California’s mental health vote is still undecided. Why?

California has about 12 percent of the U.S. population, but more than a quarter of America’s homeless population — more than 181,000 finally counted.

There are many reasons for this outrageous problem, including generations-old state laws that deinstitutionalized mentally ill people, as well as the high housing costs that have since cost tens of thousands of people their housing. But since the pandemic turned fentanyl abuse and tent encampments into inescapable symptoms of a public health crisis, policymakers in the state have been under intense pressure to rethink California’s approach to behavioral health.

Last week, Californians voted on a key part of that rethink: a deeper focus on treatment and housing for homeless people with serious mental illness and substance use disorders. The ballot measure, called Proposition 1, was the culmination of months of work by Gov. Gavin Newsom to build statewide support.

Opinion polls suggested that Proposal 1 would be a slam dunk. But so far it’s barely passing. Going into the week, the measure remains in place, with 50.5 percent of the vote and an estimated 2.5 million ballots still to be counted. So what happened?

Here’s what you need to know about Proposition 1 in California.

What is proposal 1?

Proposition 1 was put to the vote by state lawmakers and Mr. Newsom last year and asks voters to dramatically expand treatment centers and supportive housing for people struggling with mental illness and addiction. The measure would authorize $6.38 billion in bonds to pay for facilities and housing and would amend the Mental Health Services Act, a two-decade-old state tax on millionaires, to shift about $140 million annually from the counties to the state . The measure would also set aside about $1 billion for housing for homeless, mentally ill or addicted veterans.

What are the arguments for and against statement 1?

Proponents of Proposition 1 say it is key to restructuring California’s behavioral health system. One reason why so many addicts and mentally ill people are on the streets, they say, is because the state did it an acute shortage of treatment beds for adults. Proposal 1 would help house more than 11,000 sick people and support CARE Court, a new state program that requires people to seek treatment for certain psychotic disorders. The measure would explicitly provide a huge source of treatment dollars homeless substance abusers. And, proponents say, Proposition 1 would reduce taxpayer spending on a population now largely treated in prisons.

Some civil libertarians fear that Proposition 1 heralds a return to the days when involuntary treatment was the norm for mentally ill people. But most opponents cite fiscal concerns. Critics say California has already poured tens of billions of dollars into homelessness, only to see the situation worsen. Critics note that while Proposition 1 would not add new taxes, it would limit the amount the state could borrow for other issues and force taxpayers into new debt amid high interest rates. Additionally, counties rely on the Mental Health Services Act to pay for programs not covered by California’s version of Medicaid or other, less flexible funding sources, and Proposition 1 would shift some of that money to the state.

Why is the vote so close?

Newsom administration officials say their internal polling had always predicted a close outcome. Turnout in California tends to be lower in primaries than in general elections and is less heavily dominated by like-minded Democrats.

The bond measure is lengthy and confusing and comes at a time when the state is facing a budget deficit. Mental health policy is a fraught issue in California, and proposed shifts often draw passionate opposition from civil liberties groups. And many voters are frustrated and fatigued by the sheer scale of homelessness in California — and skeptical that any ballot measure could solve the problem.

But turnout was low, even for a primary. Without a close race for the presidential nomination in either party, only about a quarter of the state’s roughly 22 million registered voters cast ballots. according to the most recent statistics – the lowest participation rate in presidential primaries in at least two decades.

The surprising share of Republicans also influenced the results. They make up less than a quarter of registered voters, but as of this weekend were on track to reach almost 30 percent of the turnout. Some Democratic analysts have pointed to the state’s Senate race, in which the front-runner, Adam Schiff, spent tens of millions of dollars on ads that raised the profile of his favorite opponent, Steve Garvey, a political novice and Republican.

When will the final results be known?

Because California relies heavily on mail-in ballots, vote counting typically takes weeks, but most observers expect a clearer picture within days.

Each of California’s more than 22 million registered voters received a ballot, but only about a third of them voted. About 2 million ballots remain to be processed, according to the most recent state figures. Election officials have until April 5.

But the sources of the remaining ballots hint at the prospects of Proposition 1. Campaign officials said late last week that while there were still some large conservative precincts to be counted, there were many more outstanding ballots in major metropolitan areas. Those parts of the state — Los Angeles and Alameda counties, for example — are heavily Democratic and more likely to vote “yes.”