California Mental Health Policy Is At A Desperate Crossroads

In response to The SF Chronicle, the new legislative session, and the people, DRC & APHC demand a better path

California mental health policy and the continuing work of The Governor and Legislature have been in a terrible death spiral for years now, and as the new legislative session begins, lawmakers need to seriously change course toward better, more effective, cheaper, and less cruel alternative policies.

1.

In the last month, the Editorial Board of The SF Chronicle has published multiple opinion pieces that fixate on single examples and use them to make sweeping, inaccurate claims that inappropriately tie violence to mental illness.

The Chronicle’s headlines and repeated sensationalizing of an individual case to build a narrative connecting crime to mental illness is dangerous, irresponsible and plainly inaccurate. As SAMHSA (Substance Abuse and Mental Health Services Administration) lays out, “most people with mental health conditions are no more likely to be violent than anyone else. Only 3%–5% of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of a violent crime than the general population.”

These scary headlines and inaccurate narratives lead directly to policymakers putting forward policies that fail to address root issues and meanwhile cause real harm to individuals and communities. At the federal and state level, we are seeing a coordinated, ongoing effort to strip people with mental health disabilities of their dignity, autonomy, and civil rights. In San Diego, Assemblymember Carl DeMaio has already announced two bills that would push California even further toward incarceration instead of care: one that would expand the legal definition of “physical harm” to include sexual harassment and sexual battery, opening the door for people to be held in locked facilities for verbal harassment, and another that would require state hospitals to retain so‑called “dangerous offenders” who meet at least four of six risk criteria, making it easier to hold people for longer—sometimes indefinite—periods of time with less cause. While the full details of these bills are not yet public, their direction is clear, and we will almost certainly oppose them in full as they double down on failed mental health policies instead of investing in the supports and economic justice Californians actually need. In his announcement, DeMaio directly cites The SF Chronicle’s recent series of opinion pieces.

2.

For decades, California has filled jails, prisons, and institutions with people who have mental health disabilities. California incarcerates people at a higher rate than anywhere in the world. While the Chronicle’s series frames jail and prison as a last resort, it’s actually been used as a first option for generations.

In recent years, California has doubled down on failed policies designed to incarcerate our way out of California’s inability to meet the needs of people with mental health disabilities and the unhoused. This includes the failing CARE Court, SB 43 (with the poisonous expansion of “gravely disabled”), Prop 1, and Prop 36. In direct response to the Chronicle’s fearmongering, we are already seeing and responding to proposals in the California legislature that would double down on this carceral approach, while evidence continues to show that the laws we’ve put in place are not working.

As this new legislative session begins in California, the state must stop and reset, including committing to actually addressing what individuals and communities need: community-based mental health services and affordable, accessible housing. Disability Rights California, All People’s Health Collective, mental health peers, and organizations representing the interests of the people most impacted agree: California must stop doubling down on harmful, ineffective policies and make a radical shift.

3.

When trusted media institutions like The Chronicle reinforce fears and negative stereotypes, they also do real harm to people with mental health disabilities at an individual level, including reinforcing stigma, making people afraid to seek treatment, and increasing the likelihood of unnecessary arrest and incarceration, physical harm, and death.

This includes harm at the hands of the police, especially against Black and brown people with mental health disabilities. As The Guardian reported recently, “a significant portion of police killings in the US” have taken place when police respond to a mental health call. Nationally, the police have shot and killed 2,057 people in the past decade who were experiencing a mental health crisis. In California, police have shot and killed at least 274 people experiencing a mental health crisis – more than any other state.

People with mental health disabilities are 12 times more likely to experience police use of force, and 16 times more likely to be killed by law enforcement. And severe racial disparities persist. Black Americans are over 3 times more likely than white Americans to be killed by law enforcement.

These opinion pieces are not only ill-conceived, they display a bizarre commitment to reinvesting in the problem itself rather than sustaining tried and true preventative models.

