State ballot measure shakes up LA County’s response to homeless, mental health services

It was a highly contested state measure that passed by just a handful of votes, yet despite receiving a high number of no votes, Proposition 1 is in place, bringing substantial changes to how Los Angeles County delivers care for those unhoused with mental health and substance abuse disorders.

In late July, Gov. Newsom, who campaigned for the measure with several LA County supervisors earlier in the year, announced the release of about half of the $6.4 billion in Prop. 1 bond money for treatment facilities and housing. Counties and cities in the state, and local nonprofit service providers, must compete against each other for state grants.

In a discussion on Tuesday, Oct. 1, the Board of Supervisors and county department heads indicated several challenges in pivoting to a new state system that emphasizes housing over outpatient care. One concern is that Prop. 1, the Behavioral Health Services Act (BHSA), gives the state more control over which entities get the money and where it can be spent, officials said.

Nonetheless, the county departments of Mental Health and Public Health are preparing the county applications for state dollars due Dec. 13, in the hopes that grants will be awarded for more treatment programs. The county is also providing support for applications from many of the 90 contracted service providers, who provide services for mental health and substance abuse treatment under county guidance.

“It puts out there a significant dollar amount that we and other organizations will be able to apply for and get,” said Fourth District Supervisor Janice Hahn.

“If we are awarded any of this funding, we can use it to build more treatment facilities. We really need more facilities to house and treat people who have mental health challenges,” added Hahn.

One of the biggest holes in the county’s mental health services net is placement. For example, some individuals need acute, in-patient treatment for serious mental health challenges such as schizophrenia. When left untreated, a person can have emotional outbursts, delusions and hallucinations.

The county estimated it needs 250 more beds for people with mental illnesses who cannot live independently. Often they are released from jails or state hospitals and have no place to go, said Dr. Lisa Wong, director of the Department of Mental Health.

It also needs 250 more housing units that are similar to board and care facilities but with added services for mental health and substance abuse. “We need to make capital investments. Los Angeles County does not have enough housing that are good, safe places for people to live,” Wong said.

Prop. 1 changes the formulas for state funding.

“There is a shift of BHSA funding from services to housing,” Wong explained. “There is a 30% housing category.” About half of the 30% are to be used for the chronically homeless, she added.

She said the shift in dollars for housing could include building new units, but also can be used for rental assistance and rental subsidies.

The county and the state, with help from legislation by state Sen. Bob Archuleta and Newsom, recently agreed to build housing and mental health treatment facilities in vacant buildings on the grounds of the Metropolitan State Hospital in Norwalk.

“We think that project will stand the test of time for Prop. 1 money,” Hahn said. In fact, $5 million was approved by the state as a one-time allotment to the county for the project.

Licensing board and care facilities, which dwindled in numbers in the county in the last several years, also are part of the county’s plan. Many were shuttered because of poor care or other problems.

“We are having to bring that back and be more careful about what kind of care they are providing,” said First District Supervisor Hilda Solis.

She wanted the county to work with cities to locate these and other similar facilities. She said there is a “care desert” in the San Gabriel Valley and in East Los Angeles.

“For the San Gabriel Valley, there is little permanent supportive housing and little interim supportive housing for our clients,” said Wong.

Brian Thorne, chief development officer for Gateways Hospital and Mental Health Center in Los Angeles, told the board he supports the changes the county is making to adapt to Prop. 1, but was concerned about service providers getting grants for new facilities too close to existing ones.

“We need to see the state and county are working together to make sure funding is equally distributed. And also, to make sure East Los Angeles and the San Gabriel Valley are not left out,” he told the board.

Another concern raised is Prop. 1 switch toward housing development. Last year, the county received 32% of funding for outpatient services, such as medication, therapy and helping clients find housing. With new formulas under Prop. 1, that will drop to 17.5%, Wong said.

“How are we going to guarantee that continuum of care?” asked Fifth District Supervisor Kathryn Barger. “We want to to make sure people don’t fall through the cracks and end up unhoused.”

Wong said the answer could be transferring more patients from outpatient status to a higher level of care, which is better funded. She is working with the state to adjust buckets of funding to fit L.A. County’s needs, she said.

Some said the changes foisted on counties by Newsom’s Prop. 1 move the goal posts and make it more challenging for L.A. County to treat those on the streets with mental health and substance abuse services.

“It is a bit confusing,” said Solis. “The public and the provider world are as concerned as we all are.”