Efforts to reduce homelessness increasingly have focused on mental illness and substance abuse among those living on the street.
New state laws have created high expectations that those problems will be addressed, but in some cases the resources to make headway fall short.
Even if these laws eventually work as designed, their impact could appear underwhelming given the scope of homelessness in San Diego and across the state.
A split decision by the county Board of Supervisors Tuesday to delay implementation of a law that expands involuntary mental-health holds comes at a time when public frustration is growing over homelessness, which regularly is cited as a top issue among voters in opinion polls.
The law passed as Senate Bill 43 expands the definition of “gravely disabled” that allows authorities to temporarily detain people who, because of their mental state, are unable to provide for their personal safety or necessary care, in addition to creating a safety concern for the public. Substance use can factor into the decision about whether to detain someone.
Such holds can be an initial step toward court proceedings to determine whether a person should be placed in a conservatorship.
The measure was signed into law in October and takes effect Jan. 1, though counties have the choice of delaying implementation for up to two years. San Diego supervisors, on a 3-2 vote, opted to push back SB 43 for a year, though they ordered an update in 90 days on progress toward moving ahead.
Most other California counties also reportedly opted for delays, with some taking the full two years. San Francisco is one notable exception in moving ahead with SB 43.
Across the state, local officials say they need more time to deal with the anticipated increases in hospital emergency room visits — and some have pointedly said the state has not provided enough resources to successfully carry out the law.
Another law enacted with considerable hype — but a more generous timeline and some money behind it — created CARE Courts. That program, launched in San Diego in October, seeks to provide incentives through a legal process to get mental health and substance abuse treatment for people with very specific, limited psychotic disorders to keep them from becoming homeless or incarcerated.
Both SB 43 and CARE Court have been touted as major moves to address homelessness, though much more will be needed to make a significant dent in the problem. Still, officials hope these programs will help get some of the most troubled homeless people the assistance they need and off the streets — and, to be blunt, out of public sight.
Meanwhile, billions of dollars have been spent on services, shelters and housing aimed at homeless people. Further, the city of San Diego and other local governments have passed ordinances banning camping in public places, though in some areas the law can’t be enforced if shelter beds are not available.
Yet the unhoused population continues to grow.
Elected officials are looking to provide any hint that things may be turning around, especially with an election year approaching.
With those policy and political implications looming in San Diego, there was a split over the delay of SB 43 not just among the supervisors but between the city and county.
Mayor Todd Gloria was a leading supporter of SB 43 — and CARE Court — and pressed the supervisors not to defer the expanded involuntary holds, saying the need for action was urgent. He was joined by leaders of the city’s public safety agencies, City Councilmember Stephen Whitburn, and officials in other cities.
The local health care industry, county health officials and San Diego County Sheriff Kelly Martinez all counseled the board to delay, with some insisting that pushing ahead too soon could actually make matters worse.
The Hospital Association of San Diego & Imperial Counties argued more time was needed to prepare for the increased activity triggered by SB 43 at emergency departments that are already struggling with “record-level patient volumes.”
Gloria didn’t seem to buy that things would be so dire. Paul Sisson, who covers health care for The San Diego Union-Tribune, asked the mayor’s office whether Gloria was saying he believes those assertions were false. In a remarkable response, a spokesperson said in an email, “yes, he is.”
The Board of Supervisors has a 3-2 Democratic majority, but the vote on SB 43 was not along party lines. Republican Joel Anderson and Democrat Terra Lawson-Remer opposed the delay, which was supported by board Chair Nora Vargas, fellow Democrat Monica Montgomery Steppe and Republican Jim Desmond.
Anderson, Lawson-Remer and Vargas are up for re-election next year, as are Gloria and Whitburn.
On the same day the supervisors made their decision, the San Diego City Council voted unanimously to declare that a shortage of behaviorial health beds is a crisis in the city. The resolution is mostly symbolic, though it does call for examining land use and permitting policies that may discourage mental health facilities.
The county is the primary local public agency that oversees mental health services. In recent years, both the county and city have increased mental health outreach and expanded programs for the general public, with a focus on homeless people.
Gov. Gavin Newsom and the Legislature are pushing to do much more in this area. In the March primary, California voters will be asked to approve Proposition 1, a $6.38 billion bond issue to finance more than 11,000 behavioral treatment beds and supportive housing units, along with outpatient services for more than 25,000 people.
The recent report from the California Legislative Analyst’s office that the state faces a whopping $68 billion budget deficit no doubt will be discussed during the campaign.
The ballot measure also would adjust the Mental Health Services Act passed by voters in 2004, which levied a 1 percent tax on personal income over $1 million for mental health services. The change would allow some of the money to be spent on facilities envisioned under Proposition 1. Critics expressed concern this would take money away from existing outreach efforts, outpatient care and other programs financed by the tax.
There appears to be uneasy public support for more assertive action to move homeless people off the streets, be it camping bans or broader behavioral-health detentions.
In a few months, we’ll see whether voters are willing to take an expensive step to do that.
