with mental illnesses and addictions. It also would restructure some current funding to funnel more mental health money toward housing.
Gov. Gavin Newsom, who has championed the measure, said it will "prioritize getting people off the streets, out of tents and into treatment." The governor has a lot riding on its success, as voters become increasingly frustrated with the state's lack of progress when it comes to cleaning up encampments and helping the people suffering within them.
But experts are cautioning against putting too much stock in Prop. 1 as a solution.
It won't help everybody -- not by a long shot. Nor is it designed to. In addition to funding 6,800 beds in facilities treating mental illness and addiction, the $6.4 billion bond would create up to 4,350 new homes for people who need mental health and addiction services -- 2,350 of which would be reserved for veterans, according to the Legislative Analyst's Office. In a state with an estimated homeless population of more than 180,000, that will hardly make a dent.
"It will be great for those individuals, but still leaves almost 98% outside or in shelters," said Bob Erlenbusch, executive director of the Sacramento Regional Coalition to End Homelessness.
Prop. 1 also would require counties to spend 30% of their Mental Health Services Act funds on housing -- including rental subsidies and new construction. Those funds, which come from taxing California's millionaires, are expected to raise about $1 billion per year for housing programs.
New homes funded under Prop. 1 would target homeless Californians who often are both the most visible and the hardest to help, including those in the throes of psychosis and addiction. Many unhoused Californians don't fit that description.
"The public perceives it as everyone, and it's definitely not everyone," said Dr. Margot Kushel, who directs the UCSF Benioff Homelessness and Housing Initiative, "but there are a fair number of people who have these disabling conditions."
In a recent comprehensive study of homeless Californians, 27% of people surveyed had been hospitalized in their lifetime for a mental health problem. When asked if they had ever experienced a prolonged period of hallucinations, 23% said they had, according to the study by the Homelessness and Housing Initiative.
About one-third of those surveyed reported using drugs three or more times per week.
Even though it leaves people out, pouring resources into the sickest subset of California's homeless community is the humane thing to do, said Sen. Susan Talamantes Eggman, a Democrat from Stockton.
"They count too," said Talamantes Eggman, whose bill reforming the Mental Health Services Act became half of Prop. 1. "We can't just see people as a problem. You have to see people as people and (ask) how do we do our best to help those who need it the most?"
Targeting the people with the highest needs may be politically savvy as well. Voters who are up in arms over the state's increasingly dire homelessness crisis -- and politicians' seeming inability to fix it -- aren't complaining about the person who drives for Uber during the day and sleeps in his car, out of sight, at night. They're complaining about the people living in encampments, walking into traffic and shouting at nobody. Those are the people this measure could help. And that's where voters might actually see the measure make a difference on the street.
"We're at a point where voters need this," said Christopher Martin, policy director for Housing California. "Voters are feeling fatigued on housing and they need to see some progress, and I think we need to demonstrate that."
But Susan Ellenberg, president of the Santa Clara County Board of Supervisors, doesn't anticipate Prop. 1 will do much on that front.
"In terms of addressing homelessness, we need more housing, period," she said. "And I worry that when people's expectations are conflating, they're disappointed and feel that problems aren't being solved even though so much money is going out the door."
She also worries that some of the unintended consequences of Prop. 1 could end up exacerbating her county's homelessness crisis. To pour the required amount of Mental Health Services Act funding into housing, the county will have to take money from other programs. That means there will be fewer dollars for things like homelessness prevention and early mental health interventions. If the county skimps on the types of services that keep people off the streets in the first place, Ellenberg worries more people will fall into homelessness or their mental health will deteriorate to the point where they need even more care.
Los Angeles County's mental health department also has "some serious concerns" about Prop. 1, said Director Lisa Wong. Last year, the county spent 32% of its Mental Health Services Act funding on outpatient services -- the psychiatric care, counseling, medication and more that helps stabilize someone living outside a psychiatric facility. If Prop. 1 passes and redirects a chunk of that funding into housing, the county will be able to spend less than 18% on outpatient services -- and other programs such as crisis response and homeless services will have to dip into that funding pool as well.
"We are concerned that missing those service dollars might compromise the ability of people to stay in housing once they're housed, or to get to a place of wellness where they can be successfully housed," Wong said.
Recent expansions in Medi-Cal mean more people are covered for more services, which should help offset funding losses, Talamantes Eggman said.
"I don't see it as cuts," she said. "I see it as a reprioritization."
There's also the question of how counties will come up with the resources needed to make the necessary program shifts. Santa Clara County is facing a shortage of workers and hiring freezes brought on by a budget deficit, Ellenberg said.
"I feel like we're being asked to do significantly greater amounts of work with fewer and fewer tools," she said.
Kushel, who specializes in the intersection of homelessness and health, said the authors of Prop. 1 -- Talamantes Eggman and Democratic Assemblymember Jacqui Irwin of Thousand Oaks -- have their priorities in the right place.
It's nearly impossible to stabilize someone's mental health or treat their addiction while they're living on the street and pouring all of their effort into surviving day to day, Kushel said. But when given housing combined with the right treatment plan, even people who seem incredibly sick can thrive.
"Will it be enough? I don't know," she said. "But it seems like we should try."
How can Prop. 1 funds be put to the best use? In San Diego, Deacon Jim Vargas says: detox beds. He runs Father Joe's Villages, which has more than 1,000 shelter beds -- none of which are specifically for detox. The entire county has only 77 detox beds -- not nearly enough, he said.
Vargas hopes to use Prop. 1 dollars to open more.
"I'd like to think that yes, it will make a difference on the streets," he said.
Martin, of Housing California, has more tempered expectations.
"It's certainly a step in the right direction," he said. "But it's not everything."