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Sacramento's mayor talks homelessness and mental health

Mayor Darrell Steinberg
Erica Tricarico
Mayor Darrell Steinberg

Mental health took center stage in Oakland last week at the Association of Health Care Journalist’s fall summit, “Homelessness and Health Care”where Sacramento Mayor Darrell Steinberg spoke with CalMatters health reporter Jocelyn Wiener. Over 90 people attended this one-and-a-half-day event that brought together researchers, clinicians, journalists, and people with lived experience.

About 20 years ago, Mayor Steinberg co-authored California’s Mental Health Services Act, also known as Prop 63. That law created a 1% tax on millionaires that has now raised over $30 billion for county mental health services in the state.

That may sound like a lot of money, but by the mayor’s own admission, those funds — now almost $4 billion a year — “have not been focused strategically on the issues that are most important to the people of California.” Steinberg partially blamed this on a decision the state made to allow counties to spend the money as they see fit, as well as on a focus on “process and expenditures” rather than outcomes.

California has the highest per-capita homeless population of any state in the U.S. While major metropolitan regions like the San Francisco Bay Area and Los Angeles county make up much of this population, Sacramento’s unhoused population is also significant. According to 2022 census data, there are slightly more than 9,000 unhoused people living in Sacramento.

Widespread income inequality and an increasingly unaffordable housing market have created a kind of housing “perfect storm” in the state. However, a lack of access to mental health services as well as a worsening drug crisis are major factors in the homelessness crisis.

The mayor expressed hope that in March, California voters will vote to change the way the state uses the billions generated by Prop 63. He pointed to Prop 1, which would require 30% of the money generated to go to housing intervention programs. He also commended Gov. Gavin Newsom on the role he has played in addressing homelessness in the state, citing Medicaid reform and CARE Court, a new legal process that makes it easier to hospitalize Californians most severely impaired by mental illness or substance abuse.

Jocelyn Wiener, the panel’s moderator, responded to Steinberg’s mention of CARE Court, saying: “There is a sense among a lot of mental health consumers that the state is going in a more punitive direction.”

But Steinberg brushed these concerns aside: “The problem with the involuntary commitment debate … it is the sexy issue and it has become the center of the debate … when really it’s about the end of the continuum.” While not everyone is qualified for involuntary treatment, at a certain point it becomes “an appropriate tool,” he said.

Journalists in the audience pointed to other issues contributing to the homelessness crisis, including the failures of Medi-Cal, California’s Medicaid program, to reach people in marginalized communities and the failures of the private housing market to provide affordable units.

To get at the root of the problem, Steinberg called for California and the nation to guarantee a legal right to housing and to mental health treatment similar to Americans’ legal right to public education.

Reprinted with permission from the Association of Health Care Journalists.

Wren Farrell (he/him) is a writer, producer and journalist living in San Francisco.