The past two weeks, Gov. Gavin Newsom has signed several bills that will dramatically alter how the state treats mental health conditions and problems. The effort to improve treatment of mental health is also intended to help reduce homelessness throughout California.

Newsom’s efforts to address the growing problem began in September 2022 and will continue into 2024. Last September, he signed the Community Assistance Recovery and Empowerment (CARE) Act, Senate Bill (SB) 43. The CARE Court, which began proceedings in Riverside County Oct. 2, is intended to help those suffering from untreated mental health and substance abuse disorders leading to homelessness, incarceration or worse.

In March 2024, Proposition 1 will be on the ballot. This is a $6.38 billion bond for constructing behavioral health treatment and residential care settings, and permanent supportive housing.

Oct. 10, Newsom signed Senate Bill 43 that significantly updates California’s conservatorship laws for the first time in more than 50 years. It redefines “gravely disabled” to include a person with mental health problems or substance abuse, such as chronic alcoholism, who cannot care for themselves, according to his press release.

“Gravely disabled” Californians, including those SB 43 now protects, can have a conservator appointed to direct their care with continued protection of individual rights and increased transparency on data, equity and outcomes.

Under California law, “gravely disabled” will now include the possibility of substantial risk or serious harm to individuals, including causes such as a mental health or a substance abuse disorder. Several actions or inactions had been used to determine when “serious harm” was occurring. These include the inability to seek and satisfy nourishment, seek personal or medical care, or inability to find adequate shelter or clothing.

No longer will help be limited to those with the inability to provide for food, clothing or shelter. Going forward, those who cannot provide for their own personal safety and necessary medical care or to understand the nature or purpose of efforts to provide help will be eligible for help.

Sen. Susan Eggman introduced SB 43 in December 2022. In March, the Senate’s Health Committee held a hearing on the bill and unanimously cleared it.

In her news release before the hearing, Eggman said, “People are suffering needlessly, many on our streets, and we are leaving family members who are seeking help for their loved ones with few tools and little help. It is time to do better.”

“California is undertaking a major overhaul of our mental health system. The mental health crisis affects us all, and people who need the most help have been too often overlooked. We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve,” Newsom said after signing SB 43.

Health professionals were strongly in support of these changes in the current law.

“SB 43 contains several changes to law to ensure that individuals who are truly the most gravely disabled Californians obtain the services they need,” said California State Association of Psychiatrists Chair Dr. Jessica Thackaberry. She expressed gratitude to both Eggman and Newsom “for understanding that state law needs to be updated so that it reflects the unfortunate realities of what behavioral health professionals see manifesting every day in our communities.”

All of this comes just as CARE Court, Newsom’s mental health legislation from last year, begins rolling out in Riverside County and six other counties — Glenn, Orange, San Diego, San Francisco, Stanislaus and Tuolumne — and eventually all California counties. They will become the state’s new court system for people with untreated schizophrenia and other severe mental illness.

CARE Court allows family, close friends, first responders and behavioral health workers to petition a court to compel a person with untreated schizophrenia spectrum or other psychotic disorders into a court-ordered treatment plan.

Two days later, Oct. 12, Newsom signed two more bills aimed at mental health issues and initiatives. Together, Senate Bill 326 that Eggman also sponsored, modernizing the Mental Health Services Act, and Assembly Bill 531 that Assemblymember Jacqui Irwin sponsored, a $6.38 billion bond to build new behavioral health housing and treatment settings across the state, will dramatically increase the state’s capacity to provide behavioral health care and housing.

These reforms would complement and build upon Newsom’s Mental Health Movement that is increasing access to mental health care for all whether insured through MediCal or private insurance; providing treatment and housing to those in crisis and with serious mental illnesses; supporting and serving kids and young adults; and building the health care workforce, according to his news release.

Both will be packaged into Proposition 1 and be on the March 2024 ballot for voter approval.

“These reforms, and this new investment in behavioral health housing, will help California make good on promises made decades ago,” Newsom said after signing both. “We see the signs of our broken system every day — too many Californians suffering from mental health needs or substance use disorders and unable to get support or care they need. This will prioritize getting people off the streets, out of tents and into treatment.”

Prop 1 funds will support creating more than 11,150 new behavioral health beds and housing and 26,700 outpatient treatment slots, plus a proposal to require counties to redirect roughly $1 billion in current money toward housing, according to the news release.

According to the Vanguard Davis organization, a coalition of professionals is already forming in opposition to Prop 1.

In their opinion, “Proposition 1 would massively expand involuntary treatment options. There is no evidence base of effectiveness for these forced treatment proposals, and a multitude of reports show how these attempts at care primarily result in further distress and harm to the service user.”

But recent surveys indicate that Californians are concerned about mental health problems and substance abuse and their concomitant effect on the individual as well as communities.

In a survey released last month, the Public Policy Institute of California reported that 87% of Californians believe there is a mental health crisis in the country today. The response was consistent across political parties and races.

The survey also asked about the 988 hotline, Suicide & Crisis Lifeline. In 2022, the 988 hotline replaced the National Suicide Prevention Lifeline (which had a much longer phone number) with a three-digit number. In the year since the launch of 988, the U.S. hotline has fielded almost 5 million calls, texts and chats, offering support to people in mental health crises.

“A majority of Californians (56%) say they have heard nothing at all about the new 988 hotline that helps connect people with mental health services; about a quarter say they have heard a little (24%), and a quarter say they have heard at least some (4% a lot, 17% some). Half or more across partisan, demographic and regional groups say they have heard nothing at all.

While most have not heard much about this hotline, after reading a summary of what 988 is, about six in 10 adults “say they would be very or somewhat likely to call the 988 hotline if they or a loved one were experiencing a mental health crisis,” the report found.