The fate of Proposition 1, Gov. Gavin Newsom’s ambitious overhaul of the state’s mental health services that would also approve $6.4 billion in bonds, was too close to call Wednesday morning.

Voters so far are evenly split on the ballot measure which has been heavily touted by its supporters as a way to ease the state’s homelessness crisis by addressing some of the most severe cases including people living in encampments. 

According to results from the Secretary of State, Prop. 1 was at 50.2% Yes and 49.8% No, with less than half a percentage point between them. The measure needs a simple majority to pass. The final results will be certified statewide by April 12.

Central Valley voters were also closely split on the ballot measure. San Joaquin County voters gave the proposition a razor thin lead, mirroring the statewide results so far with 50.2% approval. But voters in Stanislaus and Merced counties both opposed the measure, with No ballots at about 54% in both counties.  

The No campaign said the close election results shows that legislators, and governor, cannot steamroll their way out of the homelessness crisis. The Yes campaign, which received about $20 million in donations and even ran a local network advertisement during the Super Bowl, vastly outspent the opposition which raised about $2,000. 

“It seems that all the money in the world can’t sell a bad idea, and Prop. 1 was a bad idea,” said Paul Simmons, co-founder of the Depression and Bipolar Support Alliance and a director of the No campaign. “They had goals to improve some public services, but to do it, they would cut existing mental health care, and likely make the problem worse. That’s what made Prop. 1 inexcusable and, ultimately, unpopular enough to potentially fail.”

Here’s what Prop. 1’s passage, or failure, would mean in the Central Valley. 

What is Prop. 1?

Prop. 1 is a two-part initiative that will shift how county behavioral health services funding is allocated and will approve $6.4 billion in bonds to build largely institutional treatment and housing facilities statewide.

If it passes, the state’s landmark Mental Health Services Act of 2004 will be amended to put more guidelines on how counties can use their so-called “millionaire’s tax” funding to support behavioral health programs. The name of the act has also been changed to the Behavioral Health Services Act (BHSA).

How will this affect behavioral health services in the Valley?

Prop. 1 requires all counties to reallocate roughly a third, or 30%, of their BHSA dollars toward housing intervention programs. Statewide, that is about $1 billion now going exclusively into programs like rental subsidies, transitional housing, shared housing, family housing, housing projects and more. The housing funds cannot be used for mental health or substance abuse treatment services. 

About half of those housing funds will go toward the “chronically homeless” with a focus on encampments, the other half will go to those with mental health and/or substance abuse disorders. 

The remaining 70% of county MHSA funds would then need to be split between full-service partnerships (35%) and behavioral health services and support (35%) including workforce education/training and early intervention programs. 

When do the changes go into effect in the Valley?

If Prop. 1’s lead holds up, counties will have an 18-month window, from Jan. 1, 2025 to June 30, 2026, to make the necessary changes. The law should be fully enacted across the state by July 1, 2026.  

Valley behavioral health departments will need to create new budgets which take in account the housing requirements. 

San Joaquin County Behavioral Health Director Genevieve Valentine said it is expected to cost the county $1.7 million in administrative costs to make the necessary changes in both infrastructure and transparency to enact all of Prop. 1. Of that, $900,000 would be ongoing annual administrative costs. 

Stanislaus County Behavioral Health and Recovery Services Director Tony Vartan declined to comment or answer questions on Prop. 1, citing California Government Code 3206 which prohibits public officials from “participating in political activities of any kind while in uniform.”

Will existing programs previously funded by MHSA/BHSA dollars now be cut?

If it passes, counties will have to make decisions on which programs to fund, with a third of all funding now designated for housing programs. Valley behavioral health departments will need to make administrative, infrastructure, budgetary and other changes. 

Before the election opponents of the proposition said they feared LGBTQ+ and BIPOC community-based programs might be on the chopping block. Proponents have said programs seeking funding should look into shifting into Medi-Cal billable services to make up for possible shortfalls. 

How will the bond work?

Prop. 1 also passed $6.4 billion in bonds that will allow public and private developers to build both treatment facilities and housing.

If approved, some $4.4 billion in the bonds will go toward treatment facilities, for both voluntary and involuntary programs. The other $2 billion will be to build or renovate housing for those experiencing homelessness, mental health and/or substance abuse disorders. 

The Legislative- Analysis Office estimates the bonds could pay for some 6,800 treatment beds and 4,350 housing units. Roughly half of those housing units (2,350) would be reserved for veterans experiencing homelessness. 

How many homeless people are there in the valley?

According to the most recent federally mandated count numbers from 2022, the state has some 171,500 unhoused people. About 10,400 of those are veterans. Prop. 1 has a potential to house about 2.5% of the overall homeless population and about 22.5% of the homeless veteran population. 

In the Central Valley, latest count numbers from 2022 showed 2,319 unhoused people in the Stockton/San Joaquin County continuum of care, 1,857 in Modesto/Stanislaus County, 855 in Merced/Merced County and 4,216 in Fresno/Madera counties, according to the U.S. Department of Housing and Urban Development.

If Prop. 1 fails, will nothing change in mental health services in the Valley?

If Prop. 1 does fail, changes are still coming to the state’s mental health services. Across the state and Central Valley, county administrators are in the process of implementing SB 43, a new law which expands who can be placed in involuntary conservatorship and treatment. 

Passed last year, the law expands the definition of “gravely disabled” to include “severe substance use disorder” without any accompanying mental illness. It also broadens the criteria for those with existing mental health disorders to include those who cannot provide for their “personal safety or necessary medical care.” Previously only those who could not provide for their own food, clothing and shelter could be eligible for involuntary care. 

All San Joaquin Valley counties opted to delay enactment of SB 43. San Joaquin County officials pushed back full implementation until January 2026, the longest allowed. Neighboring Stanislaus County opted for a shorter transition period, and aims to have the changes implemented by January 2025, a year earlier than required. 

Valley counties are also in various stages of implementing CARE Court, another Newsom championed change to the state’s mental health services which creates a voluntary pathway for people to receive behavioral health services through the judicial branch.

Stanislaus County was among six other counties to launch the first pilot programs for CARE Court, more than a year before the rest of the state. The Modesto-based court debuted last October. Other Valley counties, including San Joaquin and Merced, have until Dec. 1. to implement the new mental-health focused judicial division. 

People with severe mental disorders, primarily schizophrenia or some other psychotic disorders, are eligible for the new court program. Referrals can be made by family members, county and community-based service providers and first responders.

Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom based in Merced, in collaboration with the California Health Care Foundation (CHCF).