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California mental health court won't help homeless, advocates say. 'This idea is broken'

Sacramento Bee logo Sacramento Bee 4/25/2022 Lindsey Holden, The Sacramento Bee

Apr. 25—Last month, Gov. Gavin Newsom unveiled a plan to create a civil court system to compel treatment for people suffering from serious untreated mental illness, saying it's time for the state to "take some damn responsibility to implement our ideals."

Newsom presented his proposal — the Community Assistance, Recovery and Empowerment Court, or CARE Court — as a way to help unhoused residents with conditions that cause psychosis.

The policy is moving through the Legislature in the form of two bills — Assembly Bill 2830 from Assemblyman Richard Bloom, D-Santa Monica, and Senate Bill 1338 from Sen. Susan Eggman, D-Stockton, and Sen. Thomas Umberg, D-Santa Ana.

The bill is getting push-back from disability rights advocates, who say CARE Court forces treatment on mentally ill people with little regard for their civil rights. They also argue it wastes money that would be better spent on public education, early intervention and programming that doesn't involve coercion.

"We are neglected throughout the whole process, up until the point our condition is so severe that we can't control it and we start doing things like breaking the law," said John Vanover, legislative committee chair for the Depression and Bipolar Support Alliance of California. "And at that point, now, the governor wants to step in and make us criminals. So fundamentally, this idea is broken, just from that."

How would CARE Court work?

CARE Court would effectively create a new wing of the civil court system in all 58 of California's counties that would allow a judge to order a mental "care plan" for those dealing with severe untreated mental illness.

The program would apply to everyone who meets the criteria, but Newsom has repeatedly referenced it as a tool to help the homeless population.

A person qualifies for CARE Court if they're at least 18, diagnosed with "schizophrenia spectrum or other psychotic disorder," are not receiving treatment, and lack "medical decision-making capacity," according to SB 1338.

California was home to nearly 162,000 homeless people in 2020, according to U.S. Department of Housing and Urban Development data. Nearly 38,000 people from that population — about 23% — were considered "severely mentally ill."

CARE Court is meant to target the 10,000 to 12,000 people dealing with schizophrenia and psychosis who may qualify for the program, said Jason Elliott, a senior counselor to Newsom.

The CARE Court program would enable a host of people — including family members, first responders and behavioral health professionals — to petition the court to create care plans for those who meet the criteria, according to SB 1338.

County behavioral health departments would be responsible for carrying out the care plans. Those who don't comply with their plans could be subject to California's existing system of involuntary hospital stays and conservatorships.

Such programs have been in place since the 1960s, following the state's shift away from mental health hospitals and toward community-oriented care.

Since California dismantled the hospital system, the state has primarily made use of the Lanterman-Petris-Short Act and Laura's Law to care for people who suffer from severe mental illnesses.

LPS — which then-Gov. Ronald Reagan signed in 1967 — ended the practice of long-term involuntary commitments to mental health institutions.

However, it does allow involuntary hospital stays for those deemed a danger to themselves or others. The most well-known of these hospitalizations is the 5150 hold — nicknamed for the section of legal code in which it appears — which requires someone to receive treatment for 72 hours.

LPS also created the conservatorship system, through which other people take responsibility for a gravely ill individual's medical care and personal assets.

Laura's Law, passed in 2002, created an assisted outpatient treatment program that can be court-ordered after a person who's mentally ill has repeatedly been hospitalized or arrested.


Video: Care Court: Gov. Newsom's plan for care courts as one solution for homelessness faces challenges (CBS SF Bay Area)

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The program is voluntary for counties, and they previously needed to opt in to Laura's Law for it to take effect. However, a 2020 bill from then-Assemblywoman Eggman now requires non-participating counties to opt out and state why they're doing so.

Why are advocates against CARE Court?

Disability rights advocates say the CARE Court system won't help the homeless in the way Newsom wants. They also argue it perpetuates stigmas around mental illness and does little to help those suffering.

