Assembly Standing Committee on Housing and Community Development

There is no phone testimony option for this hearing. All witness testimony will be in person. Please feel free to submit written testimony through the position portal on the Committee's website. This will become part of the official record of the Bill. The hearing room will be open for attendance of this hearing. All are encouraged to watch the hearing from its livestream on the Assembly's website. Thank you for your patience and understanding. And with that, we have Assemblymember Irwin here to present SB 531.

Well, thank you very much, Madam Chair and Members. For all of us legislators, we know the number one issues to our constituents are homeless crisis that we're facing and the mental health crisis that we're facing. And all of us have stories about family members that are dealing with these issues. All of us have seen homeless folks in the streets, in our own communities.

And I am really pleased that the Governor and the Legislature have decided in a very big way to tackle an issue that has been really neglected for many, many years. There has been a lot of decisions made that have led to the crisis that we face today. So I'm pleased to present AB 531. Senate amendments have increased the amount of funding in the bond to $6.38 billion.

This funding will be used to finance the construction or conversion of permanent supportive housing using home key and treatment settings using the Behavioral Health Continuum Infrastructure Program, known as BCHIP. Within this, 6.38,922,000,000 will be used for permanent supportive housing for those experiencing a behavioral health challenge. Just over $1.0 billion is set aside exclusively for veterans with behavioral health challenges facing homelessness. Just under 2.9 billion will be used to invest in infrastructure needed to expand the BCHIP program for all guarantees, including nonprofits.

This includes acute care facilities. Lastly, 1.5 billion has been added exclusively for cities and counties, with 30 million of that set aside for tribal entities to build treatment settings. These investments will go even further with the proposed reforms to the Mental Health Services Act and Senator Eggman's SB 326, which will help fund the operations of these new facilities.

The provisions of both AB 531 and SB 326, which require voter approval, will be placed on the March 5, 2024 primary ballot as a single measure, designated Proposition One. With me to testify in support of the Bill and answer any technical questions is Myles White from the Business, Consumer Services and Housing Agency. And will you be just answering questions?

Sure.

Okay, move the Bill.

We have a motion.

Can we have a quorum?

Let's establish quorum first. How about that? Let's establish.

Gabriel present. Wicks? Wicks here. Patterson? Patterson here. Carrillo? Carrillo here. Quirk-Silva? Quirk-Silva here. Grayson? Grayson here. Sanchez? Sanchez here. Ward.

Okay, we have a quorum, and we have a motion. Can you make that motion again?

Move the Bill.

Move the Bill. And a second. Okay. And now we'll go to our first witness in support.

Good evening. Myles White with the Business, Consumer Service and Housing Agency on the housing component of the bond. As the Assemblymember mentioned, ultimately, $2 billion of investments, long term affordable housing, 55 year covenants. That's really doubling down on our successful home key strategy here for these permanent placements with speed and making sure that these are long-term, viable units for a very vulnerable population.

Here, in tandem with our counterparts, the Department of Healthcare Services, the tremendous amount of work we can do together on the interim housing interventions, and then in tandem with the permanent housing options here for a really comprehensive proposal and long term results. So that thank you.

Michelle Baass, Director of the Department of Healthcare Services. Of the $6.38 billion, $4.4 billion will be used. It's a historic investment in the behavioral health continuum of residential treatment and treatment facilities. Really, our policy objective remains and is to ensure that individuals are served in the least restrictive, integrated into the community, focused on choice, recovery and rehabilitation and cost effective mechanisms to serve California's with behavioral health needs.

Thank you. Thank you. And do we have additional folks in the room wish to express support, please name, organization, and position.

Leah Barros on behalf of California Hospital Association, in support.

Sharon Gonsalves on behalf of Mayor Karen Goh and the City of Bakersfield, as well as the cities of Santa Rosa and Carlsbad, in support.

Thank you, Madam Chair Members. Doug Subers on behalf of the California Professional Firefighters in support.

Good evening. Ross Buckley on behalf of Sacramento Mayor Darrell Steinberg, in support.

Great. And now we'll go to witnesses in opposition. Primary witnesses in opposition. You'll have two minutes each. Yeah, you can come up here. Feel free to sit there. Yeah, just pull a little bit closer to you.

All right. Good evening. My name is Clare Cortright. I'm the Policy Director of Cal Voices. Our organization took an opposed position to the bond after the Monday amendments. And we're here because for months, since March, the Administration promised the Bill digest promised, the operative language promised, that this money would be exclusively for voluntary, unlocked treatment facilities. And specifically, LAO addressed that this would not be for BCHIP and that it would not build acute care, locked facilities. Obviously, Monday at 3:05, that changed.

