Newsom signs landmark mental health bill in San Jose

Eight months ago Gov. Gavin Newsom came to San Jose to explain his vision for changing the mental health care system, and how the sickest of the sick would receive treatment for severe mental illness and substance use disorders.

Today, Newsom came back to sign the Community Assistance, Recovery and Empowerment (CARE) Court bill, structured to provide court-ordered comprehensive treatment, housing and supportive services for severely mentally ill individuals for one year. He sweetened the financial pot with another $63 billion to help with the rollout of the program, and added another $1.4 billion for retraining and rebuilding the talent pool of social workers and counselors, after cities and counties pressed for workforce assistance and dollars for competitive wages.

These dollars are in addition to the $14.7 billion in funding for a spectrum of already approved supportive housing services, along with $11.6 billion in funding for behavioral health services.

Reforms haven’t worked, so it’s time to change the system in its entirety, Newsom said. Part of that change includes billions flowing down from the state to the counties, he said.

“It was just a few months ago I stood here and we laid out a vision, and a marker and a dream, and here we are and we made it a reality,” Newsom said.

The landmark bill aims to stop the revolving-door of emergency room treatment and insufficient hospitalization and provide a community-based program that connects a person in crisis with a court-ordered plan. But implementation will not come without growing pains.

The shortage of behavioral health care workers and the carve out of a new court system have local officials wondering how this will be accomplished.

“The judges were particularly concerned and rightly so because of the lack of case workers available,” state Sen. David Cortese told San José Spotlight.

CARE Court is essentially a new court system and getting it up and running is not going to be easy, he said. Right now law enforcement  puts people in jail because that is the only place where they can receive treatment. That’s due to a lack of  community-based services for individuals with mental illness and that is fundamentally wrong, he said. This program aims to treat people proactively before that happens.

“We don’t want to be criminalizing mental illness,” he said.

CARE Court focuses on individuals diagnosed with schizophrenia and other psychotic disorders, and those with co-occurring substance use disorders. Unlike Assisted Outpatient Treatment, also known as Laura’s Law which required the Santa Clara County to opt-in, this law requires all 58 counties to participate in CARE Court. If a county fails to comply it could be fined from $1,000 a day up to $25,000 per violation.

For Santa Clara County Supervisor Susan Ellenberg, the county requirements are disconcerting. The county isn’t looking to evade its responsibilities, she said, but it’s also not in the business of building housing.

“We can’t do this alone, and we need the cities to step up and help us by moving quicker to approve zoning and permitting for health care infrastructure,” Ellenberg told San José Spotlight. “We need to hear them say, ‘We are your partners.'”

Seven counties will pilot the CARE Court program starting Dec. 1, 2023. Santa Clara County will be in the second cohort beginning Dec. 1, 2024. This could work to the county’s benefit.

“I know this county well having served as a supervisor. They will use the time to get ready and watch and figure out what they need,” Cortese told San José Spotlight. “I think they will also be crying out for additional resources.”

Ellenberg is gratified to see all levels of government—from the governor to city mayors—recognize what she and her county colleagues proclaimed as a mental health crisis back in January, and as recently as August described it as a broken system.

“Treatment for mental health and substance use disorders have long been underfunded,” she said. “ The light the CARE Court framework shines on the insufficiency of investments in infrastructure, programs and workforce is significant and we must use it to shift priorities in funding to meet this statewide crisis.”

Moryt Milo is San José Spotlight’s editorial advisor. Contact Moryt at [email protected] or follow her at @morytmilo on Twitter. Catch up on her monthly editorials here.