Updated Sept. 14. Originally published Aug. 26.
Governor Gavin Newsom signed legislation Wednesday that will allow county judges to order treatment for people suffering from addiction and severe mental illness, one of his top policy priorities this year.
The governor has called the new program known as CARE Court a “paradigm shift” and a “new approach” to addressing the state’s homelessness crisis. It aims to connect people with mental health services before they end up in a hospital or jail.
But civil and disability rights groups have compared it to forced treatment. The ACLU of Southern California said it plans to file a legal challenge against the new law.
Newsom, backed by mayors and state lawmakers who supported the measure, maintained it will help cities and counties reduce homelessness.
“This problem is solvable. We know that,” the governor said. “We don’t have to fall prey to the cynicism and all the negativity that it’s just too big, it’s too hard. It’s hard. It’s big. But we can meet this moment.”
Seven Counties – Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne – must start the program by no later than October 1, 2023. The rest of California’s counties are required to have their own programs up and running by December 2024.
Original story:
A controversial new plan that could pave the way for county judges to order housing and treatment for thousands of people suffering from addiction and severe mental illnesses was approved by California lawmakers Wednesday.
The proposal known as Community Assistance, Recovery and Empowerment Court — or CARE Court — would set up a new branch in the judicial system. It would allow first responders and family members to petition a county judge to order treatment for people suffering from addiction or severe mental illness.
But civil and disability rights groups, county officials and other advocates say CARE Court is the wrong approach and that they lack the resources to staff and deliver the treatment required.
Governor Gavin Newsom and local officials say it would be an alternative to a broken system that cycles people through jail, hospital stays and back onto the streets. His administration estimates CARE Court would serve 7,000 to 12,000 people per year.
Newsom has called the growing number of people living — and dying — on California’s streets “unacceptable” and “inhumane.” He invoked the death of an unsheltered woman under a San Francisco freeway when he unveiled the proposal earlier this spring.
“There’s no compassion in reading about someone losing their life under [Interstate] 280 in an encampment,” the governor said at a news conference outside a San Jose residential mental health treatment center in March. “We could hold hands, have a candlelight vigil and talk about the way the world should be, or we could take some damn responsibility to implement our ideals.”
The proposal now goes to Newsom for his signature.
Concerns from civil, disability rights groups
For unhoused resident Sharon Jones, the prospect of CARE Court is troubling.
Jones has lived for the past six years with her wife at an encampment near the American River Parkway. During that time, she’s witnessed people struggle with mental illness and addiction.
“I see them everyday,” said Jones, a former bookkeeper, speaking near her collection of tents in North Sacramento. “But most of them are harmless. Some of them are a little off the hook.”
She said she doubts Newsom’s proposal will be effective.
“You can’t force people into treatment if they don’t want to be treated,” Jones added. “Addiction is something that only you can fix.”
The ACLU and disability rights groups from 27 states agree it won’t work. In an open letter to the governor, they detailed concerns about the autonomy of mentally disabled people and access to housing, and asked him to halt the proposal.
“CARE Court will not solve the complex issues of homelessness in California, nor will it meet the needs of unhoused people with mental health disabilities – primarily because the investment of funds is in a new court system,” the letter reads.
Advocates say affordable, accessible housing and voluntary treatment would be a better path to reducing homelessness for those with severe mental illnesses.
“In our experience, compulsory treatment for any individuals with mental health disabilities will end up resulting in resistance, frustration and additional trauma,” said Eric Harris with Disability Rights California.
He continued: “Folks will have one terrible experience and say, ‘I never want to go back there again. I never want to do that again.’”
Harris said people with mental disabilities, especially those with marginalized backgrounds, haven’t been part of the discussions crafting the CARE Court proposal.
“If we're really trying to help those communities, then we should at least pause right now and make sure that all of those folks are at the table as we make some of these very big decisions,” he said.
Newsom’s office disputes that any treatment would be compulsory. Jason Elliott, a senior advisor to the governor, is adamant that there “will be no locked doors in CARE Court” and that it is meant to help people before they end up in the criminal justice system.
“It’s a civil court process that provides people the services they need before extreme trauma, like a hospitalization, like incarceration, like a conservatorship,” Elliott said in an interview.
Even though treatment could be ordered by a judge, Elliott said it would take place out of legal custody and in community clinics. He argues that court-ordered treatment would be different from conservatorships, which allow a judge to appoint a legal decision maker to oversee someone’s day-to-day life.