And the exact opposite is now what this bond is dedicated for without any of the protective language around voluntary-unlocked and without any particular amount of money dedicated to voluntary-unlocked programs and the explicit language that allows for locked infrastructure.

So obviously, this is hugely concerning in relation to the entire raft of legislation that's coming down this year related to mental health. That includes the expansion of the ability to involuntarily hold someone for substance use disorders, conserve someone on new bases, and the obvious lack of infrastructure to support SB 43. We also understand that the bond is intended to work with MHSA funds and 326. However, we've never understood exactly how, because those bills don't really speak to each other legally. They don't talk about each other.

And so what this is in total, what the vision is here has not been clear. And our community has been deeply concerned that the greatest investment that is going to happen in the state is in this acute and involuntary side of the system while we have underfunded, inadequately funded, inaccessible, voluntary services.

If you could wrap up. Thank you very much. Appreciate it.

Susan Gallagher, Executive Director of Cal Voices. Ditto everything that Clare said, but I just want to say know, people don't get better in beds and treatment facilities. They get better in their communities. And the best that we can do for anybody in the mental health community is build community for them, not institutions. This seems like we're going back to a fail-first model. Like Claire said, neither Bill referenced each other.

So it sort of feels like the community, the stakeholders we represent, the 632,000 people that are receiving services in the public mental health system, have been left out of the discussion. No subject matter experts, any of us that have been working, I've worked in this field for 26 years. Nobody consulted with me or our agency. We're the oldest peer-run organization in California, and we've had nothing to say about this. We've had to push our way indoors to be heard.

And it seems to us that we have a wide-scale mass reinstitutionalization effort going on here. And there's a recent PBS documentary about this, how states are using involuntary services to lock up those who are mentally ill, those who have substance abuse abuse problems. California is going in the wrong direction here. You are on the wrong side of history with this Bill, rolling it into a Proposition that includes SB 326, although it never referenced either one of them.

We just feel like we've been dealt a political maneuver, that this has been assaultive to the community because we have been largely left out of these discussions despite our subject matter expertise over decades. My agency has been in existence in the State of California for 77 years. So what's happening here is a big hoodwink to get the homeless off the street, and it's not going to work. It's not going to work because you did it outside of communities.

Public policy doesn't work when you don't engage the community. It just doesn't. I've watched this dozens of times. Good luck building things that people don't come to because it's building a lack of trust. You're creating a huge lack of trust with this community by making these decisions that are coercive, that are forceful, that are against our will. Do you really think that people that are going to get rehab for their substance abuse services should be locked in an institution? Because that's what you're voting for today.

And so I just want you all to know what you're voting for because it's been hidden. It has not been explicit. No one's ever told the public this is what's happening. We have to find out through these late, last-minute amendments. Everything has been done in bad faith. And so I just want to be on record that this is bad faith. We know everybody here is going to vote for it because everybody seems to blindly follow this Administration.

And so many people have voiced concerns to us, but not one person has really stood up and said, no, don't let this happen. We don't want to hearken back to those days. I mean, Clifford Beers was the creator of our agency, Mental Health America. He was institutionalized. He created the bell of freedom out of the shackles and the chains of these institutions. They are not good places to be. These are vulnerable people and you're doing them harm. And that's all I can say. Thank you.

Thank you very much.

Very much for letting us.

Thank you for your testimony. We appreciate it. And you can stay there if you want. If folks have questions, you can feel free to stay there and we'll go to other folks in the room. If you'd wish to express opposition, please name organization and position.

Hi there. Rachel Bhagwat with ACLU California Action. We did not take a position on this Bill throughout session, but did register concerns after the most recent amendments, just around some of the implications shared and also because Clare was going to do this, but she's now at the mic on behalf of Mental Health America, California Depression and Bipolar Support Alliance and Disability Rights California, wanted to register their opposition. They had to go home. Kyan, also. They all had to go home. Thank you.

Thank you. We will bring it now back to Committee questions. Ms. Quirk-Silva?

I can see all of the passion in the support for the Bill, but also in the opposition and it does put us in a difficult situation of us wanting to move forward on some of the most critical issues that we have seen in our state and yet having some of these late information. I'm sorry. It's Michelle?

Could you speak to the part that is new, at least to me, as far as the change related to the institutionalizing that we did not because we had a whole day hearing a few weeks back, and that was not brought up.

