California lawmakers approved a first in the nation bill that prompts court-ordered mental health treatment and support for individuals suffering from severe mental illness, but there is concern about how it will work.
The Community Assistance, Recovery and Empowerment (CARE) Court program sailed through the state Legislature, with a unanimous vote in the Senate and only two opposed in the Assembly. Gov. Gavin Newsom, who introduced the program in March at a San Jose mental health facility, is expected to sign the bill into law.
Assemblymember Ash Kalra, who opposed the bill and represents District 27 that covers a large swath of San Jose and a portion of Santa Clara, said CARE Court could have a disproportionate impact on homeless individuals who are already stigmatized.
While the program has good intentions, it also allows for a wide range of individuals, including law enforcement, to refer unhoused residents to CARE Court without their consent, Kalra said. His other issue with the bill is it doesn’t guarantee housing for people once they leave the program.
“What I really worry about is that at the local level, it’s going to be applied in a manner that takes the voice away from (unhoused) individuals, rather than finding other opportunities to heal them so that they can voluntarily enter into treatment,” Kalra told San José Spotlight.
CARE Court is tailored toward specific individuals, including those with schizophrenia and other psychotic disorders. The program provides yearlong treatment in an attempt to prevent people from being incarcerated or placed under conservatorships due to their mental illness.
The program mandates statewide participation, with two implementation dates. The first group of counties is expected to start CARE Court by October 2023. Santa Clara County is expected to implement CARE Court in late 2024.
Uday Kapoor, president of the NAMI (National Alliance on Mental Illness) Santa Clara chapter said the bill is a major change in the way those with severe mental illness will receive treatment. CARE Court has the potential to prevent these individuals from enduring an ongoing cycle of short-term hospitalizations or emergency psychiatric services without proper care. Through the program, participants can access specialized care that also allows for the involvement of family members.
“In the case of people that have substance use or people that have schizophrenia or both, those are the people that are considered the sickest of the sick. They are the ones that the governor is targeting right now,” said Kapoor, who joined the governor in Sacramento to advocate with NAMI in support of CARE Court. “People that have chronic mental illness, they go through a revolving door… CARE Court forms a team that consists of specialists to take care of them.”
Services will be tested
Santa Clara County should receive $288.4 million in funding for housing and $301.4 million in behavioral health funding from the state, according to reports from the California Health and Human Services Department.
Yet even with the delay until 2024 and millions flowing down from the state, county Supervisor Susan Ellenberg still has reservations about how the program will work.
“My concern about implementing the mandates of the legislation is that the plan creates a new expensive court system with allegedly increased powers to coerce treatment, but it doesn’t ensure or provide any new housing or treatment capacity,” Ellenberg told San José Spotlight. “We need facilities and a workforce more urgently than we need a new court system. But our county will certainly work to maximize whatever benefits CARE Court can offer our residents.”
Supervisors declared a countywide mental health crisis in January. In July, Santa Clara County launched 988, its mental health crisis hotline, which also requires immediate service response. This includes a new youth psychiatric facility at Santa Clara Valley Medical Center that has been delayed. At a recent board meeting, Ellenberg stated the mental health care system in the county is “fundamentally broken” due to a shortage of behavioral health care workers and supportive services.
While the program could help families who have severely mentally ill members obtain better care, CARE Court is a legalistic process rather than a medical, public health-focused one, said former state Sen. Jim Beall, noting the state needs to work toward comprehensive mental health care.
“Over half the people that have mental health problems are not treated whatsoever in California,” Beall told San José Spotlight. “I’d much rather have a full service mental health system which would reduce the need for a CARE court.”
Kalra also sees continuity of care as a key factor in helping those with mental health challenges. Both state and county governments need to focus on ensuring CARE Court successfully provides long term solutions for participants, he said. The goal should be permanent housing and ongoing mental health support.
“If someone doesn’t have housing and they’re expected to complete a program that they are not voluntarily entering into successfully, this is not a realistic outcome,” Kalra told San José Spotlight. “I am concerned that there’ll be so much pressure on cities to use CARE Court to clear the streets.”
Contact Loan-Anh Pham at [email protected] or follow @theLoanAnhLede on Twitter.