“I would argue that forced treatment is right now what we are putting people into when in fact, they could be successful in a lower level of care” in a community setting, he said.
According to the California Department of Health Care Services, 1,459 people were placed on temporary conservatorships in 2020 while 3,672 people were under a permanent arrangement.
CARE Court would allow participants to select a “volunteer supporter” to help them “understand, consider, and communicate decisions to ensure the [participant] is able to make self-directed choices to the greatest extent possible,” according to a program FAQ. People in the program would retain a level of independence, as CARE Court would offer “out-of-custody” treatment different from conservatorships and state medical institutions, Elliott added.
Counties say CARE Court could burden overtaxed workforce
California’s county governments would be responsible for carrying out nearly all elements of Newsom’s proposal. County public defenders would represent people selected for the program in court. County social workers, nurses, therapists, counselors and psychiatrists would evaluate the candidates, file assessment reports, spend time in court and eventually provide the judge-ordered treatment.
But county leaders say CARE Court and its added duties represent a major burden on their already overtaxed behavioral health departments. During the pandemic, counties saw a spike in demand for mental health and addiction treatment but struggled to retain workers, some of whom left their positions for higher-paying private sector jobs.
“We already have a workforce crisis where we don’t have enough clinicians to be delivering the mental health, substance use disorder services that are needed out in our community,” said Ryan Quist, director of Sacramento County’s department of behavioral health services.
Quist said his department has a deficit of more than 100 clinical workers and that the new program would tie up many of his existing staff in court.
“CARE Court would add on new administrative burdens that would take our scarce clinical resources away from actually serving the folks that need those services,” he added.
Elliott with the Newsom administration described the workforce shortage “as a real problem and one that we’re taking very seriously.” He said funding recently approved by the Legislature and governor should help.
“The answer to it is a $1.7 billion workforce initiative to develop more than 20,000 new clinical social workers and other professionals in adjacent space,” Elliott added. “Because we can do everything else right and if we don’t have people to do the jobs, then none of it matters.”
County leaders and their advocates say that money should eventually produce new, trained workers, though it could take years.
“I hope that those investments will yield a lot of success, but it’s not happening this second. And we’re layering another program on top of it,” said Jacquline Wong-Hernandez, deputy executive director at the California State Association of Counties, which lobbies for county governments at the state Capitol.
Editor’s note: Ahead of a crucial vote in the Legislature on CARE Court, county leaders say amendments to add one-time, up-front funding of $57 million for counties to implement the program have addressed their “the most immediate fiscal and policy concerns.”
Housing first or treatment first?
There’s another severe shortage counties would have to contend with if CARE Court were to become law: housing for people in the program.
Advocates say the program emphasizes treatment before housing, when it should be the other way around.
“There's this sense that mental illness and in some cases substance use are one of the root causes of homelessness,” said Mari Castaldi with the advocacy group Housing California. “What evidence shows is that high housing costs and low housing vacancy rates are the primary predictors of the rate of homelessness in a given community.”
While the bill would allow judges to order housing as part of a patient’s “CARE plan,” Castaldi says counties, which would be on the hook for meeting those plans, have limited housing resources.
Quist with Sacramento County said there’s already a severe lack of available housing locally and across the state. The region has an estimated shortfall of nearly 60,000 affordable homes for its lowest-income renters, according to the Sacramento County Housing Need Report 2022.
The county is also short several thousand shelter spaces. There are only about 3,400 shelter and housing beds available by local governments, nonprofits and faith groups for people experiencing homelessness, according to a report from the nonprofit California Housing Partnership. But there are nearly 9,300 unhoused people in Sacramento County. The existing shelters are typically full on any given day.
“We can get individuals into services, help them get better. But then once they’re better, where are they going to live?” Quist said.
But Elliott points to some $15 billion in state funding approved since 2020 for counties to build and acquire more housing units. For example, the state has funded 12,500 homes for people exiting homelessness through its project Homekey, which pays cities and counties to buy and convert hotels, motels and other buildings into homes.
“Do we have enough housing to provide a permanent supportive unit to every single person experiencing homelessness in California? No, we do not, and it's a goal,” he said.
But, he added: “The scarcity mindset that we very appropriately operated under for many, many decades is now no longer the case.”
Elliott also pointed to $1.5 billion in the state budget approved earlier this year to house people enrolled in behavioral health treatment.
The California Assembly approved amendments to the bill Aug. 25 to make clear that families can be more involved in the “CARE plans” of their loved ones.
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