So the recent amendments added $1.5 billion to the total bond Fund. So it went from about $4 billion to about $6 billion. So with the addition of that, also hearing from stakeholders and legislators about the need for acute care settings in their communities.

And so with that changed, essentially the proposal to model it off the Behavioral Health Continuum Infrastructure Program, which today funds the entire continuum from acute care settings, where short-term, intensive stays may be needed, all the way to residential-based, pure respite-type settings where individuals get services and care in their communities. And so the entire continuum of care is part of the Behavioral Health Continuum Infrastructure Program.

And with the addition of these dollars and the hearing, the need for some of the acute care settings that aren't available in some of our counties, that was the revision that was proposed on Monday.

And then just one more follow up. Anybody can answer it. I mentioned in the last hearing my concern that there is quite a bit of dollars put aside for different categories here, but none of it makes a county or a city apply for it.

So we very well could have what we see now, where there are some counties that have a very robust take on applying, trying to get every dollar they can and others still not choosing to use any of these funds. Do we have any answer related to that?

Well, I think also as we award BCHIP grants, we look at not just a county, but regionally, what are the resources available, what do we think might need to be developed in a particular county or region to really maximize efficiency in terms of what we build with these dollars? And so maybe not every county may need the entire kind of continuum because other resources are available in the region.

But I guess what I'm saying is, what if a county does need them, or at least there's some indication they do, and they still don't want to choose, in essence, they want to push it off to other counties or cities. We see that already with homeless, where we see the need in city by city, neighborhood by neighborhood, but some are actually choosing to put ordinances in place, not go after state dollars and therefore not deal with the problem.

And so if we have these funds and, just say it's Los Angeles, that aggressively uses them and another county doesn't want to partake at all, you're going to have this scenario where you have some facilities in some place and other counties not doing anything. So I guess if you could address that.

I think it would be as this grant program gets built out, it'd be part of the discussions as we look at the region and look where applications are coming and where grants are being made and having conversations with counties on kind of how it maps out over the years.

I would just add on the permanent housing front a lot of the focus that we've had with different block grants where it is directly provided to counties. So, Assemblymember, to your point here, ultimately when we look at the totality of resources that are provided at block grant level, what those uses are and what they correspond to on competitive funds, we look at really how they are strategically utilizing those resources.

And if there are glaring gaps when we see from one county to the other trying to shift that obligation, ultimately we're looking at there are other dollars that are available in addition to this augmentation of capital for permit housing.

Thank you. Other questions from Committee. Mr. Patterson.

Thank you. Question about, I see there's a buy right approval process for, it seems, all of the facilities. But I was wondering what the insight or what the reason was for that.

Assemblymember, the buy right approval for the interim facilities, when you think of the infrastructure, those are authorities mirroring off of existing law with BCHIP. But ultimately, a lot of the revisions on different siding and the principal permitted uses, those are revisions and discussions with Legislature about what are really the focus and the community integration aspects that we're hopeful to see. And then, of course, from the permit supportive housing context, also, similarly building off of precedent where we have with similar authorities provided under, for example, AB 2162 over several years ago.

So really looking for ways to accelerate the approval and ultimately minimize the costs that are associated when these projects get delayed for subsequent years, and making sure these dollars go as further as possible and to see immediate results.

Will the buy right process, or how the sites are selected or however that works, are there going to be some kind of regulations that come from that on what that looks like? Because I'll just give you an example. In my district, there was recently a proposal to build a behavioral health facility that also had involuntary holds there, right across the street from school, for example.

And I've seen that in some communities, but naturally that raises concerns in probably every community, which is why A, I assume there's buy right process here. But will there be some kind of regulations that set sort of standards on that sort of thing?

So two points. First, I'll just start with the permit supportive housing component. So a lot of the success that we've seen with Homekey is making sure that the jurisdiction are considered a lead applicant. So having that buy in, they are on the grant agreement essentially. So that really helps facilitate their accountability of making sure these line use approvals and authorities are facilitated. And then similarly for the Beaver Health infrastructure, a lot of support is a condition that has been mirrored off of existing practice with BCHIP.

So a lot of this local government buy in, and ultimately these buy right approvals, are still consistent with objective standards. So whether you have setback requirements, different height limitations, that the basis of what a local municipal government has in place, that all overlays with these state laws that we would provide for both settings.

