As CARE Court faces key vote, counties say Newsom’s proposal adds burden to overstretched behavioral health departments

A controversial new plan that could pave the way for county judges to order the housing and treatment of thousands of people with addictions and serious mental illnesses will soon face a key vote in the California Assembly.

The proposal known as the Community Assistance, Recovery and Empowerment Court — or CARE Court — would create a new branch in the judicial system. This would allow first responders and family members to ask a county judge to order treatment for people with addictions or serious mental illness.

But civil rights and disability groups, county officials and other advocates say CARE Court is the wrong approach and they lack the resources to staff and provide the treatment needed.

Governor Gavin Newsom and local officials say it would be an alternative to a faulty system which sends people to jail, hospital stays and back to the streets. His administration estimates that CARE Court would serve 7,000 to 12,000 people a year.

Newsom called the growing number of people living – and dying – on the streets of California “unacceptable” and “inhumane”. He invoked the death of a homeless woman under a San Francisco freeway when he unveiled the proposal earlier this spring.

“There is no compassion in reading the story of someone who lost 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.”

Proposal received near unanimous support from lawmakers and interest groups expect it to pass the legislature before the end of the month.

Concerns of Civilian Disability Rights Groups

For homeless resident Sharon Jones, the prospect of CARE Court is unsettling.

Jones has lived with his wife for six years in a camp near the American River Parkway. During that time, she saw people struggle with mental illness and addiction.

“I see them every day,” said Jones, a former accountant, 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 doubted Newsom’s proposal would be effective.

“You can’t force people into treatment if they don’t want to be treated,” Jones added. “Addiction is something only you can solve.”

The ACLU and disability rights groups in 27 states agree it won’t work. In an open letter to the governor, they detailed concerns about the autonomy of people with intellectual disabilities and access to housing, and asked him to put the proposal on hold.

“CARE Court will not solve the complex issues of homelessness in California, nor will it address the needs of homeless people with mental health issues – primarily because the investment of funds is in a new court system,” the letter states.

Advocates say affordable, accessible housing and voluntary treatment would be a better path to reducing homelessness among people with serious mental illnesses.

“In our experience, mandatory treatment for anyone with a mental illness will eventually lead to resistance, frustration, and additional trauma,” said Eric Harris of Disability Rights California.

He continued, “People are going to have a terrible experience and say, ‘I never want to go back there again. I don’t ever want to do that again.'”

Harris said people with intellectual disabilities, especially those from marginalized backgrounds, were not involved in discussions about the development of the CARE Court proposal.

“If we’re really trying to help these communities, we should at least take a break now and make sure all of these people are at the table as we make some of these really big decisions,” he said.

Newsom’s office disputes that any treatment is mandatory. Jason Elliott, a senior adviser to the governor, is adamant that ‘there will be no locked doors at CARE Court’ and is meant to help people before they end up in the system of criminal justice.

“It’s a civil court process that provides people with the services they need before extreme trauma, like hospitalization, like incarceration, like guardianship,” Elliott said in an interview.

Although the treatment could be ordered by a judge, Elliott said it would take place outside of legal custody and in community clinics. He argues that court-ordered treatment would be different from guardianships, which allow a judge to appoint a legal decision-maker to oversee someone’s day-to-day life.

“I would say forced treatment is currently what we’re 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 under temporary guardianship in 2020 while 3,672 people were under permanent guardianship.

CARE Court would allow participants to select “volunteer support” to help them “understand, review and communicate decisions to ensure [participant] is able to make autonomous choices to the extent possible,” according to a program FAQ. Those in the program would retain a level of independence, as CARE Court would offer “out-of-custody” treatment different from state guardianships and medical institutions, Elliott added.

Counties say CARE tribunal could weigh in on overstretched workforce

California county governments would be responsible for implementing nearly all elements of Newsom’s proposal. County public defenders would represent those selected for the program in court. County social workers, nurses, therapists, counselors and psychiatrists would assess applicants, file assessment reports, spend time in court and possibly provide treatment ordered by the judge.

But county leaders say CARE Court and its additional duties are a major burden on their already overstretched behavioral health departments. During the pandemic, counties have seen an increase in demand for mental health and addiction treatment, but have struggled to retain workers, some of whom have left for better-paying jobs in the private sector.

“We already have a workforce crisis where we don’t have enough clinicians to provide the mental health and addictions services that are needed in our community,” said Ryan Quist, service department director. Sacramento County Behavioral Health Center.

Quist said his department had a deficit of more than 100 clinical workers and the new program would tie up much of its current staff in court.

“CARE Court would add new administrative burdens that would prevent our scarce clinical resources from actually serving the people who need these services,” he added.

Elliott with the Newsom administration described the labor shortage “as a real problem and one that we take very seriously”. He said funding recently approved by the legislature and the governor should help.

“The answer is a $1.7 billion workforce initiative to develop more than 20,000 new clinical social workers and other professionals in the adjacent space,” Elliott added. “Because we can do everything else properly and if we don’t have the staff to do the job then none of that matters.”

County leaders and their advocates say the money should eventually produce new skilled workers, though it could take years.

“I hope that these investments will yield a lot of success, but that is not happening this second. And we’re layering another agenda,” said Jacquline Wong-Hernandez, deputy executive director of the California State Association of Counties, which lobbies county governments at the state Capitol.

Housing First or Treatment First?

There’s another serious shortage that counties would face if CARE Court becomes law: housing for those enrolled in the program.

Proponents say the program emphasizes treatment before housing, when it should be the other way around.

“There’s this feeling that mental illness and in some cases substance use is one of the root causes of homelessness,” said Mari Castaldi of advocacy group Housing California. “What the evidence shows is that high housing costs and low housing vacancy rates are the strongest predictors of the rate of homelessness in a given community.”

While the bill would allow judges to order housing under a patient’s “CARE plan,” Castaldi says counties, which would be required to follow those plans, have limited housing resources.

Quist, of Sacramento County, said there is already a severe lack of available housing locally and statewide. The region has a deficit estimated at nearly 60,000 affordable housing for its low-income tenants, according to the Sacramento County Housing Needs Report 2022.

The county also lacks several thousand accommodation places. According to a report by the nonprofit California Housing Partnership, there are only about 3,400 shelter and shelter beds available through local governments, nonprofits and faith groups for people without shelter. But there are almost 9,300 people without housing in Sacramento County. Existing shelters are usually full every day.

“We can get people to access services, help them get better. But once they get better, where will they live? Quist said.

But Elliott points to some $15 billion in government funding approved since 2020 for counties to build and acquire more housing. For example, the State financed 12,500 housing units for people leaving homelessness thanks to its project home keywhich pays cities and counties to buy and convert hotels, motels and other buildings into homes.

“Do we have enough housing to provide a permanent support unit for every homeless person in California? No, we don’t, and that’s a goal,” he said.

But, he added, “The scarcity mindset that we very appropriately operated in for many, many decades is 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 on Thursday approved amendments to the bill to clarify that families can be more involved in their loved ones’ “CARE plans.” The bill must pass before the end of the legislative session at midnight on August 31 and be signed by Newsom to become law.

About Antoine L. Cassell

Check Also

Nonprofit hospitals expand charitable care, but not all changes are positive

Photo; The Good Brigade/Getty Images About 84% of nonprofit hospitals updated their charitable care policies …