SACRAMENTO, Calif — Earlier this month, Governor Gavin Newsom unveiled a new plan to help solve California's growing homeless problem in what he called a "compassionate" way to fix California's broken behavioral health system.
In other words, a way to get those with mental health issues off the streets and provide them with services.
The plan, called CARE Court, would create a new branch of court within the civil division and allow county courts to mandate a 12-month personalized plan, including drug stabilization, for "the most severely ill and vulnerable individuals."
According to California's Health and Human Services Agency (CHHS), CARE Court's framework "supports a self-determined path to recovery" and said self-sufficiency is core to the program, although it is court-mandated and if a person doesn't participate in their court-ordered program, it could result in severe consequences like them being referred to a conservatorship.
You may have heard the sentiment that homelessness isn't a mental health problem. It's true. With California's housing crisis, COVID and drug issues - a number of factors contribute to why so many are living on the streets across our state.
With that being said, while the new CARE Court plan does target those living on the streets with mental health issues, someone doesn't have to be homeless to qualify; There are two main criteria, the first being those falling on the schizophrenia spectrum or having another psychotic disorder diagnosis. The second is those whose judgement is so impaired from symptoms of mental illness that they are not able to "make informed or rational decisions about their medically necessary treatment."
Governor Newsom and CHHS have referred to CARE Court as an "upstream diversion" option that would help those in crisis get the "treatment they desperately need" prior to more severe involvement like conservatorships or incarceration.
As of mid-March, the framework of CARE Court has been released - but not a fully laid out plan, which insiders said is expected in the months to come.
Here's the framework:
Step 1: Petition
A number of individuals can file a petition for an individual with severe mental health issues. These folks include family members, behavioral health providers, first responders or "other approved parties," the CHHS said.
Like any other court, the petition would launch a case to be opened for the respondent who allegedly appears to need CARE Court services.
A petition to CARE Court may be sparked from a short-term involuntary hold, like a "5150" which is a 72-hour hold or "5250" which is a 14-day hold. Arrest could also spark a petition to divert "from a criminal proceeding," the CHHS said.
Step 2: Clinical Evaluation
The civil court would order a clinical evaluation after "a reasonable likelihood of meeting the criteria is found." CHHS has yet to release further specific information on what exactly the "criteria" is.
The court would then appoint a public defender as well as a new role called a "supporter."
"The role of the supporter is to help the participant understand, consider and communicate decisions, giving the participant the tools to make self-directed choices to the greatest extent possible," said CHHS.
After reviewing the evaluation and if it is met, the court would order a "Care Plan." This plan is created for the individual by the person themselves with their supporter as well as the "county behavioral health." It would include items like "behavioral health treatment, stabilization medication and a housing plan."
Step 3: Support
This is the step where treatment of the individual begins by way of their care plan. CHHS said along with the "county behavioral health care team, participant and supporter" the plan is regularly reviewed and updated "as needed" as the individual gets treatment.
CHHS said a second 12-month treatment period is possible if needed.
Step 4: Success
If the participant successfully "graduates" in the eyes of the court, they remain eligible for ongoing treatment and other services like housing and long-term recovery support.
What happens if someone doesn't participate?
As we've seen with the COVID vaccine in our society - many demand the freedom of choice in regards to vaccines and medication, so it's not surprising one of the main critiques of CARE Court is mandating drug rehabilitation.
CHHS touches on this in their CARE Court framework saying the "stabilization medication" is different from an involuntary medication order in that "they cannot be forcibly administered." They said the medication will primarily consist of antipsychotic medications, i.e. evidence-based treatments to reduce symptoms of hallucinations, delusions and disorganization.
However, if someone were to not participate in their CARE plan, it could result in them being referred to an LPS conservatorship. This conservatorship typically is within a span of 12-months where the court legally strips someone of their civil rights and gives them to another - whether that be a relative, state entity or public guardian. LPS conservatorships are different from general conservatorships for the elderly or limited conservatorships for those with disabilities as they're specifically for those with severe mental health issues and do not go through the probate court. If someone were in a criminal proceeding or conservatorship proceeding before they were referred to CARE Court, they could go back to that proceeding if they were to not follow their Care plan.
The CARE Court also relies on counties to establish, deliver and execute CARE plans, a big responsibility for civil courts that are already inundated with caseloads.
There is no option for counties to opt-out, CHHS said. In fact, if counties and local governments don't adopt the CARE Court, it could result in sanctions and in extreme cases the state could "appoint an agent to ensure services are provided."
Who is paying for this?
It's a question any taxpayer has when a new, hefty idea is lifted by our state.
"Existing funding sources include nearly $10 billion annually for behavioral healthcare and $1.5 billion for behavioral housing and bridge housing," CHHS said.
They also said various housing and clinical residential placements will be available under Governor Newsom's $12 billion homelessness investments which began in 2021. However, they also said costs for court, public defenders and the new supporter roles as well as state oversight will require new funding. Where exactly that funding is coming from hasn't been made clear yet.
Critics and concern
California Republicans have said while they're intrigued by the CARE Court proposal, it's "short on details" and that "what Democrats have done in the past decade is not working."
These words came from Assembly Republican Leader James Gallagher Wednesday as he proposed a number of bills that are alternatives to CARE Court but focus on solving homelessness. The bills would both audit the state's homelessness efforts as well as expand who is eligible for conservatorship, and likely create more LPS conservatorships for homeless individuals.
Others see CARE Court and other ideas of conserving homeless as a violation of human rights. Cal Voices, an affiliate of Mental Health America - the country's oldest and largest nonprofit organization addressing aspects of mental health and mental illness - provided ABC10 with the following statement in-part:
"Governor Newsom's proposal to end homelessness is one of the greatest threats to civil liberties in the 21st century. Forcing unhoused individuals into mandated treatment for the 'crime' of being homeless is reminiscent of California's shameful history of institutionalization, sterilization, and forced treatment of those with psychiatric disabilities. The solution to homelessness is permanent, affordable and supportive housing, not criminalizing the most vulnerable among us based on their unhoused status."
Do you have thoughts about Newsom's CARE Court proposal? ABC10's Investigative Reporter Andie Judson has been covering California's conservatorship system as well as homelessness for years and would love to hear your thoughts. You can reach her on Facebook or Twitter.