SACRAMENTO, Calif. — Republican lawmakers say that, before California spends even more money battling homelessness, the public deserves to know exactly how the tens of billions of dollars already put toward the epidemic are being spent and whether the state is getting results. Among the GOP lawmakers calling for greater accountability is state Sen. Roger Niello, a businessman who returned to the Capitol in December after a 12-year hiatus.

As a fiscal conservative from the Sacramento suburbs, with more than a decade of experience in local and state politics, Niello wants to work with Democrats. But he characterized the volume of money poured into fighting homelessness in recent years as runaway spending, saying Democratic Gov. Gavin Newsom hasn’t yet proved the money is working adequately to place homeless people into services and permanent housing.

“There’s nothing more urgent for us to address, in some successful way, than homelessness,” Niello told KHN. “But I do believe that just spending money without actually measuring those achievements is generally a waste of money.”

He argues that Newsom and his fellow Democrats, who control the legislature, shouldn’t allocate any more taxpayer funding for homelessness policies unless the state can show that current spending is reducing homelessness. Niello and other Republicans have pushed for an audit of homelessness spending — and this year were joined by some Democratic lawmakers, who increasingly are also calling for more accountability. A legislative committee in late March approved their audit request.

Newsom says that the state has already placed 68,000 homeless people into temporary or permanent housing and that California can reduce homelessness by 15% in two years. Yet more low-income people are falling into homelessness, and many are living with untreated mental health conditions and addiction disorders.

Since Newsom took office in 2019, he and state lawmakers have dedicated more than $20 billion to move people off the streets and into shelters or housing. That’s on top of more than $12 billion in additional state spending slated for new behavioral health and social services, largely aimed at serving vulnerable low-income residents experiencing homelessness or those at risk of falling into crisis on the streets. And Newsom is proposing more spending, including a 2024 ballot initiative that would allocate as much as $6 billion for new behavioral health treatment beds and mental health housing for homeless people.

Niello sees opportunities for bipartisanship on homelessness and behavioral health. The Republican supports one of the governor’s more controversial initiatives, passed last year to compel people with serious mental illness into court-ordered treatment: the Community Assistance, Recovery, and Empowerment Act, or CARE Court. And Niello is working with the Democratic chair of the Senate Health Committee, Sen. Susan Talamantes Eggman, on bills that would expand the state’s ability to put people into court-ordered conservatorships by redefining who is gravely disabled.

Eggman said it’s important to work across the aisle on solutions that can benefit not just seriously mentally ill individuals and their families but also the community.

“The level of vitriol and blame we’re seeing contributes to the angst and anxiety people are feeling,” Eggman said. “It’s important to work with Republicans to alleviate that and help people who are unwilling, or unable, to help themselves.”

Niello, who believes Republicans should work with Democrats to find solutions, discussed the state’s homelessness crisis with KHN senior correspondent Angela Hart. The interview has been edited for length and clarity.

Q: Are Californians seeing the results of this unprecedented investment and how do you think the governor is handling the crisis so far?

What we’re doing is not working. Homelessness has never really existed outside the urban core before. It’s getting worse, not better.

When the governor talks about his efforts on homelessness, he often talks about all of the money that has been spent under his administration. But spending is not a metric. We spent $20 billion, but I can’t find any measure of results that relates the spending on programs showing people actually getting out of homelessness and into supportive programs — or, aspirationally, even, to self-sufficiency. What Republicans would like to see is some measurement of the results.

The problem is we don’t know if it’s being well spent; it appears, based on evidence on the streets, that it’s not being well spent. The homeless counts have increased rather substantially.

If you’re not going to measure results more effectively, you may as well hold back on the money completely until you’re willing to do that.

Q: How can California improve its homelessness response?

One of the problems that we have with homelessness, both federally and in the state of California, is we have a policy called “Housing First,” which was adopted in California in 2016, and it eliminates any public money to any program that requires treatment for the entry to the program, and we’ve only seen the homeless counts explode since then.

It’s hard to deny that there isn’t some relationship there. And I believe there is. I think it’s too restrictive and compromises getting results. Under the Housing First approach, the philosophy is you offer housing and shelter, and you offer services, but don’t require it. And people can stay in the shelter and continue to use substances or not get mental health treatment. I think we should do more to allow for programs that require treatment and sobriety within those programs.

And for the people who have been touched by this dizzying array of different programs, we need to try to assess the successes in terms of getting people into housing, getting people into treatment, and getting people out of homelessness and into self-sufficiency.

Q: Your Senate Bill 232 expands the definition of “gravely disabled” in the context of mental health treatment, which could compel more people into court-ordered conservatorship. Why is this important?

While not all homelessness is caused by substance abuse and mental illness, I think that is probably the largest single contributor. And it is virtually impossible to compel mentally ill people into treatment.

There is a definition of “gravely disabled” in California’s Lanterman-Petris-Short Act that if somebody is gravely disabled, they can be compelled to treatment. But it’s a rather simple and limited definition.

So I have a bill, just like Sen. Susan Eggman has a bill. And we intend to work together in a way that redefines gravely disabled, to include what we think is a better definition of somebody who truly is gravely disabled. It includes redefining it with a clinical condition explaining that somebody is literally severely disabled.

We think that if we have this new definition, then we will be able to compel more people into treatment or, if needed, conservatorship. Then they can work toward a recovery, whereas the alternative is they continue to languish on the streets with a severe and disabling condition.

It is consistent with the governor’s CARE Court initiative that compels treatment for people like those who are homeless living under freeway overpasses or rummaging through garbage cans.

Counties have to provide the services, but they need more money. Here is a fiscally conservative Republican who is going to say that treating mental illness is very expensive. And we have to fund it.

Q: Newsom has called on cities to make more progress on ending homelessness before giving them more money. But separately from direct homelessness funding, you’re saying counties need more money for treatment and services?

We can’t expect counties to be the service delivery of health treatment, which they are, unless they have the resources to provide the service. And I think that with the revised definition of gravely disabled, I think it would be easier for CARE Court to be implemented.

There’s one definition of a good society, and you judge it by how a society takes care of the least advantaged of their citizens. And this is a good example of that, and to allow people to continue to live in unhealthy conditions is going to cause them to die at a much earlier age. So not trying to help is just plain wrong.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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By Angela Hart
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.