CARE Court: Can California counties make it work? | News
In early March, Gov. Gavin Newsom unveiled a controversial proposal to compel people with serious mental health issues into care and housing.
Mental health advocates, mayors and family members who stood alongside him at the press conference at a San Jose behavioral health treatment program heralded the plan, known as CARE Court, as a visionary move.
But some county officials say they were stunned.
“They really sprung it on everybody,” said Farah McDaid Ting, public affairs director at the California State Association of Counties, who said lawmakers didn’t consult or even give her organization a heads-up.
Four months later, the bill to establish CARE Court has sailed through all of its policy committees in the Legislature, secured unanimous approval from the Senate in May, and is widely expected to become law later this summer. CARE Court — short for Community Assistance, Recovery and Empowerment Court — has garnered enthusiastic support from leaders of more than 45 cities, many of whom face fiery criticism over their handling of homelessness. Many family members, who for decades have felt stymied by strict eligibility rules for conservatorship, are also celebrating the new plan.
But county representatives continue to ring alarm bells about their ability to implement the proposal, especially as an aggressive timeline comes into focus. A handful of counties have registered support for the proposal, including Marin, Contra Costa and San Diego.
Many of the counties’ concerns come in the form of questions: Will the necessary housing be available? Where can they find the outreach workers and therapists needed to serve the population, given massive statewide shortages of both? What happens to all the struggling people who want housing and treatment, and already can’t get it?
Disability rights advocates are raising fundamental questions about the very premise of CARE Court: Is it effective to compel people into care? Is involuntary treatment a violation of their civil rights?
But many of those who support the concept say the practical questions feel especially pressing right now, as the legislature continues its deliberations. While many details are still in flux, the gist of the proposal remains the same as initially outlined. Anyone from family members to first responders could petition a civil court to create a court-ordered care plan for people who meet specific criteria. These include a diagnosis of schizophrenia or other psychotic disorders, along with being at risk of harming themselves or others or being unlikely to survive on their own. Participants would receive legal counsel and a range of mental health services, medication and supportive housing. Following a series of check-ins during a yearlong period, the participant could either graduate or be referred to an additional year of treatment. If a person refuses to comply, or “fails out,” they could be considered by the court for conservatorship.
Conversations about CARE Court have been peppered with frequent references to people living on California’s sidewalks and under freeway overpasses. But the administration hasn’t been clear about how much of a dent the proposal would make in the state’s massive homelessness crisis. Prior to the pandemic, more than 161,000 people in the state were estimated to be homeless on any given night; that number has likely grown since. The administration says the program will serve 7,000 to 12,000 people with the most acute mental health needs. Homelessness isn’t a prerequisite to participate.
The administration says the proposal represents a crucial step toward addressing one of the state’s great morale and policy failings: the vast ranks of unhoused people languishing with serious mental illness and without care.
“What CARE Court is saying is we must create a pathway whereby these individuals that live in the shadows and often die in the shadows, become a priority group,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, who has been championing the program on behalf of the Newsom administration.
CARE Court’s supporters say no more time can be wasted. Judge Stephen Manley, who started the state’s first mental health court in Santa Clara County nearly 25 years ago, notes the growing percentage of people in local jails and prisons with serious mental illnesses. Only by mandating that counties prioritize this population, he said, will anything change.
“People are always telling me it can’t be done,” he said. “To me it is a tragedy that we repeatedly, year after year after year after year, talk about this issue, do nothing, and all these individuals end up in the criminal justice system.”
Is there enough housing or will there be?
Perhaps the most prominent question that has arisen among legislators and advocates is whether there is enough housing available to get the CARE Court program started.
But the state believes that bringing CARE Court participants to the front of the line, along with making unprecedented investments in housing this year, will allow counties to meet the needs of this population. Opponents fear others awaiting voluntary services will be bumped to the back of the line, leaving their needs to intensify.
“I worry if it houses some but leaves others out, are we just reshuffling things?” said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at Zuckerberg San Francisco General Hospital and Trauma Center.
While the new budget deal includes $65 million this year and $49 million in ongoing annual funding to cover training, court costs and legal representation, counties say the proposal doesn’t include any new funding for housing or services.
“There’s a new door being built onto a small house,” Ting said. “There’s no square footage, there’s no nothing, just a new door. That’s what’s kind of frustrating about the premise.”
The administration points skeptics to a $14 billion multiyear homelessness budget put together before the proposal’s announcement — which includes about $5 billion to build thousands of mental health treatment beds and homeless housing. This year’s budget includes $1.5 billion for interim treatment beds to hold patients over while permanent units come online. In response to counties’ concerns that even the bridge beds won’t be ready in time, the bill’s authors recently said counties would be phased into the program over two years, starting in July 2023.
Sen. Susan Talamantes Eggman, D-Stockton, the bill’s co-author, says she believes counties are unhappy with the proposal because it finally holds them to account. It requires that they provide the care and housing a participant needs and if they don’t, face court fines of $1,000 per day. The money collected by the state treasury would eventually fund local services for the people CARE Court targets.
“We’re not just saying the person has the obligation to accept, we’re saying the system has the obligation to treat,” Eggman said during a recent hearing.
Counties counter that these penalties will only take away from their already limited resources to treat people.
While the bill says a county has to provide services during the program, courts can’t enforce a participant’s post-graduation plans. Advocates worry that without guaranteed housing people will wind up back on the streets, in emergency rooms and county jails.
“We’re going to release them back into the streets but we expect them to continue to adhere to the care plan and continue to be taking medication,” said Shonique Williams, a statewide organizer for Dignity and Power Now, who opposes the proposal. “But they’re going back into survival mode.”
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