Gov. Gavin Newsom made a bold move Wednesday. In his second State of the State address, an annual speech that usually focuses on political wins or the state's booming economy, Newsom dedicated 35 of 42 minutes to the urgent but unsexy issue of homelessness.
By proclaiming homelessness the most "pernicious crisis in our midst," the first-term Democratic governor staked his political reputation on his ability to solve it.
That means his reputation also rides on his ability to fix mental health care in California.
"Health care and housing can no longer be divorced," Newsom declared in the ornate, mint-chip-ice-cream-hued state Assembly chambers. In attendance were the state's other executive officers, legislators from both houses, and their families and guests.
During the speech, Newsom outlined several mental health proposals he plans to push this year.
He touted his ambitious "once-in-a-generation reform" plan for Medi-Cal, California's public insurance program for low-income people. Newsom wants to invest $695 million to help the state's most vulnerable residents, including homeless people and those with mental health problems, in unconventional ways, such as housing aid.
He also raised the controversial issue of involuntary treatment for people with behavioral health problems.
While he criticized the historic practice of confining patients with mental illness to asylums, he said the state needs to make it easier for law enforcement, health care providers and families to get people into treatment. "All within the bounds of deep respect for civil liberties and personal freedoms," he added.
One of the impassioned parts of Newsom's speech was his call to reform the Mental Health Services Act, or Proposition 63. Adopted by voters in 2004, the law imposes a 1% tax on personal income over $1 million to help counties expand mental health care.
Newsom said the problem is that counties aren't held accountable for how the money is spent.
"The money is used in 58 counties in 58 different ways," said Tom Insel, chair of the board of the Steinberg Institute, a nonprofit that focuses on mental health and homelessness, whom Newsom calls his "mental health czar."
That's not going to work for Newsom, who said in his speech that he wants the money to be spent primarily on three populations: children, homeless people and formerly incarcerated people.
And, he demanded, the money has to be spent.
Newsom said counties are hoarding $160 million in funding that could be used to get people off the streets and into treatment.
"My message is this: Spend your mental health dollars by June 30th, or we'll make sure they get spent for you," Newsom said.
State Sen. Scott Wiener, a Democrat from San Francisco, has made mental health and housing reform signature issues. He said Newsom's speech has created "political space" to accomplish some controversial housing reform that has stalled in the legislature.
"Impactful housing bills are controversial, impactful homelessness bills are controversial, and impactful mental health and addiction bills are controversial," Wiener said.
It's not the first time Newsom has taken responsibility for an intractable issue. A month before the State of the State address, he promised $105 million in new spending to fix the wildfire crisis, saying he would dedicate "emphasis, energy and sense of urgency" to the issue.
Now, he'll also be judged on how he tackles homelessness, a problem that worries 85% of Californians.
"The governor has a very full plate," said Mike Gatto, a former Democratic state Assembly member from Los Angeles who is trying to put a November ballot measure before voters that would increase involuntary treatment.
"We saw him take ownership of the wildfire issue and now he has boldly taken ownership of this issue, too. The state has to be ready to help him with these tremendous endeavors."
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.