4. A BETTER PATH

For the State of California to get serious about mental health and homelessness, we must fully fund and implement community-based services that actually work. There are a number of policies and program models already working in many communities that we support and that address the real issues facing unhoused, unsheltered people with mental health disabilities in California.

We support Peer Services & Supports.

As SAMHSA reports, when communities center peer-led services and supports, they experience a decreased need for costly, harmful interventions and community members experience improved outcomes. Evidence shows that, when we center peer-led responses, communities experience a decreased need for emergency or in-patient services, decreased unnecessary interactions with law enforcement, decreased incarceration or institutionalization, and therefore severely decreased costs. Evidence also shows that, when we center voluntary, community-based, peer-led responses, individuals are more likely to engage in services, feel empowered and hopeful, and break cycles such that they’re less likely to need crisis services in the future.

We support a robust Crisis Response Continuum.

A robust crisis response continuum means 24/7/365 community-based services that are peer-led, person-centered, trauma-informed, culturally responsive, age-appropriate, linguistically relevant, and gender-affirming. A full continuum of care that includes early intervention and prevention – including peer-led hotlines and warmlines, mobile response teams, and peer respite centers – is key.

As CalMatters reported last spring, “There is little disagreement on the need to minimize the role of law enforcement in mental health crises.” A NAMI (the National Alliance on Mental Illness)-commissioned Ipsos poll last year found that 86% of US adults agree that someone experiencing a mental health crisis should receive a mental health response, not a police response.

We support Voluntary, Community-Based Mental Health Services.

A comprehensive, community-based mental health system includes a menu of voluntary options including for prevention and mild-to-moderate mental health needs, which are key to reducing and preventing crises. This menu can – and in many communities does – include outreach, community engagement activities, skill building, supportive employment, peer wellness centers, drop-in centers, full-service partnerships, assertive community treatment (ACT), youth and transitional aged youth (TAY) services.

Acknowledging the social determinants of health and that people need to not be in poverty and desperation in order to be well,

We support Permanent, Affordable, Supported Housing and Housing First Models

Everyone needs an affordable, accessible, safe place to rest. Recognizing that everything is harder when one’s basic survival need of shelter is not met, Housing First is an evidence-based model that connects individuals with housing first and then connects them with individually tailored, voluntary, community-based supportive services. Housing First is considered the gold standard for homelessness programs domestically and abroad, and has been instrumental in cutting veteran homelessness in half over the past decade.

Accessible housing includes housing that is accessible for individuals’ disability needs as well as housing that is accessible to public transportation, schools and jobs, food, and medical care. Too often, renters are priced out by rent prices that grow multiple times faster than wages and structures in place that keep barriers to entry high, including nonrefundable application fees, security deposits, and fronting multiple months of rent. California must stop compounding its own housing crisis and ensure that California policy considers housing a human right.

We support Economic Justice and Basic Universal Benefits For All

We support economic justice and universal basic benefits because everyone deserves real income and stability, not poverty traps disguised as help. Economic justice is a mental health issue: it is one thing to seek services when you have money and stability, and another to need care when you are scrambling to pay rent, buy food, cover medical insurance co‑pays, or afford transportation. The current social safety net, including programs like Supplemental Security Income, keeps benefits below the federal poverty line and punishes people for working or saving, locking disabled people and people with psychiatric labels into permanent precarity. We must end these traps by calling out negligence by media and political figures, eliminating asset limits, raising benefit levels above the poverty line, and providing unconditional cash, while ensuring that no one is ever punished for working or striving to build a better life, even when a loved one has committed crimes that are painful and difficult to understand.

These systems and solutions are less expensive and more effective. We call on The SF Chronicle to do better and not proactively contribute to negative policy, we call on California policymakers to immediately redirect their efforts towards these better policies, and we call on all Californians to join us in demanding a better future for our mental health care system.

Sincerely,

Disability Rights California & The All Peoples Health Collective