All right, just a comment, if I may. On one hand, I do appreciate the governor's office taking a proactive role here in probably one of the biggest crises our state is facing. I do have some concerns about these sorts of things. Late at 09:00 p.m. Or 9:30 or something on the last day of session, somebody joked on the floor, nothing happens good after 08:00 p.m. on the last day of session. But I only say that from the sense of obviously this is a big decision.

Obviously this is a major issue going on in our state. And I was talking with some Members of the Committee on the Floor, and I hadn't had a chance to review it, obviously until like an hour ago. But I do have some concerns with putting $6 billion worth of investments in a buy right process only because I honestly think that one of the top orders of calls that I get are various site selections for various things that--they could be very noble causes.

But whether it's a behavioral health facility or a homeless shelter or something like that that are going into neighborhoods, I mean, they generate a lot of phone calls. And so I can't really envision a way in which the community would be involved. And I don't fully understand how that would work. Like I said, $6 billion worth of investment being made. So that does concern me at this early hour.

But like I said, I do appreciate the recognition and the importance put behind solving a major issue, maybe the major issue our state is facing right now. So thanks for hearing out my concerns and appreciate it.

Thank you. Any other questions from Committee Members? I have a question, and then I'll let you close, Assemblymember Irwin. But I think part of the challenge is and I want to just appreciate the testimony of the opposition witnesses here, and we hear your passion. One of the challenges is we're not the Health Committee, right? And so we're looking at the housing component of this and what that looks like.

I'm wondering if the supporters could talk a little bit about, particularly for the acute and subacute settings that have been raised, what currently exists in terms of guardrails or the current law or legal protections to address some of the concerns that are already in existence.

Thank you for the question. I will also highlight we are in the process of applying for an 1115 waiver with the federal government BH Connect. And with that, we will have to demonstrate even more kind of quality and oversight over our acute care facilities. Really working on the discharge, working on the quality, working on the facility, kind of just even the licensing of the facilities. So as part of this, there's just this entire effort with regard to the entire continuum.

And how do we ensure that there are placements available or resources available to kind of flow through the continuum? That's part of what we will be working with the federal government on, as well as part of BH Connect. And so all of these pieces together, really, we want to ensure individuals are really served at the least restrictive, most integrated, most recovery based setting as possible.

Thank you, Madam Chair. So on this federal waiver, how confident are you that you will receive it and what happens, what's your plan B if you don't?

Thank you. And with that, if there are no--yes, Ms. Carrillo?

So I think it's a pretty standard waiver that we're applying for. We have just finished up the public comment period. And I think it's part of this is kind of integral to kind of everything we're doing in CalAIM, everything we're doing kind of in the behavioral health space to really ensure this continuum, the ability for individuals to step down to lower levels of care where they can integrate into the community and really have kind of a recovery philosophy as part of their treatment.

Thank you. And Senate Member Irwin, would you like to close?

Certainly, at this late hour I won't make it too long, but just to say, as our streets and parks and freeways demonstrate, our entire continuum of care needs dramatic expansion and AB 531, as you've heard, invests in programs that are already set up and successful. BCHIP, Homekey. We've been very successful with VHHP, which has been the Veteran Housing and Homeless Prevention Program, has been a housing veteran since 2008, and the voters continue to approve that spending.

I think that we are at a crisis. We have had intense negotiations on the language with Members of the Legislature, the Administration, and stakeholders. And I think now is the time to act to get this on the ballot and to start to deal with what I said at the very beginning is the number one issue for our constituents in the number one issues for our constituents in California, the mental health crisis and homelessness. And with that, I respectfully ask for your aye vote.

Thank you, Ms. Irwin. And you've done a lot in the space for veterans, so appreciate your leadership in that space since I've been in the Legislature, so thank you for that. I understand the concerns that are raised. I share some of those concerns. But I also think there's a lot in this Bill that we like and there's a lot that we need, and there's a lot of resources devoted to this community that's really, really important.

I hope that we continue to work through some of those challenges. I'll be supporting the measure today and hope that my colleagues do as well. The motion is to concur in the Senate amendments, and then I believe the Bill will go into the floor. And with that, if you could take the roll call, please.

Wicks? Wicks aye. Patterson? Patterson no. Carrillo? Carrillo aye. Gabriel? Gabriel aye. Grayson? Grayson aye. Quirk-Silva? Quirk-Silva aye. Sanchez? Sanchez no. Ward? Ward aye.

And that is out, 6-2. Thank you. Thank you. And this is our last housing hearing of the session right at the wire. So good job, Housing Committee staff. And our meeting is adjourned.