A group of organizations — including Disability Rights California and the California Association of Mental Health Peer Run Organizations — wrote a letter to the Assembly judiciary committee considering AB 2830 that says CARE Court is "antithetical to recovery principles, which are based on self-determination and self-direction."

Instead, the letter urges a housing-first approach that guarantees a place to live and investment in "intensive voluntary outpatient treatment." That approach, the authors say, has better outcomes than involuntary treatment.

The letter also points out that those who qualify for CARE Court are supposed to be incapable of making medical decisions. However, someone found to be in need of a care plan is also meant to participate in developing and adhering to it.

"If an individual lacks medical decision-making capacity, why are they not being served in the LPS system or Laura's Law?" asked Matt Gallagher, assistant director of Cal Voices. "Why do we need to create a new $1 billion system in all California counties, when these individuals presumably meet the criteria to be served in other existing systems?"

In addition, Vanover, from the Depression and Bipolar Alliance, said that linking homelessness and mental illness is not helpful and perpetuates stereotypes.

He wants to see early intervention to help people with mental illnesses stabilize before they need CARE Court, as well as public education to help people better understand those who are struggling.

"That's the gross stigma that is involved in this legislation and the governor's messaging — stigma that says all homeless are mentally ill, and, therefore, mental illness is responsible for homelessness," Vanover said. "And stigma that says mentally ill are criminals. We are statistically way more likely to be victims of violent crime than perpetrators."

Newsom's office says CARE Court is needed

California needs an entirely new way to help care for those suffering from psychosis, as current systems aren't sufficient, said Elliott, Newsom's senior counselor.

CARE Court provides a way for those people to remain in the community while receiving mental health treatment, Elliott said. He disagreed with assertions that CARE Court represents involuntary treatment.

The alternative is shifting people back into the current system of conservatorships, involuntary hospitalization and jail, Elliott said.

"The idea is we should be able to serve more people before they have to be incarcerated and held against their will, with a very similar suite of services, frankly, that people can receive in state hospitals, or in prison, or in conservatorship," Elliott said. "So let's just take what we know works, what the evidence has shown to work, what clinicians tell us works, and just provide that before someone is in handcuffs."

Only 218 people received treatment through Laura's Law during the 2018-19 fiscal year, according to an October 2021 Department of Health Care Services report. Elliott cited that statistic as an example of the need for new programming.

"It's not that it's totally broken," Elliott said. "It does help a number of people, but it's not working at scale. We're not calling to repeal Laura's Law. We're not calling to zero out the conservatorship laws. We're simply saying we need a tool to do better."

Elliott also pointed to the $12 billion Newsom allocated for homelessness and housing last year, as well as the $2 billion he's asking for this year. The governor also plans to spend more than $4 billion on a youth mental health initiative, Elliott said.

Where are the CARE Court bills now?

The Assembly and Senate bills are both due in each house's Judiciary Committee on Tuesday.

AB 2830 had been set for a hearing on April 19, but it was pushed to the following week.

Ultimately, if the measures make their way through committees, the Newsom administration may negotiate with legislative leaders to add one to his revised budget as a trailer bill, said Mike Herald, director of policy advocacy for the Western Center on Law and Policy.

That would mean a short CARE Court approval process; it would wrap up by mid-June, as Newsom wants.

"I think the likelihood is it's addressed in the budget," Herald said.

The Western Center would prefer to see the measures remain policy bills, which would take longer to pass but would prompt more robust policy discussions, he said. The organization signed on to the letter of opposition, with similar concerns about housing and using a court setting to require treatment, Herald said.

But Newsom is likely to get CARE Court approved this year, whichever route it goes, he said.

"I think the political will is there to move something this year," Herald said.

(c)2022 The Sacramento Bee (Sacramento, Calif.) Distributed by Tribune Content Agency, LLC.

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